About contraceptives, consent and underserved communities — John Teo

JULY 12 — I am very sad to read about the recent newspaper reports about the claims of forced contraceptives on the Orang Asli communities by a memoradum submitted to the government.

It’s even more distressing to note that there were many remarks by public and healthcare professionals who regarded this issue with mixed reaction, confusion, 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 the lives of mothers and infants. It also 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 underserved and marginalised is even more marked with issues of accessibility to healthcare — 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 underserved. 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 World Health Organisation’s (WHO) sustainable development plans to improve maternal and infant health associated with the concept of leaving no one behind.

Contraceptive counselling

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.

Contraceptive methods

The oral contraceptive pills is one of the most difficult methods to use, necessitating the user to be very discipline 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 taking the pills if they are not keen on the method, forget to take the pill or their 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 to 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 a lack of proper procedure rooms or sterile instrumentations, 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 the timing of mobile clinic visits or other transportation modalities are dependent on weather conditions, supplies or staff availability.

All contraceptive methods are generally safe as long as proper medical guidelines in its usage are adhered.

In conclusion, the challenges of delivering contraceptive care to marginalised, underserved 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.

* This is the personal opinion of the writer or publication and does not necessarily represent the views of Malay Mail.

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