Access to contraception & abortion

In Malaysia, women now have very good access to education and employment of their choice, and maternal and infant mortality have fallen dramatically. In the area of reproductive health and reproductive rights, however, much more needs to be done for women. Use of modern contraception is low and has not improved for 20 years, resulting in a high rate of unwanted pregnancies. While the law allows for abortion if a doctor deems the pregnancy injurious to a woman´s life or to her physical or mental health, this legal right is not widely known. Many women therefore have difficulty accessing quality contraceptive and legal abortion services.

This situation affects women´s physical and mental health. Reproductive choice is central to women´s right to control their lives and also to their development and empowerment. Improving women´s access to contraceptive and abortion services is thus not only an important public health issue but is also a women´s human rights and a reproductive rights issue

High unmet need for contraception – Many women do not want more children but are not using contraception

Many women in Malaysia do not have control over their decision to become pregnant due mainly to a lack of confidence in contraceptive methods. In the 2004 national demographic and health survey, 25% of married women said they did not want another baby but were not using any kind of contraception due to fear of side effects or dissatisfaction with modern contraceptive methods.

Low contraceptive use

In the last 20 years, the rate of contraceptive use has remained unchanged. In 1994, 54% of married women used contraceptives; in 2004, use dropped to 51% and only 33% used modern methods like the pill, IUD and condoms. (Huang, 2007) This clearly indicates the continuing problem of public perceptions about the safety of modern contraception and the inadequacy of family planning programmes and the media to accurately inform and reassure people. In comparison, some Asian countries have done much better despite their lower socioeconomic status. Contraceptive use rate is between 70 to 80% among married women in Thailand, Vietnam and China.

Women´s and couples´ reproductive right to decide on the number of children they want is also not yet implemented as a policy priority. Aside from not being included in demographic surveys as mentioned earlier, sexually active young or unmarried people are not permitted to obtain contraceptives from government and NGO services of the national family programme.

Barriers to women´s access to contraception and legal abortion services

  • Limited training of doctors.
    Contraception, reproductive health and rights and abortion laws are minimally addressed in current medical curricula. Some government medical schools give minimal attention to training on termination of pregnancies. This means that doctors are likely to not be well trained in provision of this service.
  • Attitudes of doctors.
    The 2007 RRAAM survey of doctors and nurses found that in response to the question “What do you think women who are pregnant due to rape should consider doing?” 38% said that women should continue the pregnancy and either look after their baby themselves or give it up for adoption rather than consider having an abortion (RRAAM, 2007). This shows judgemental attitudes and lack of empathy of a large number of health professionals for women whose rights have already been violated. These unsympathetic attitudes would act as an obstacle to women trying to access an abortion.
  • Misconceptions of doctors on the legalities of abortion.
    Despite broad permissible conditions for abortion, the Penal Code is a criminal law inherited from colonial times wherein the woman and the health practitioner can be charged if the law is not followed. Fear, together with negative media portrayal, has contributed to doctor´s silence and secrecy in the provision of legal abortion and prevented many doctors from providing abortion services. In reality though, in the last 20 years, doctors have been rarely charged for abortion offences, with all cases having been acquitted. No woman has ever been charged (Radhakrishnan, 2007).

 

References:

  • Huang, M. (2007). “Prevention: Increasing Contraceptive Use.” Presented at the Seminar on´ Reproductive Health, Rights and Miscarriages: Problems & Solutions,´ 3 July 2007, Hospital Tuanku Ja´afar, Seremban, Negri Sembilan.
  • Radhakrishnan, S. (2007). “The Legal Dimensions.” Presented at the Seminar on ‘Reproductive Health, Reproductive Rights and Miscarriages: Problems and Solutions,´ July 3rd 2007, Hospital Tua´anku Jaafar, Seremban, Negri Sembilan, Malaysia.
  • RRAAM. (2007). “Survey Findings of Knowledge and Attitudes of Doctors and Nurses on Abortion by the Reproductive Rights Advocacy Alliance Malaysia.” (unpublished).