On Contraceptive Access in Malaysia by Sin
On the 21st of August 2019, Abdul called me, panic stricken. In the months prior to the phone call, he had had intercourse with his girlfriend that resulted in a 3 month absence of menstruation. He was panic stricken. The phone call lasted an hour, during which I referred him to an organisation that could help.
I got the number through another friend of mine, Anne. It was the outcome of a pregnancy scare. She was affected by her experience viewing posts on social media, detailing healthcare service providers’ complaints over patients’ sexual lifestyles. It was the reason why Anne preferred clearing her doubts anonymously on the internet instead of asking a healthcare provider.
Contraceptives have always been universally accessible in Malaysia. In one particular case, they were distributed widely among Orang Asli women. This accessibility was brought to my attention by my brother who is a doctor stationed in Gerik. Routine care by means of family planning were done by healthcare authorities of Gerik for the Temiar women in an excessive manner all the while the women’s curiosity over the necessity of sterilisation were left unanswered. A memorandum of understanding was later required to detail the reasoning for the actions that were deemed as an unwarranted breach of the Orang Asli women’s right over themselves.
Voluntary abortion nevertheless, is still interpreted as an offense under Section 312 of the Penal Code. This causes doctors to assume that abortions cannot be offered to patients without due cause*. It is the common misreading of this law that perpetuates instances such as when a case of statutory rape in Gerik resulted in the girl carrying her pregnancy to a birth and marriage.
I am also reminded of a family living in PPR Kota Damansara. In the small unit of the flat, reside 9 siblings born to a security guard and a housewife. The young mother had just had her youngest when I visited the area. I was curious about the viability of the space in the upbringing of those children. I have to question whether health authorities in the area provided the same level of care and access to contraceptives for the urban poor residents of Kota Damansara as they had for the Orang Asli women in Gerik. Was this mother of 9 informed about her reproductive choices leading up to all 9 children? It seems there was a lack in health authorities that could assist her in family planning resulting in her unawareness of available contraceptives in the nearby clinics.
This collection of stories is a fascinating reminder on the bizarre reality that we live in. Abdul is studying a medical course. He had learnt about the reproductive system in the same year I received his call yet he was unaware of the practical aspect of sexual and health reproductive rights issues. The same goes for Anne. She came from an upper middle income family residing in an urban area yet her awareness of her options did not come with the privilege of her social status. It was an understanding made possible by the urgency of the moment. Even then, the awareness was short of being sufficient. She was oblivious to the fact that the universal availability of contraceptives could have avoided her from having a pregnancy scare which precipitated her search for a voluntary abortion. There was also the issue of the need to rely on anonymity for her to gain this knowledge. She had to manoeuvre through anecdotal experiences websites in order to reach a coincidental refuge. Both of them were unaware of the significance of protection and contraception until the reality of the severity of the situation forced their hand.
There is an inconsistency in the way information is disseminated throughout communities in Malaysia. Two marginalised communities faced different levels of awareness with one of them experiencing excessive family planning while another community managed to raise 9 children in a 3 bedroom per unit flat. While a singular case may not be reflective of the whole community, it is a symptom of an underlying issue regarding a lack of sexual and reproductive health rights awareness. It symbolises a detriment within sexual education, in that it is selectively distributed.
Sexual education is more than spreading awareness of the proper handling of circumstances such as an unwanted pregnancy. It is about realising the rights one have over themselves as a sexual and reproductive being. Sexual education cannot be considered effective just because contraceptives are made available in the country, and individuals are able to prevent unwanted pregnancy and sexually transmitted infections. It does reach somewhat of a conclusion when every individual is successfully autonomous in their decision to lead a sexual lifestyle and procreate based on the choices that are natural within their rights.
While I was writing this piece, a sex worker decided to undergo an abortion. To assist her in the situation, a fundraising effort was made by social workers to pay for the surgery. However, even among the progressives, it still sparked a polarising debate with one side contemptuously berating the decision and another side defending the need for sex workers to have access and exercise their right, despite this individual probably not having the option to escape this lifestyle.
Discrimination of marginalised persons is all too common. The lack of individual awareness of rights, the intentional misrepresentation of “care for all” and the dismal attention paid to the underbelly of society shapes our current reality in which access is available, yet not made accessible. We cannot become complacent in our efforts to educate. Information and assistance without judgement should be made available to everyone, regardless of social standing. Those in need require more than just access; empathy and understanding form a society in which we all can thrive.
* In fact, the Penal Code Amendment Act (1989) allows a medical practitioner registered under the 1971 Medical Act to terminate a pregnancy if the doctor believes that the continuance of the pregnancy would involve greater risk to the life of the pregnant woman or injury to her mental and physical health.