Preventive or prescriptive? Teen pregnancies and how parents can be heroes
Almost 11% of all births are to adolescent women between 15 and 19. There are complex socio-economic, educational, cultural and service availability factors that influence this. Adolescent pregnancies can compromise the health and development of the mother and child.
“I’ve come to regard these girls as my own,” says Dr. Harlina Halizah Siraj, a professor of obstetrics and gynaecology and clinical educator at the Universiti Kebangsaan Malaysia Medical Centre (PPUKM) about the teens who were under her care at Raudhatus Sakinah, a shelter for pregnant girls managed by Jamaah Islah Malaysia (JIM) where she was active for ten years.
She sits on the technical committee of the Family Health Development Division along with Dr. Nik Rubiah and Dr. Nazrila whom she hails as sexual reproductive health heroes. Her personal involvement with sexual reproductive health among teens has given her a pragmatic perspective. “You can either prevent it, or remedy it,” she said.
Affectionately known as ‘Dr. Har’ by her clinical students, Dr. Harlina, along with Dr. Nik Rubiah and Dr. Nazrila advocate good parenting as a measure to educate and help youths in this important area.
The 4A’s of a pregnant teen’s choices
She explains how pregnant teenage girls have the 4As choices – acceptance, adoption, abortion and abandonment, each with its own implications.
In the first instance, the girl’s family could “accept” the pregnancy and she is likely to be married off. However, abuse, neglect, and divorce are common stories among married teens, as Dr. Nazrila shares on page 36.
The second option is adoption and Dr. Harlina says about 75% of mothers in the shelter she used to oversee wanted to give their babies away. However if adoption is not handled within the legal guidelines, it could unfortunately become baby trafficking.
The next option would be abortion. The Penal Code metes out a three-year prison sentence for causing a “woman with child to miscarry” or a seven-year sentence if she is into her fourth month of pregnancy. Section 312 exempts a registered doctor if he or she forms an opinion with good faith that the pregnancy jeopardises the mother’s mental or physical health.
Nowadays, many people use drugs available online and terminate the ongoing pregnancy within a few days.
“Of course there are side effects, because it causes forceful uterine contractions and bleeding. These drugs have to be given and monitored by specialists who are trained. These are controlled drugs and not openly available in Malaysia.
“These medications should not be taken as self-prescribed medication,” she says. She acknowledges the dilemma of legalising access to these drugs versus the high risk of morbidity in using them without a prescription or proper care.
The final “A” is abandonment and is divided into two categories. The first is labelled “intended to live” where the mother wants the baby to be found alive and leaves them where they will be found such as places of worship or charity homes. The other category is called “intended to die” or infanticide as the mother either ends the life of the baby or abandons it in such a way as to cause death.
“We can either deny this is a problem, like the ostrich with its head in the sand, or we acknowledge that it is happening, and we need to do something about it,” says Dr. Harlina. “If they are sexually active, the most pragmatic way is for them to practice safe sex.”
Preventive: Sexual education
“Of course, the fact that we mention the word sexual education is already making an uproar,” says Dr. Harlina. “People think it’s about teaching them to have sex.”
She cites the success of the Netherlands’ sexual education model versus the sex education model of the US (the latter has the highest teen pregnancy rate among developed countries). The Dutch holistic model passes the responsibility to parents to incorporate what is taught in school at home along with their family’s values. Dutch teens have a low pregnancy rate, have sex much later in life and when they do, they practice safe sex.
In a PBS article, Ineke van der Vlugt, a youth development expert for Rutgers WPF, the research institute behind the Dutch sexuality education curriculum said, “People often think we are starting right away to talk about sexual intercourse [with kindergartners].” On the contrary, “sexuality is much more than that. It’s about self-image, developing your own identity, gender roles, and it’s about learning to express yourself, your wishes and your boundaries.” Children are first and foremost taught about respecting others.
How parents can talk about sex
According to Dr. Harlina, there are five dimensions to sex education.
First, the biological dimension. She stressed that this cannot be taught on its own like other school subjects. “If it’s just that, then it’ll be a discovery of science, and end up with experimentation.”
The second dimension of sexual education is the cognitive dimension. “The most important sexual organ is the brain. It’s the brain that decides what you do with your genitalia.”
Third is the emotional dimension as sex is not just physical. “That’s why we don’t want it forced upon anybody. It’s supposed to be fulfilling, enriching and strengthening with love. If not, then it’ll turn out to be something painful, humiliating, and degrading.”
The fourth is the social dimension which covers how we relate to people of the same gender, the opposite gender, and people who are younger or older and what we are supposed to do or not do within these relationships.
The fifth would be the spiritual dimension. “If you look into all the cultures of the world, sexual relationships have been regarded as sacred. It is actually how you come up with your self-identity and how you merge with another person’s identity and how you raise small humans between you and your sexual partner,” Dr. Harlina says.
“Our sexuality is an identity, whether we like it or not, as we have defined ourselves in that area,” she says. Our foundational identity is ingrained within our families. Schools then facilitate the socialisation. “Every child who goes to school should already have the foundation of their sexuality identity, ingrained by their parents.”
“Empowered parenting” in sexual education
So how do we convince parents to be responsible and to be in charge?
Dr. Harlina thinks that Malaysian parents want to do more but don’t know how to talk about sex.
There is what she calls “empowered parenting”. It is where parents set reasonable expectations of their children’s behaviour based on family values while being sensitive to their needs. “For instance, you could say “we don’t expect you to have sex at 15, 16, or 17 because in our family’s religious values, you only do that with somebody who has pledged to the whole society that he is going to look after you or for boys, with someone you have promised that you’re going to look after. At the same time, I know you want to have somebody to love and that’s important, but this is the least I expect you to do,” Dr. Harlina said.
She believes it isn’t effective to use fear to get the message across.
“It is impossible for people to be forced to practice a certain lifestyle. But what is important now is to provide right, accurate information, so that people can make informed decisions. I think parents have to be given more knowledge about how they can actually assist,” says Dr. Harlina. She was recently involved in a booklet guiding parents on how to teach kids at different ages about sex.
“To me, the preventive is still very important. We have to let these young people, particularly those who are not yet sexually engaged know that (sex) is a very big decision and it’s okay to delay that until you are ready. You should not be forced into it,” she concludes.
Early initiation of sexual activity for adolescent girls increases their risk of getting pregnant during adolescence.