World Health Organization (WHO) statistics have revealed that about 16 million adolescent girls give birth every year, with most of them from low- and middle-income countries.

An estimated three million girls aged 15 to 19 undergo unsafe abortions every year. And, worldwide, one in five girls have given birth by the age of 18.

It has been reported that in Malaysia, an average of 18,000 teenagers get pregnant each year. On an average, 1,500 young girls get pregnant each month or 50 a day nationwide, and medical attention is sought mostly at government clinics.

UM Specialist Centre (UMSC) experts have recommended that a think-tank working group, drawing the expertise of doctors, parent-teacher associations, teenagers, social workers and various religious groups, be established to put a concrete system in place to deal with the issue of teenage pregnancy that has now become rampant.

"This outreach team should be able to break through religious and cultural borders. They must be pragmatic, open-minded, forthcoming and non-judgemental in order 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 UMSC obstetrician and gynaecologist Dr Aizura Syafinaz Ahmad Adlan.

She said the think-tank group should collaborate with ministries such as the Education Ministry and the Women, Family and Community Development Ministry to seek practical solutions to reduce teenage pregnancy, if not eradicate it.

Awareness campaign

Aizura stated that 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," she told Bernama during a joint interview with her sister, UMSC psychiatrist Dr Aida Syarinaz recently.

Aizura 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 the day an underage pregnant girl comes to the hospital, if attended by an anti-abortion-opinion doctor, the teenager would be advised to carry on with the pregnancy and give the baby away for adoption later. 

"If she meets a doctor who has no qualms about abortions, a termination can be arranged easily.

"In Malaysia, two consultants are required to give their signatures on the document for pregnancy termination."

Complicated situation

Aizura said there were also instances where doctors have to deal with young patients who were in their advanced stage of pregnancy.

She cited the example of a teenage patient who came to the hospital to seek orthopaedic treatment for swollen joints.

"After undergoing an MRI scan, it was found that the girl was carrying a baby and the blood clot identified was developed due to pregnancy. 

"She was among the fragile groups of patients doctors face. 

"The situation became complicated as the unwed mother was in the advanced stage of pregnancy."

Aizura said teenage mothers were at greater risk of having medical complications. With little or no prenatal care the girl is more likely to develop pre-eclampsia, a severe condition associated with high blood pressure.

She said the incidence of caesarean section 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.

Aida, meanwhile, said the risk of postpartum depression was also higher among teenage mothers, noting that with poor support from the family, the depression could get worse.

"If the teenage mother’s parents are not supportive and helpful, and if she is left alone, she may resort to abusing drugs," she added.

In some cases, severe depression can lead to suicidal and filicidal (thoughts of killing one's own offspring) ideas and attempts. Untreated depression can be complicated if it develops into psychotic depression, where the mind is impaired and loses contact with external reality.

Baby hatch

Rising concerns over baby dumping saw the setting up of Malaysia's first baby hatch in May 2010 by OrphanCare Foundation in collaboration with KPJ Healthcare Bhd.

The baby hatch offers mothers, who do not want their babies, a safe place to surrender their infants, 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," Aizura said.

Aida added that teenage mothers faced difficulties in pursuing their studies due to the social stigma they encountered.

"Our society’s approach towards unwed mothers to continue their studies in the mainstream education system is not a welcoming one. 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 more trying, she has to get a police report before delivery."

Clearer way

Aizura opined that there should be a clearer way for the attending doctors, police and parents to manage the situation involving out of wedlock teen pregnancy.

"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."

Relating the case of a teenager who was regularly raped by her own father since she was nine years old, Aizura said the girl became pregnant the minute she got her period at the age of 15. 

Her mother and other siblings were victims of domestic violence.

"The 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.

Aida, meanwhile, said that "sex education should start at home. If the family is united and open to discussing 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 the matter in the best possible manner."

Better approach

Aizura's take on the issue was this: "Don't be punitive as it won't solve the problem. Let's think of a better approach, better ways."

The Health Ministry has implemented the ‘Generasiku Sayang’ programme that is aimed at increasing public awareness of the importance of efforts to prevent teen pregnancy.

Under the programme, the ministry has set up care centres to provide protection to teen girls or women who get pregnant out of wedlock, as well as their babies.

Such centres have already been set up in all the states except Kuala Lumpur, Labuan and Pahang.

The Terengganu Health Department opened the state's first 'Rumah Generasiku Sayang' in October 2018 to house teenagers who become pregnant out of wedlock. 

- Bernama