Creating safe spaces for teen mums: Issues and challenges
In Malaysia, there are 50 cases of teenage pregnancy every day. Every month, there are 1,500 cases. Out of that number, 30% of the teens are unmarried, according to Ministry of Health statistics.
“Pregnancy is not just a health issue. There are psychosocial aspects involved. It affects not just the mom, but the child and the family. There is also the social stigma to cope with,” says Dr. Nazrila Hairizan Nasir Head of Services and Senior Consultant who is attached to the Klinik Kesihatan (health clinic) at Presint 9, Putrajaya but works closely with the Adolescent Health Unit.
“And the teenager’s future is in jeopardy along with the baby’s,” she said. Approachable and with a gentle yet attentive demeanour, Dr. Nazrila tells us of her experience dealing with pregnant teenage girls. She is also trains healthcare providers in how to engage with teens using the HEADSS framework.
Physical care – accessing pre- and post-natal care
One of the main issues is that the pregnant teenager is usually unable to care for herself, much less her unborn child due to lack of awareness of health resources and lack of support, be it emotionally or financially.
“In some cases, the pregnancy even results in the death of the mother and the baby as their young bodies may not be able to cope with childbirth. They do not seek proper healthcare. Some have opted for self-harm (like participating in rough physical activities to cause a miscarriage), illegal abortions or even suicide,” Dr. Nazrila said. Others may choose to give birth and then dump the baby.
A strong correlation also exists between anaemia in teenage mothers and an increased risk of mortality along with low birth weight, babies who are small for their gestational age and premature babies.
Statutory rape cases
There are also many legal issues. “Some are underage. They could’ve been coerced or raped so you’re dealing with statutory rape. Some men or boys don’t understand statutory rape laws when they have sex with girls aged 15 and under. Or sometimes, the girl is raped and abused by the people she knows and trusts. These are the many things that we have to look into when they come to our clinics saying they’re pregnant,” said Dr. Nazrila.
“I even have teenagers who come when they don’t have family support. That’s when the problem really starts. They’re on their own. So, the legality for us in the clinic is when they are sixteen and below, it becomes a challenge,” Dr. Nazrila added. She stresses that patience is needed when they assess each case and try to come up with solutions according to MOH guidelines.
When it’s no longer a secret
Although there’s confidentiality in what teens share with doctors and healthcare providers, cases of statutory rape must be reported. “Of course the adolescent will not want it reported. That’s why HEADSS training is so important. We tell them – yes, it’s confidential but when things harm you or if you harm others, then the confidentiality will be off because we need to report to keep you safe. It’s not to punish you, but so that your safety is assured,” she said.
Teenagers are asked for their consent before the healthcare provider takes the next step so they are empowered to make their own decisions, including how they want to inform their parents of their pregnancy.
With the SOPs and guidelines in place after many rounds of fine-tuning their implementation, healthcare providers are now clear as to how to deal with each case.
“It’s no longer about going to the police for everything, but there are forms you can fax, call up child protectors, or refer some acute cases to hospitals with one-stop crisis centres where they have social welfare workers, the police and O & G specialists. We now have options,” Dr. Nazrila added.
Marriage – not the solution
In some cases, the girl’s family marries her off to the person she has had sex with to cover up the whole matter. Dr. Nazrila recounts the story of one case. “There was this 17-year-old married girl. After her second delivery, two nurses visited her at her house. They knocked on her door. No reply. Finally the girl came to the door, weak and crying in the dark house, saying “I’m hungry”. Her husband had left her alone with no food. “I can’t find my baby. My baby isn’t here!” We discovered she was married off by her parents after having had sex with this man. When her first child was delivered, it was given away at a price,” she explained. They couldn’t do much except to refer her to the welfare department as she is not a minor and also legally married.
“Marriage is not a solution. Sometimes, it can create more problems. That’s the issue we’re trying to explain. Which is why we’re always telling them, go back to school,” an adamant Dr. Nazrila said.
The lack of support from families
A common thread in many of the pregnant teen’s individual stories is that they come from broken homes. “They’re just looking for love and attention,” Dr. Nazrila said. In one case, a girl’s maternal uncle stepped in to help her to the dismay of his own wife. “It’s the stigma,” Dr. Nazrila paused to say. The girl delivered her baby while staying in a room rented by her uncle and his support made all the difference. Her father and brother had beaten her up and even threatened to beat her uncle up. Other girls get disowned.
Abortion – to keep or not to keep?
“Sometimes, the parents insist on abortion. But they first have to go through counselling. Usually after counselling, many of them won’t want to abort. They usually choose abortion in the first place because they think pregnancy is the end of the road or to avoid the stigma,” she said.
The counselling service is available to all regardless of the patient’s religion with guidelines outlined in the HEADSS training to help provide the girls and their families support for better decision-making.
There is hope
Dr. Nazrila said “The thing we want to say to these girls is – ‘you are not alone. Being pregnant is not the end of the world. There is still hope. There are things you can do to help yourself. Please come and seek care. Don’t run away from the system.”