KUALA LUMPUR Oct 25 — Public sexual healthcare providers appear to be discriminating against single women on moral grounds, with clinics regularly withholding access to contraceptives, among others, without proof of marriage.

Despite the lack of directives to limit universal sexual health care to the married, its provision by government clinics to unwed women is inconsistent from one location to another.

Recent attempts by Malay Mail Online to obtain contraceptives at one such clinic was initially denied as caregivers there insisted that they have never provided birth control medication to unmarried women, although the reporter was able to convince them to dispense these after a long negotiation.

At another clinic, also in the Klang Valley, the nurses outright said it is mandatory for clients to bring in their marriage certificates in order to be registered and treated.

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Calls to 18 maternal and child health clinics in Kuala Lumpur and Selangor also supported the suspicion that unmarried women face informal barriers to obtaining sexual health services that are provided unchallenged to their married counterparts, with all saying they must check if they are allowed to dispense contraceptives to singles.

Seven later said no, while five said it is not encouraged; another said to seek the doctor’s advice first.

Six said it was possible after further checks, although one said it was necessary for patients to disclose their religion, explaining that Muslim women must provide proof of marriage in order to obtain the medication.

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Premarital sex and sex in general remain taboo subjects in conservative Malaysia, and such views are hampering access to sexual health services at government clinics in times of changing norms and values.

According to the World Health Organization (WHO), men and women have the right to be informed of and have access to safe, effective, affordable and acceptable methods of fertility regulation of their choice.

“Reproductive health, therefore, implies that people are able to have a responsible, satisfying and safe sex life and that they have the capability to reproduce and the freedom to decide if, when and how often to do so,” according to its web site.

The unofficial barriers to single women securing contraceptives from public healthcare providers also come at a time when cases of teen pregnancies and baby dumping are on the rise.

According to Welfare Department statistics, there were a total of 472 abandoned babies in the country between 2005 and 2010. Activists attributed many of the cases to the stigma that unwed mothers face as well as the lack of access to sexual health education.

Figures from the Health Ministry revealed that 16,528 teen pregnancies were recorded last year based on the number of adolescents that registered at government clinics. On average, there are around 50 teen pregnancies a day.

Reproductive health care includes not only access to contraceptives such as birth control pills, condoms, but also scientific rather than religious-based information on reproductive health, treatment for sexually transmitted infection and diseases, access to safe abortion, among others.

These services are technically available to all at the 1,061 government clinics all over the country, inclusive of standalone Maternal and Child Health Clinics and 1810 Community Health Clinics, under the Health Ministry.

Dr Choong Sim-Poey, the president of the Penang Family Health Development Association (FHDA), said the fact that sexual health services are given to singles on a “discretionary” basis allows cultural and religious bias to operate.

The co-chair of Reproductive Rights Advocacy Alliance Malaysia (RRAAM) said some official data indicated that this unmet need for better contraceptive and abortion services has long been ignored by health authorities because of such biases.

“In a nutshell, the government considers that all single women are celibate, and if they are not, they should be punished.

“And because of stigma and prejudice, a lay person may find it quite difficult to get accurate information on where to get such services,” he explained.

He said a more controversial aspect of discrimination in reproductive health services is termination of pregnancy or induced abortions for unplanned and unwanted pregnancies.

Although Section 312 of the Penal Code allows for terminations on grounds of mental distress, he said records showed that government hospitals only provide abortion for serious medical risks of a continuing pregnancy.

As such, most abortions here are provided by private doctors who are willing to recognise mental distress as a valid and legal indication for an abortion, he noted.

“But because the private sector abortions are unregulated, clients, especially if they are single, are exploited by some doctors with exorbitant fees putting this procedure or treatment beyond the means of many women,” he said.

WHO calls for legal abortion a “fundamental right of women, irrespective of where they live” and “legalisation of abortion on request is a necessary but insufficient step toward improving women’s health”.

Dr Choong said an official Health Ministry guideline released in September 2012 made it clear that government health facilities should provide this service according to the law, but based on informal feedback, he said this has yet to be effected.

“The concept of reproductive rights of women as a human rights principle has yet to be recognised by our government,” he said.

Sex educator and activist June Low said the answer to the current situation is not to tell staff at government clinics not to apply their own morals on patients; rather, she advocate comprehensive sex education for everyone, from students through to adults.

“Get sex ed in schools, get people talking about sex and being more open about it as an issue that affects us all.

“Only then can we expect a shift in attitudes,” she said.