Doctors: While birth control protects Orang Asli women from high-risk pregnancies, they must not be forced

KOTA KINABALU, July 17 — Medical experts specialising in reproductive health say it is common for doctors to prescribe birth control for women who may be at risk of complications during pregnancy.

In rural communities, poor nutrition and short interval pregnancies can lead to anaemia during pregnancy.

Experts told Malay Mail that although anaemia alone is not enough to warrant birth control, they all agree that complications from the red blood cell deficiency could pose health risks for both mother and baby.

Medical experts weighed in on the subject after news portal Malaysiakini reported that Health Ministry staff had administered contraceptive injections to Orang Asli women, especially those who had recently married.

The ministry has set up an internal committee to investigate allegations that ministry officials had forced members of the Orang Asli communities in Perak and Kelantan to take birth control pills and injections.

Dr John Teo, a consultant obstetrician and gynaecologist, said a woman with a background risk of anaemia may have a high-risk pregnancy.

“It’s pertinent in particular in these communities that every pregnancy is planned in order to optimise maternal health and decrease complications before they become pregnant.

“The use of contraceptives allows the mother to not have an unintended pregnancy with its associated complications and consequences and thereby, ensuring that each mother, when pregnant, is at the best of health. This would increase tremendously a healthy outcome for both mother and baby,” said Teo.

Teo pointed out that rural communities such as the Orang Asli and hill tribe communities in Sabah or Sarawak who have limited access to healthcare are at higher risk of delivery complications, and more so if they have a history of anaemia.

Reproductive Rights Advocacy Alliance Malaysia (RRAM) founding member Dr SP Choong said that although anaemia is a condition that has no direct relationship with birth control, pregnancies do take a toll on the body.

“Of course, repeated pregnancies at short intervals depletes the body’s protein stores and causes among other things severe anaemia,” he said.

He, however, added that there are methods of contraception which may help anaemia by reducing or stopping menstrual bleeding.

When asked whether it was common to recommend birth control to those suffering from anaemia, Dr Choong said since pregnancy causes a drain on the body’s protein and iron stores, preventing a pregnancy is beneficial.

Both medical practitioners warned that contraceptive counselling and consent are important when it comes to administering birth control shots, no matter what the health risks are.

“It is unethical and illegal to force a woman to adopt birth control, even if it’s clearly beneficial to her health. We can only explain and persuade her if we think she really needs it,” Dr Choong said.

Dr Teo said it is imperative that counselling be delivered within the local context so that it is appropriate to the women’s beliefs and culture, and must be done while keeping in mind the sensitivity of their needs, limitations and the community background.

“Communication and counselling are made even more complex and challenging with women who have lower literacy rates and lack an understanding of modern contraceptive methods against a background of cultural beliefs, myths and misinformation.

“The final decision to use or not lies in the hands of the women and no one else,” he said, adding that consent can be given in many forms, including verbal or written, or both.

He said that he has encountered many women who have refused birth control despite the doctor’s advice.

“It’s very challenging as each time they get pregnant, they endanger their lives as well as their babies. Some mothers die during pregnancy because of their medical conditions. Maternal deaths complicated by medical conditions is another major cause of death among Malaysian mothers.

“Doctors and nurses will always try their best to give the appropriate advice and information to the woman as well as her family, but ultimately it is the woman’s decision,” he said.

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