KUALA LUMPUR, Dec 17 ― Did you know that in Malaysia a woman needs her husband's approval if she chooses to undergo a procedure to prevent pregnancy?
This special consent form is for a surgical procedure called bilateral tubal ligation (BTL) which involves blocking the Fallopian tubes to prevent the ovum or egg from being fertilised.
By contrast, if a married man wishes to have a vasectomy, a procedure which prevents the release of sperm when a man ejaculates, he does not need his wife's consent.
Both these surgeries are considered permanent forms of birth control, although in some cases they can be reversed successfully.
So why the double standards?
“The form is more of a practice and it is used to preserve marital harmony,” a gynaecologist at a government hospital said, referring to a special consent form specifically for the BTL procedure which requires the patient's and the husband's signatures.
When asked why the wife's consent is not needed for a vasectomy, he said “by right there should be” and then shrugged.
He admitted, however, that legally all medical procedures only need the patient's consent if he or she is of sound mind.
“So if the husband disagrees to the procedure but the wife is adamant, the doctor will not be penalised if the case was brought to court,” he said.
A medical officer at a government clinic called the situation a “grey zone” as Malaysia is a “Muslim country” so a lot of rules are based on that.
He said BTL requires husband's approval but if he's not around to sign it, verbal approval can be accepted.
“I've known surgeons who refuse BTL if the patient is young and of 'child-bearing age.'
“They say, 'muda lagi, baru dua anak',” he said, which means they are still young, with only two children.
The medical officer also said two months ago, he referred a woman to get BTL as she said she didn't want any more children.
“She came back saying they refused to do it... she wasn't too sure why.
“I'm guessing because she was in her early 30s and only had two or three kids,” he said, adding that she was not educated.
And there lies the heart of the matter. An uneducated woman who does not know her rights may be pressured into accepting her doctor's personal opinion. It does not matter if she does not wish to have any more children.
If, however, a woman knows her rights she can insist on having the procedure. After all, it is her body.
And what about single women who wish to have the procedure? Although it is rare for single women to ask for BTL, medical officers told Malay Mail Online that it is generally allowed.
In the private sector, however, Malaysian Medical Association (MMA) president Dr Ashok Philip said most doctors in private practice do require both partners to consent to such an operation, whether vasectomy or tubal ligation, to avoid “future problems.”
“If both partners are not in accord, perhaps the relationship needs work, and you should avoid a potentially irreversible step. After all, there are many other methods of contraception,” he said.
Dr Ashok also said that he was not aware of any regulations in government hospitals that apply only to women but not men.
“Perhaps individual consultants may have different requirements, but I do not think it is government policy,” he said.
A source working at a private hospital in Perak, however contested his claims that both parties’ consent were needed. She said a surgeon from the hospital confirmed that married women need their husband’s consent for BTL but husbands do not need their wife’s consent for vasectomy.
As for doctors who refuse to do BTL, Dr Ashok said he did not think doctors should impose their own views on patients.
“As I said before, a mentally competent patient should be allowed to make his or her own choice. Even if some doctors refuse to perform BTLs, there are many others who will,” he said.
