Reproductive choices can overcome sale of illegal abortion pills

It is disheartening to note that the sale of illegal abortion pills online is proliferating.

Clearly, it reflects the increasing desperate attempts by women and girls in resolving their crisis when faced with unplanned pregnancies.

While the health ministry has been clamping down on such sales, we are concerned that it may be ineffective as these sales are conducted through various platforms like Facebook, WhatsApp, Twitter and WeChat that appear and disappear as fast as a flash.

In addition, many sell fake pills or, at times, adulterated pills that either have no effect, resulting in desperate women getting scammed, or endanger their health and lives.

Even the genuine pills are often given with medically inappropriate doses or regimes by sellers that further threaten women’s health.

So, what are the root causes of such a rise in procuring illegal online abortion pills? Among them are:

• Low usage of modern contraceptive methods by women and girls at risk of unplanned pregnancies, stigmatisation of single mothers, and premarital sex.
• Lack of childcare support for couples and single mothers.
• Lack of access to legal safe abortion when indicated, exacerbated by stigma, poor knowledge about sexual and reproductive rights as well as persistent discrimination against women and girls.
• Confidentiality and secrecy that online procurement offer women, girls and couples, thus fuelling the demand.
• Unwillingness to address sexuality and sexual health care in an open and comprehensive manner, which poses a continuous health threat especially to vulnerable groups such as adolescents, women with disability, victims of forced marriages, violence or abuse, migrants (legal or trafficked) and sex workers, to name a few.

Here are the solutions:

Prevention

Behind every abortion is an unplanned pregnancy. The usage of contraceptive clearly prevents unplanned pregnancy and thus abortion.

Malaysia’s contraceptive usage of modern contraceptive is at a dismal 35% for the past few decades. The health ministry and healthcare providers should redouble their efforts to increase contraceptive uptake for women and girls who are at risk of unplanned pregnancy.

We need to continually debunk the myths and perceptions regarding contraceptive and sexual health in the community.

Healthcare workers must be taught to sensitise to the reproductive needs of women and girls.

Support

Should an unplanned pregnancy occur, there must be adequate support for women who are unprepared for any pregnancy.

Support can come in three critical areas – emotional, physical and financial.

Increasing the number of counsellors and social workers, making available facilities for childcare, offering single mother allowances, and tax incentives for employers providing childcare facilities, etc will add towards decreasing the need for abortion.

The option of adoption should also be streamlined so that deserving couples can adopt in a less emotionally draining and roller-coaster process. By the same token, mothers who opt to give up their children for adoption must be offered full support in all aspects.

Destigmatisation

Premarital sex and single motherhood are cultural taboos frequently frowned upon or discriminated by society. Conservative cultures look down on single motherhood and support is rarely forthcoming.

Society, authorities, communities and religious leaders have to engage comprehensively in trying to effect a paradigm shift in how we view single motherhood. We need to be more accepting with non-judgmental attitudes on how we can offer help rather then reject and ostracise.

Access to safe legal abortion

When indicated and legally permissible, women or girls need to have access to safe abortion.

The World Health Organisation has published updated comprehensive guidelines on medical abortion based on good evidence research globally.

The availability of medical abortion as a safe choice for women supervised by medical professionals will, in turn, decrease the need for women to resort to illegal unsafe methods.

Unsafe abortion is a public health crisis that threatens women’s lives and health globally, including in Malaysia.

The clamping down on illegal online abortion pills may hardly make a dent on their availability if we do not address the root causes and institute a holistic approach towards women’s reproductive healthcare.

The democratising of healthcare and offering women and girls real reproductive choices are universal health rights.

Dr John Teo is a medical committee member of the Federation of Reproductive Health Association of Malaysia. - FMT