UM Specialist Centre (UMSC) obstetrician and gynaecologist Associate Professor Dr Aizura Syafinaz Ahmad Adlan (right) and her younger sister UMSC psychiatrist Dr Aida Syarinaz during a joint interview on teenage pregnancy at UMSC recently.
--fotoBERNAMA (2019) ALL RIGHTS RESERVED
(Last of a Two-Part Interview)
By Salbiah Said
PETALING JAYA, Jan 2 (Bernama) -- The World Health Organisation (WHO) has identified about 16 million adolescent girls giving birth every year, mostly in low and middle income countries. An estimated three million girls aged 15 to 19 undergo unsafe abortions every year. Worldwide, 1 in 5 girls have given birth by the age of 18.
In Malaysia, it has been reported that an average of 18,000 teenagers get pregnant each year. On an average 1,500 young girls get pregnant each month or 50 cases a day nationwide, and medical attention is sought mostly at government clinics.
Moving forward, a think-tank working group drawing the expertise from doctors, parent-teacher associations, teenagers, social workers as well as various religious groups should be established to put a concrete system in place to deal with the rampant teenage pregnancy.
"This team of outreach group should be able to break through religious and cultural borders. They must be pragmatic, open minded, forthcoming and non-judgemental to work together to reduce teen pregnancy and out-of-wedlock births. The outreach team should work with the relevant public authority to establish realistic hands-on programmes and activities to educate teens on the consequences of births outside marriage," said UM Specialist Centre (UMSC) experts.
UMSC obstetrician and gynaecologist Associate Professor Dr Aizura Syafinaz Ahmad Adlan said the think-tank group should complement and collaborate with ministries such as the Ministry of Education and the Ministry of Women, Family and Community Development to seek practical solutions to ease teenage pregnancy, if not eradicate.
She said significant awareness campaigns were required by involving young and forthcoming people who could work together with the community in realising the think-tank's objective.
"The more you speak of sexual issues, the less you shy away from the subject," Dr Aizura Syafinaz told Bernama in a joint interview with her younger sister Dr Aida Syarinaz, a psychiatrist with UMSC here recently.
She pointed out that there were loopholes in the system of handling teenage pregnancy, even in hospitals.
"There is no standard algorithm on how to handle the matter. On a day when an underage pregnant teenager comes to the hospital, if attended by an anti-abortion-opinion doctor, the teenager would be advised to carry on the pregnancy and give the baby away for adoption later. If she met a doctor who had no qualms about abortions, a termination could be arranged easily.
"In Malaysia it is imperative that two consultants' signature is required on the document for pregnancy termination," she added.
She said there were also instances where doctors had to deal with those seeking late medical care. To quote an example, a teenage patient came to the hospital to seek orthopaedic treatment for swollen joints.
"After undergoing MRI (magnetic resonance imaging) scan, it was found that the girl was carrying a baby and the blood clot identified was developed due to pregnancy. These are fragile groups of patients faced by doctors. The situation became complicated as the unwed mother was in the advanced stage of pregnancy," she said.
Dr Aizura Syafinaz said teenage mothers were at greater risk of having medical complications. With little or no prenatal care the girl is more likely to develop preeclampsia, a severe condition associated with high blood pressure.
She said the incidence of cesarean sector was higher in teenage mothers. This is because the pelvic bones do not reach their maximum size until the age of 18, hence, the pelvis of the teenage mother may not have grown enough to allow vaginal delivery of a normal-size baby.
Dr Aida Syarinaz said the risk of postpartum depression was also high among teenage mothers, noting that with poor support from her family, the depression could get worse. If the teenage mother’s parents are not supportive and helpful, she is left alone and may resort to abuse of drugs," she added.
In some cases, severe depression can lead to suicidal and filicidal (thoughts of killing your own offspring) ideas and attempts. Untreated depression can be complicated by becoming psychotic depression, where the mind is impaired and has lost contact with the external reality.
Rising concerns over baby dumping saw the setting up of Malaysia's first baby hatch in May 2010 by OrphanCare in collaboration with KPJ Healthcare Bhd. The baby hatch offers mothers who do not want their babies a safe place to surrender, instead of abandoning them in dangerous spots where their lives are at a risk.
"This programme allows the teenage mother to reintegrate with her baby later. The babies don't deserve to be at orphanages and that's the reason why they are given away to appropriate families," said Dr Aizura Syafinaz.
Dr Aida Syarinaz remarked that teenage mothers faced difficulties in pursuing their studies due to the social stigma encountered by the unwed mother, who will also endure emotional abandonment.
"Our society’s approach is not welcoming for unwed mothers to continue their studies in the mainstream education system. This has to change.
“Our system is punitive and less supportive. For instance, the girl comes to the hospital with a stigma that she is bearing a child out of wedlock. To make matters trying, she has to get a police report before delivery," said Dr Aizura Syafinaz.
Dr Aizura Syafinaz opined that there should be a clear way of managing the situation among attending doctors, between doctors, the police and parents.
"There are too many procedures. Doctors have to sort matters out as it can be tedious, cumbersome and painful. It's not just for the unwed teen as she is already stigmatised. At the hospital, she has to be warded separately from other patients," she stressed.
She related a case of a teenager who was regularly raped by her own father since she was 9. The girl became pregnant the minute she got her period at the age of 15. Both her mother and other siblings were victims of domestic violence.
"Doctors were in a dilemma and didn't know what to do as the girl was carrying her own father's child. The distraught girl then absconded the hospital and terminated her pregnancy elsewhere," she said.
"Sex education should start from home. If the family is united with openness to discuss any issues faced by the persons in the household, it will be easier to discuss sex education and pregnancy. If a teenager does get pregnant, the parents need to acknowledge that this is a problem, and they need to deal with matters in the best possible manner, " said Dr Aida Syarinaz.
Dr Aizura Syafinaz's take on the issue: "Don't be punitive as it won't solve the problem. Let's think of better approach, better ways."
The Health Ministry has implemented the ‘ Generasiku Sayang’ programme aimed at increasing public awareness on the importance of the efforts to prevent teen pregnancy.
Under the programme, the ministry had set up care centres to provide protection to teen girls or women who got pregnant out of wedlock, as well as their babies. At present, such centres had been set up in all states, except Kuala Lumpur, Labuan and Pahang.
The Terengganu Health Department (JKNT) opened the state's first 'Rumah Generasiku Sayang' (RGKS) in October 2018 to house teenagers who became pregnant out of wedlock.
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