TO this day, Datuk Dr Narimah Awin remembers a woman who died while delivering her 13th child in Terengganu in the 1980s.
While a kampung midwife was delivering the baby, the woman had complications. The government midwife was called and she wanted to send the dying woman to the hospital, but “her husband said we had to allow her the privilege of dying as a syahid (martyr),” recalls Narimah, who was serving as senior medical officer of Health for the Kuala Terengganu district then.
The woman’s last words still bring tears to her eyes today, she shares, “Before she died, she whispered to the government midwife, ‘If it was up to me, I would have used birth control and gone to the hospital’.”
During her almost 30 years with the Health Ministry (MOH), before she retired as Director of Family Health Development in 2007, Narimah says she had seen various conflicts between the actions that public health officials want to take and the rulings of Islam, or rather, the way they are being interpreted here in some cases.
It was the same during her service with the World Health Organisation (as regional adviser for maternal and reproductive health for the Western Pacific region and South-East Asia from 2008 to 2013), she tells – there was also an impact of religion on health in those countries.
That’s why, when Narimah helped out at the G25 forum last December as a rapporteur, she was interested to find that the two main goals of the grouping of prominent Muslims were good governance and practising Islam based on the maqasid syariah (the real, higher intent of the syariah) and on wassatiyah (moderation).
She didn’t know much about G25 before the forum, she admits, but later learned the group was concerned about sectarianism, radicalism and extremism.
“These are issues that have disturbed me, not only on a personal level as a Muslim and a citizen of Malaysia, but also in relation to the work I was doing as a public health practitioner,” she says.
And after getting to know the group and its programmes better, she accepted an invitation to join them, about seven months ago.
She sees G25 as a platform relevant to the issues she has been dealing with, and one she can both benefit from and contribute to.
“I can use G25 to contribute to the betterment of reproductive, sexual, maternal and child health in Malaysia by addressing the sociocultural determinants of health and the values that are central to achieving this – democracy, rule of law, good governance, respect for human rights, freedom from poverty and other social disadvantages, gender relations especially women’s empowerment that is so often eroded under the tradition of patriarchy, and the correct interpretation of Islamic doctrines that can ensure optimal well-being and health”.
G25 is planning for a major youth conference next year and the public health expert hopes to ‘put health on the agenda’ with sessions on how adolescents and young people can lead healthy lives – physically, mentally, socially and spiritually – and contribute to a healthy future generation that “will lead Malaysia to be a model for moderation, good governance and excellence.”
During her decades with MOH, Narimah has seen religion having both positive and negative effects on health. For example, she notes, a verse in the Quran clearly encourages breast-feeding and says mothers should do so for up to two years.
Another is how to tackle thalassaemia. One common approach is to terminate a pregnancy if the unborn foetus has the disease, and “you can see the enormous religious implications of this,” she quips.
She became optimistic when she heard about the experience of three countries with a high prevalence of thalassaemia and a majority population of Catholics – Greece, Cyprus and Italy. With public education, premarital testing and counselling, and prenatal testing with the option of abortion, they had managed to reduce the number of new cases.
In Malaysia, a fatwa says that an abortion can only be carried out within 40 days or, if the pregnancy threatens the life of both the mother and foetus, within 120 days of pregnancy.
MOH had discussed with the religious authorities in 2006 the possibility of allowing abortion for Muslims if the threat is either to the mother or the foetus, within 120 days of pregnancy – as done in Kuwait, Pakistan, Iran and Saudi Arabia.
The talks were still ongoing when she retired in early 2007, and Narimah believes the fatwa remains unchanged.
One of the main barriers to providing healthcare is the lack of decision-making power among women, Narimah notes, due to unequal gender relations in the country.
“The health of a woman is influenced by a wide range of factors,” she explains.
“Biologically, her sex, which makes her a female, is unchangeable and is a major factor. Socially, her gender makes her a woman and this affects her social status, including the power to make decisions that affect her health.”
Gender relations can be changed or improved to ensure optimal health of not only women, but also of children, men and families. And that’s the message which Narimah hopes to deliver through the G25 platform.