Tackling Malaysia’s unintended pregnancies crisis

Illustration: The Star

THE Malaysian Medical Association has called for the country to tackle the issue of unintended pregnancies in the impending Health White Paper.

The consequences of unintended pregnancies are profound and often negatively impact women and girls as well as the whole of society.

More than 50% of all pregnancies were unintended. Approximately half of unintended pregnancies end in abortion and a significant proportion are unsafe resulting in maternal deaths and permanent health impairment.

The World Health Organisation’s (WHO) Sustainable Development Goal No.3 aims to ensure healthy lives and promote wellbeing for all at all ages, and among its targets is to reduce maternal mortality and preventable deaths of newborn and children under the age of five. [The Sustainable Development Goals are a collection of 17 interlinked global goals designed to be a "shared blueprint for peace and prosperity for people and the planet".]

By 2030, the WHO also aims to ensure universal access to sexual and reproductive healthcare services, including family planning information and education and, critically, the integration of reproductive healthcare into national strategies and programmes.

The known factors associated with a high incidence of unintended pregnancies include access to family planning services; poverty; level of education; contraceptive method uptake and failure; and sociocultural, political and religious determinants.

When a woman or girl has an unintended pregnancy, it negatively affects her ability to attend school, opportunities for higher education, and to continue working or developing her career. Her economic potential can be severely impacted along with her contribution to the nation’s economy and workforce.

Often in lower socioeconomic groups, unintended pregnancies may lead to a vicious cycle of poverty in the family with adverse consequences such as domestic violence, drug or alcohol dependence and even crime.

Society and the nation as a whole are impacted negatively if the reproductive needs of women and girls are neglected.

Current status of reproductive healthcare in Malaysia

According to the Health Ministry’s Health Facts 2021 report, Malaysia’s maternal mortality ratio (MMR) is 24.9 per 100,000 live births. The three most important components that can bring the MMR down further are adequate antenatal care, safe delivery and use of contraceptives.

While Malaysia has done well in both caring for women and girls during pregnancy and delivery, sadly we have been left far behind in the use of contraceptives in the past few decades. The prevalence rate for modern contraceptive methods among married women in Malaysia is only 34.3%; the most commonly used oral contraceptive method, the pill, is at only 13.2%. Highly effective contraceptive methods such as hormonal implants or hormonal intra uterine systems are not widely available to all women and their usage is extremely low. The contraceptive prevalence rate for unmarried women and girls is not available as it is not documented but it is likely to be very low.

There is a lack of dedicated family planning clinics with family-planning-trained doctors and staff available to women. They must be an integral component of healthcare facilities if we are to provide high-quality sexual and reproductive healthcare services. Integrating family planning and sexual and reproductive healthcare into general clinics often defeats the purpose of attempting to provide this essential and sensitive service to women.

Adolescents and young adults’ sexual and reproductive healthcare needs must be comprehensive and easily accessible. This was underlined by a recent study by a contraceptive manufacturer that found that a large majority of Malaysian youth had their first sexual experience before the age of 22, with very poor knowledge of pregnancy, contraception and sexually transmitted diseases.

A total of 41,083 teen pregnancies were recorded by the Health Ministry between 2017 and 2022. This works out to an average of almost 7,000 a year – and the figure only counts those who sought services at government facilities. Figures from the private sector are unavailable and we don’t know how many girls and women didn’t seek healthcare services.

An average of nine babies are reported abandoned each month in Malaysia, with half found dead and some even macerated, according to police statistics. It’s been estimated that for every baby found abandoned, another 10 or 20 may never be found.

The solutions

The Health, Education, and Women and Family Development ministries are duty-bound to work together to come up with an integrated and comprehensive strategy to ensure all women, girls and adolescents have complete and meaningful access to sexual and reproductive healthcare services. Working in silos is not a realistic option, and neither is relying on the same old policies and programmes that have not been shown to work for decades.

Women’s healthcare and reproductive healthcare cut across all spectrums of healthcare and encompasses a wide range of services. When formulating any healthcare programme or policy, women and children’s needs and welfare must be the nucleus around which every plan is based.

All stakeholders must be involved if we are serious about tackling these problems, and solutions should be generated from the ground up rather than the usual top down approach that has failed many times.

There is a dire need to:

> Ensure that all doctors and medical staff are trained in sexual and reproductive healthcare and sensitised to the special needs of women and girls

> Set up specially dedicated family planning and sexual and reproductive healthcare clinics nationwide catering to these important aspects of female healthcare.

> Ensure full access to sexual and reproductive healthcare is given to those in need regardless of marital status, age, beliefs or sexual practices.

> Ensure all methods of contraception are made available free of charge or at very low cost to all who need it, including the highly effective hormonal implants or intra uterine systems.

> Ensure that comprehensive sexual education is made available in all school systems, not just "approved" topics.

> Ensure that community leaders, parents and teachers are engaged in the efforts to tackle unintended pregnancies and teenage pregnancies.

> Ensure that political leaders are sensitised to the enormity of the issue and its impact on society at large.

> Ensure that laws are amended to give full access to sexual and reproductive healthcare services, discarding discriminatory practices and promoting gender equality.

> Ensure that a non-judgemental approach is instilled, with a supportive system in place for all vulnerable women and teenage mothers.

How Malaysia tackles the life-altering and neglected crisis of unintended pregnancies will show our nation's resolve and seriousness in ensuring universal healthcare for all and in making women and children our most important assets.

DR JOHN TEO

Consultant obstetrician and gynaecologist

Kota Kinabalu