LETTER | We, leaders and representatives of civil society organisations, professional societies, scientific associations, faith-based organisations, government agencies and departments, private for-profit entities, non-governmental, non-profit organisations, and citizens of Malaysia, are united to reduce unintended adolescent pregnancies in Malaysia.

We desire a society where every person below 18 years of age enjoys health and well-being, is treated with love and respect, and is capable of realising their fullest potential. However, we are concerned with the reported rising rate of unprotected adolescent sexual activity, of which the health and social impacts include unintended pregnancies, unsafe abortion or miscarriages, disrupted education, child marriage, social stigma, and further victimisation.

Due to legal, social, and cultural barriers, safe and meaningful access to sexual and reproductive health education and services remain inadequate. Adolescents are one of the most vulnerable and hidden groups as their voices and health needs are not being heard or met. We believe that as a civilised and responsible society, it is time that Malaysia does everything to protect our adolescents, young mothers, and their babies.

We take note of the causes of adolescent pregnancies and the requirement of multi-factor solutions. The health needs, the developing autonomy and capacity, and the psychosocial struggles of adolescents should be highlighted. Everyone in society is responsible to stand in solidarity with our adolescents and support their needs. We are united behind the fullest range of policy options to reduce adolescent pregnancies in Malaysia. Multiple stakeholders must commit to and implement political, social, scientific, educational, health systems, and access solutions, among others.

In developing our child- and adolescent-centred commitments, we have conducted multiple robust discussions over a long period. In these discussions, we have carefully considered the ethical, religious, political, scientific, cultural, and Malaysian contexts. We have also considered the spirit and wording of the:

1. Charter of the United Nations Children’s Fund (UNICEF)

2. Convention on the Rights of the Child (1989), United Nations

3. International Conference on Population and Development (ICPD) Programme of Action (1994), United Nations

4. Constitution of the World Health Organization (updated 2014), and Universal Health Coverage

5. Sustainable Development Goals (2015), United Nations

6. Convention on the Elimination of All Forms of Discrimination Against Women (1979)

7. Position Paper on Sexual and Reproductive Health and Rights (Madrid Declaration) (2019), European Society of Contraception and Reproductive Health

8. National Strategy Plan in Handling the Causes of Child Marriage, Ministry of Women, Family and Community Development (2020).

We urge all our fellow Malaysians to join us in our commitment to reduce adolescent pregnancies and to uphold adolescents’ rights to sexual and reproductive health (SRH), and

1. To implement the widest range of health and social policy solutions to reduce unintended adolescent pregnancies in Malaysia

2. To empower adolescents to make the best health choices for themselves

3. To educate the broadest possible section of the society with comprehensive, evidence-based sexual reproductive health education (including on sexually transmitted diseases and pregnancies) that is age and culturally appropriate. This includes the education of children (like safe touch), adolescents, health professionals, teachers, and parents. It is an ethical imperative that SRH experts, policymakers, and the community work hand-in-hand to deliver SRH education effectively

4. To provide safe and effective contraception whenever it is needed, within the strict confines of a non-judgmental and confidential environment, of which the opinion and decision-making capacity of the adolescent is respected, and their health needs are met. The combination of education and the provision of contraception is most effective in preventing unintended pregnancies in all age groups. This may require amendments to the relevant laws and the way we honour mature minors’ decisions

5. To acknowledge the barriers of safe access to SRH education and health services. These barriers include the unavailability of services, the lack of information, disempowerment and inadequate training of providers, and other legal and social determinants

6. To resolve the issue of child marriage in Malaysia, in support of the Ministry of Women, Family and Community Development, and

7. To implement adolescent sexual and reproductive healthcare policies that are wholly based on scientific evidence and ethical considerations.

Adolescent pregnancy is Malaysia’s huge problem, and we must solve it together, now. We call on all stakeholders to join us in our commitments expressed in this consensus statement, in the spirit of partnership, generosity, and ambition. Together, we place children and adolescents in the centre of all our efforts as they deserve our highest protection and care.