A few years back when I was 24, curious about the affordability and accessibility of long acting reversible contraception (LARC), I called my nearest Klinik Nur Sejahtera branch to ask regarding copper IUD. I was sexually active with a single partner at that time, but we were unmarried. Obviously, there were concerns regarding unintended pregnancy, and after a few pregnancy scares I decided that condoms alone were not enough to give me a peace of mind, therefore I need an LARC with 99% effectiveness. The price according to its website was RM80, which was very affordable for me. If I were to get it from a private GP, it would probably cost me RM200 or more, so having a contraceptive device which can last for 3 years at the price of less than RM100 was a great option for me who had just started working and was struggling with my finances at that time.
The first question I got upon calling was whether or not I was married. When I said I was not, the staff in charge told me they don’t provide contraceptives for unmarried women. When asked why, they simply said that it’s just their policy. I was taken aback. I had never heard of that policy, and couldn’t find anything written on their official website regarding it. Disappointed, I totally abandoned my plan to get an IUD inserted, and continued using condoms with a few more pregnancy scares afterwards – which worsened my mental health. The confusing encounter deterred me from seeking access to subsidised contraceptives, be it from government facilities or Lembaga Penduduk dan Pembangunan Keluarga Negara (LPPKN), because I was not comfortable with the fact that my marital status would be under scrutiny before I could get my hands on an LARC. What would happen if I – a tudung-clad Malay woman at that time – were to walk into the clinic, with no sijil nikah whatsoever, and straight up ask for an IUD? Would it be scandalous? Would I get an earful from the staff about how premarital sex is forbidden?
Fast forward 3 years later, after reading an article featured on Malaysiakini, I was so surprised when I found out there was no actual black and white regarding this. It was not part of the Ministry of Health’s policy to deny contraceptive access to unmarried women from government facilities either. Theoretically if a single woman were to go to any of these facilities, she would be offered the best contraceptive method according to her medical needs and personal preferences without any prejudice. At most, I learned, she would have to undergo counselling with a medical officer before getting her contraception. However, this was definitely not what the staff on duty informed me when I called them the last time. I wondered how different things would be if, instead of getting an answer based on a non-existing policy, I was informed of the actual standard operating procedure. But then again, I thought, how many of Klinik Nur Sejahtera’s staff are even aware of this SOP in the first place?
I have always been curious as to why there was such strong resistance concerning giving subsidised contraception access to unmarried women. One of the explanations commonly offered is that restricting access will discourage unmarried women from having sex outside of marriage. However, if it’s really about preventing premarital sex, there are studies showing that increasing access to affordable contraception does not lead to an increase in promiscuity or sexual risk-taking behaviour. Readily available inexpensive contraception will not suddenly compel more single folks to engage in premarital sex, contrary to what some people might think. Considering that unintended pregnancy has a greater negative impact on unmarried women compared to married women, and such pregnancies are more likely to end up in baby dumping or abortion, isn’t it just logical to provide unmarried women and girls access to affordable contraception too?
Another common explanation is that it is simply not feasible financially for the government to provide affordable, subsidised contraception for all regardless of marital or parity status. However, one must be aware that unintended pregnancy imposes significant financial cost to society, much more so than the cost of subsidising contraceptives. A study in the United States demonstrated that for every dollar spent on providing publicly funded contraceptive services, an average of $3 is saved in pregnancy and childbirth-related Medicaid costs. Would we rather see our taxpayer money be spent on managing complications of unsafe abortions, or be spent on providing judgement-free affordable contraceptive access for ALL that will greatly reduce the likelihood of such unsafe abortions?
I was lucky in the sense that I am now able to afford an IUD inserted at a private clinic. But I still think about how many unmarried women and girls like my cash-strapped 24-year-old self that couldn’t get a safe and reliable contraceptive method because of a non-existent policy imposed by an organisation supposedly in charge of promoting and providing accessible contraception. Contraception for unmarried women is a serious unmet need that should be addressed. It is the right thing to do.