I am very sad to read about the recent newspaper reports about the claims of forced contraceptives on the Orang Asli communities by a memorandum submitted to the government.
It’s even more distressing to note that there were many remarks by public and health care professionals who regarded this issue with mixed reactions, confusions to downright conspiracy theories.
In particular, this issue highlights the many myths and misconceptions about contraception and detracts from the critical health and life preserving benefits of contraceptives.
It is a fact that contraception saves mothers’ and infants’ lives, in addition to preserving their health. It empowers women and their families to take control of their lives, improve their economic well being, and enrich communities.
The challenge in providing contraceptive care to communities who are under-served and marginalised is even more marked with issues of accessibility to health care.
Many are only reachable by mobile clinics, long boats or flying doctors services. Myths, misconceptions and misinformation are abundant among communities, more so in those communities which are remote and under-served.
This is complicated commonly by a background of poor maternal health from multiple short interval pregnancies, anaemia and other medical complications making their pregnancies high risk.
The risk of mothers dying and infants suffering complications or death are significantly higher in communities deep in the interiors, far flung remote locations with poor infrastructure that makes every pregnancy a planned one even more pertinent and essential.
Sadly, the incidence of unplanned pregnancies and lower contraceptive use are much more prevalent in these communities. Meeting the unmet need for contraception is one of the most important goals of the WHO (World Health Organization) sustainable development plans to improve maternal and infant health associated with the concept of leaving no one behind.
One of the tenets of contraceptive provision is to tailor the methods to the particular needs of the woman, respecting her rights in a language and approach that is agreeable, understandable and acceptable to her.
It goes without saying that the care that is delivered must be in accordance with her wishes and reproductive choice or plan. Good communication and social skills are essential to deliver high quality care in a non-judgmental and enabling environment.
The oral contraceptive pill is one of the most difficult methods to use, necessitating the user to be very disciplined and is entirely user dependent. The typical failure rate is nine per cent. With 100 women who use it up to a year, nine women will have an unintended pregnancy.
This failure rate is even more when communities are marginalised, remote and supply erratic, leaving many women who will simply stop the pills if they are not keen on the method, forget to take the pill or if supply runs out.
The prescriber has no ultimate control in those decisions and is commonly seen as a rights-based method with decision for continual use totally in the hands of the women.
The recommendation for high-risk mothers would be usually to use highly effective long-acting reversible contraceptives such as hormonal implants or intrauterine devices that lasts up to three or five years and are not women or user-dependent.
These methods are a challenge when delivering contraceptive care in remote communities with insertion and removal difficulties due to lack of proper procedure rooms or sterile instrumentation, for example, and are not usually offered in outreach health clinics.
Medium acting methods such as the three-monthly hormonal injections are offered more commonly in mobile clinics with its limitations, as well considering that timing of mobile clinic visits or other transportation modalities are dependent on weather conditions, supplies or staff availability among the many challenging variables.
All contraceptive methods are generally safe as long as proper medical guidelines in its usage are adhered to.
In conclusion, the challenges of delivering contraceptive care to marginalised, under-served or remote communities are complex, the contraceptive needs are urgent and the health consequences of unplanned pregnancies dire and life threatening.
Communication, respect, understanding their specific needs, limitations, social and cultural background are key to high quality women care, delivering what’s most precious, optimal health and a better secure future.
Dr John Teo is a obstetrician & gynaecologist based in Sabah.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.