In 2014, Nirmala, a young Nepalase migrant worker, was arrested after the clinic she was recovering in was raided. She was sentenced to 12 months in prison for having a legal abortion, although she was later acquitted.
The current lack of clarity in Malaysia’s abortion laws, and its restrictive nature and disregard of mental and psychological stress deprives women their right to autonomy.
Although Malaysia is one of the few Muslim-majority countries to offer legal abortion, the social stigma and taboo surrounding the matter, compounded with unclear interpretation of the law; especially surrounding special circumstances, have led the majority of Malaysians to believe abortion is illegal.
Issues With The Law
Though legal, abortion comes with extremely immense restrictions. Section 312 of the Malaysian Penal Code states that a pregnancy can be terminated only when a registered medical practitioner deems the continuance of the pregnancy to pose a risk to the woman’s life or cause injury to their physical or mental health.
In a public hospital setting, standard operating procedures requires two doctors (one of whom is a specialist) to be present during the pre-abortion assessment. However, a psychologist or psychiatrist is not needed unless deemed necessary.
If harm to mental health constitutes a legally valid reason for termination of pregnancy, the evaluation of a woman’s mental state should rightly be carried out by a mental health professional and be part of the standard.
Furthermore, abortion is illegal regardless of the circumstances. Be it rape, underage pregnancy, cases of foetal impairment, or for socioeconomic reasons. Essentially, women do not have the freedom of choice, unless their life is explicitly in danger — that is, if continuance of the pregnancy poses a greater health risk than if it was to be terminated.
The Consequences Of The Law In Medical Practice
The inadequacy of comprehension and clear interpretation of the law, especially by health care personnel, has resulted in poor implementation. In 2007, The Reproductive Rights Advocacy Alliance Malaysia (RRAAM) report showed that out of 120 doctors and nurses, 43 per cent lacked the knowledge on when abortion is legal.
The possible uninformed nature of decisions is exacerbated by the fact that public health care professionals can refuse to terminate a pregnancy based on their personal values or religious beliefs
This is true even in extreme cases such as rape or incest. Regardless of personal and/or religious beliefs, health care providers must respect civil law and assess them without prejudice.
With no legal or clinical practice guidelines in regards to such ethical issues, the availability of abortion services varies, depending on the views of the heads of obstetrics and gynaecology in public hospitals.
What constitutes harm on mental well-being is not clearly stated in Section 312, and hence, doctors can reject the procedure based on their personal views.
This results in women being passed on from hospital to hospital until they find a doctor who is willing to perform the procedure. Due to the lengthy process, many women resort to other means.
Private sector abortion services are widely available, albeit discreet. Although they are often more understanding, this comes at a hefty price.
Due to private abortion services being largely unregulated, clinics charge exorbitant prices — up to RM4,500 in later stages.
This is problematic for several reasons:
- Women who are desperate for the procedure are exploited.
- Services are inaccessible to lower socioeconomic groups and migrant workers. Women who cannot afford such services risk their lives by resorting to unsafe, back-alley procedures.
A Losing Game For Women
The cold treatment towards women by government doctors has been reported on several accounts, with the doctors often ordering women to continue their pregnancies and later give their babies up for adoption. Although this appears to be a straightforward and simple solution, it is far from the truth.
For women who are left with no option but to continue their pregnancies, little financial support is made available by the government. As the majority of women lose their jobs, especially in later stages of pregnancy, they are left defenceless.
Vulnerable, low-socioeconomic women feel the effects the most — this is exemplified by the Nirmala case. On top of the financial burden, if the pregnancy was the result of sex or incest, the entire experience can be extremely traumatic.
The stigma surrounding abortion and lack of sexual education or awareness on options following an unwanted pregnancy has cumulated into the serious rise in baby dumping. A baby is dumped every three days, and the majority are found dead.
Although protecting the sanctity of life is a valid argument to not terminate a pregnancy, the quality of life for both the mother and foetus is equally as important.
With little to no government infrastructure in place to provide financial support for single or young mothers, and adoption centres relying heavily on private funding, it seems that Malaysian society at large frowns upon the termination of pregnancy, but hardly ever considers the circumstances following such pregnancies.
A Call For Change
Public health care facilities have always been overburdened; however, the Covid-19 pandemic has exacerbated the situation. With the huge rise in unwanted pregnancies during the pandemic, many have urged the Ministry of Health (MOH) to provide medical abortion services via abortion pills.
Medical abortions can be done over the phone or the internet, hence not only increasing accessibility, but also removing stress on health care facilities.
Abortion pills such as Misoprostol and Mifepristone are listed as essential medicine by the World Health Organization and have been established as safe and effective methods for abortion care with proper guidance.
Mifepristone works by blocking the action of a hormone progesterone which stops the progression of pregnancy. Misoprostol causes the cervix to soften and uterine contractions to empty the uterus.
Irrespective of the evidence, Mifepristone is not registered in Malaysia, and Misoprostol is available only by prescription. The unavailability has fuelled unregulated sales by online retailers, many of whom are scammers.
These problems stem from the standard of sexual education in this country. The taboo and stigma surrounding abortion can only be dispelled by greater awareness and understanding.
The standard of sexual education in schools across Malaysia is lacklustre at most, and has been reported to be vague and unproductive.
This leaves teenagers unequipped on how to have safe sex and prevent pregnancy. The notion that proper sexual education promotes sexual activity before marriage is unproven and not helpful.
Teachers have no control over whether or not teenagers engage in sexual activity, and statistics have shown this is increasing. What we can control is the way we educate teenagers on the prevention of unwanted pregnancies and the promotion of safe sex.
The ignorance towards sexual activity and the lack of information or access to abortions has resulted in the vicious cycle of illicit abortions, baby dumping and infanticide.
The narratives we are taught in our youth influences us as adults. This is especially exemplified by the largely unsympathetic nature of doctors in government hospitals towards patients.
Moreover, abortion is not a part of the syllabus in local medical curricula resulting in confusion of laws pertaining to abortion and a shortage of trained doctors.
The laws surrounding abortion need serious review. Proper, detailed laws surrounding special circumstances should be made compassionately. These will enforce uniformity in how health care professionals approach termination of pregnancies.
While legislation is fundamental to ensure women have the autonomy that is rightly theirs, reproductive rights and unintended pregnancies are also of economic importance. These have been shown to have adverse social and economic effects on the healthcare system.
The steps Malaysia needs to take have been vocalised by advocacy groups and non-profit organisations. However, the issue of abortion has been long-standing and stigmatised, due to Malaysia’s heavy influence by religion.
At the end of the day, female reproductive rights and autonomy can only be obtained when politicians prioritise the matter and implement legislation objectively.
Jeslyn Kho is a final-year BSc (Biochemistry) student at Imperial College London.
- This is the personal opinion of the writer or publication and does not necessarily represent the views of CodeBlue.