Datuk Dr Raj Abdul Karim has spent decades working tirelessly to push for sexual and reproductive health and rights in Malaysia. — Picture by Choo Choy May

KUALA LUMPUR, April 24 — As Malaysians continue to stay home to slow the spread of the Covid-19 disease, many couples may find themselves growing closer and being more “productive” than ever.

Therefore, the notion that the country may witness a baby boom in nine months may not be far from reality.

Such predictions came true after natural disasters in the past, particularly those in which citizens were ordered to stay at home for a period of time.

Looking at evidences from the New Jersey Hurricane Sandy in 2013 and the Second World War, where people were put under prolonged home confinement, human rights heroine Datuk Dr Raj Abdul Karim said it was very likely to anticipate spikes in births after the movement control order (MCO).

While planned pregnancies do not often cause a social or family concern, Dr Raj noted that the problem arises when pregnancies are unintended or unplanned.

“This would lead to attempts to abort the foetus through home remedial methods or buying abortion pills online or even resorting to unsafe abortions in times of desperation,” she added.

Dr Raj also cautioned that although many may think teenagers or unmarried couples were safe during the movement restrictions, this may not necessarily be the case for some.

“They may find their own ways of seeing each other for sexual encounters, and if they engage in unprotected intercourse, it will lead to consequences such as unintended pregnancies or rise in sexually-transmitted infections (STIs) and HIV cases.”

Who is at greater risk?

Although anyone could be at risk of unintended pregnancy or being infected with STIs, Dr Raj said families living in poverty, the urban poor and People’s Housing Project settings were at higher vulnerability for several reasons.

According to her lower-class communities often live in small, overcrowded homes with limited access to home entertainment, recreation and relaxation.

Therefore, she said engaging in sexual activities would be a stress reliever for them.

“One needs to be also mindful of sexual exploitation in crisis situations which can happen at homes – especially children, girls and young women who are victims of gender-based and intimate partner violence, rape and incest.

“This has been reported among refugees, displaced persons and people on the move or in migration,” said Dr Raj, who was Malaysian AIDS Council president from 2012 to 2016.

She also said that consequences of unintended pregnancies could have personal, family and social ramifications.

“It leads to personal and family stress and conflict as it’s still not acceptable in many traditional societal socio-cultural norms.

“Dangers of pregnancy, delivery and post-natal complications present a greater risk of deaths especially in very young underage girls,” she said.

Dr Raj also highlighted that the phenomena of newborns being found abandoned is a result of unintended or unwanted pregnancies.

Last year, it was reported that 64 per cent of the 945 babies abandoned between 2010 and 2019 were found dead in the country.

“Girls and women do this out of fear, fright or shame and they suffer from deep lasting psychological and emotional effects.”

As the country may witness a spark in births, Dr Raj said a baby boom will impact on the family, society and economy.

“Families in poverty and in disadvantaged situations will find it a struggle to cope with extra mouths to feed and provide care.

“Children are likely to be neglected, abused or exploited for labour or sex; or even traded off as child brides,” she said.

Apart from its economic implications, Dr Raj said a baby boom would also increase demands on health, welfare, education and other social sectors which need to be pre-empted.

When there’s a sudden surge in new births, Dr Raj said populations living in poverty were more likely to be affected by effects of the baby boom in the low- and middle-income countries (LMICs).

“These populations lack access to healthcare and to sexual and reproductive health (SRH) services which are exacerbated during the Covid-19 outbreak as the health system is already overstretched with emergency services and other demanding priorities.

“However, SRH including family planning remain crucial services that must be provided,” she added.

What’s ahead beyond tomorrow?

Last week, several health groups criticised the government’s decision to close all National Population and Family Development Board (LPPKN) centres nationwide for the duration of the MCO, which came into effect on March 18.

LPPKN provides vital services such as family planning, reproductive healthcare, subsidised mammograms, reproductive health screening, menopause management and other comprehensive laboratory tests.

The group warned that the closure could lead to unplanned pregnancies that could result in abortions later on.

According to Reproductive Rights Advocacy Alliance Malaysia member Dr SP Choong, many family planning methods require regular visits to SRH centres along with supplies such as condoms, pills and injections.

“Major disruption of daily life by prolonged MCO, especially the closure of LPPKN clinics, will certainly affect their adherence to methods,” he added.

Citing a recent survey, Dr Choong said it was found that 40 per cent of all pregnancies (regardless of class) are unplanned and of that half are aborted mainly for socio-economic reasons.

“With the acute recession and higher unemployment anticipated, these pressures on the poor to abort will increase to avoid insolvency,” he added.

Although Malaysia has yet to explore any specific studies about the outcomes of SRH due to declined access to care, Dr Raj referred to a recent study by US-based research organisation, Guttmacher Institute, to highlight the staggering implications we may face as a result of movement restrictions.

In the study, the researchers used data from 132 LMICs covering 1.6 billion women of reproductive age (15-49) to estimate how sexual and reproductive outcomes could be altered following only a modest decline of 10 per cent in access to care.

It includes theorising a decline in access to contraceptive and abortion among other scenarios.

Citing the findings, Dr Raj said the implications were staggering in terms of the number of people whose needs would be left unserved, unintended pregnancies, unsafe abortions as well as maternal and newborn deaths.

The study found that a 10 per cent proportional decline in short- and long-term reversible contraceptive use would result in an additional 49 million women with an unmet need for modern contraception in LMICs and an additional 15 million unintended pregnancies.

“In turn, this would lead to more unsafe abortions and other negative outcomes,” said Dr Raj.

It was also found that a 10 per cent decline in the provision of pregnancy-related and newborn healthcare would have disastrous implications for the lives of women and their babies.

“An additional 1.7 million women who give birth along with 2.6 million newborns would experience major complications and not receive the care they need.

“This would result in an additional 28,000 maternal deaths and 168,000 newborn deaths,” said Dr Raj, referring to the study.

The research also outlined that if country-wide lockdowns result in non-access to clinics and under the assumption that 10 per cent of safe abortions become unsafe, we would see an additional three million safe abortions along with 1,000 maternal deaths due to unsafe abortions globally.

A policy analysis by the same study noted that the reality could be much more if more than 10 per cent of services are compromised or disrupted.

Moreover, it added that the scale of the impact could be many times greater in specific countries, religions or population groups.

What should be done?

To counter this catastrophe, Dr Raj said the policy analysis laid out a number of urgent steps for policymakers in LMICs to promote SRH care and strengthen the necessary medicine supplies.

It suggested the governments promote SRH care — including contraception as well as maternal and newborn care — as essential.

“This would allow people to travel for SRH services even in areas under stay-at-home orders or with travel restrictions without fear of legal consequences.

“Alongside private sectors, the government must strengthen the national and regional supply chains to make SRH medicines and supplies more accessible to both providers and clients,” the study highlights.

As the country is set to enter the fourth phase of MCO next week, Dr Raj cautioned that access to SRH services including family planning may continue to become more difficult.

She advised that there was a need to intensify telehealth and arrangements for delivery of SRH medicines and supplies.