A caring policy, a cradle of hope
Imagine now if you were a pregnant teenage girl. What choices do you have? You could go to a government health clinic and get a health assessment and seek help from healthcare providers who are trained to be non-judgmental and who will help you under confidentiality. There are exceptions to this confidentiality, though (do read on). However, your situation will be addressed with your best interests in mind.
This is but one of the many teen-friendly services provided by the Ministry of Health in line with the National Adolescent Health Policy.
We spoke to Dr. Nik Rubiah Nik Abdul Rashid, senior principal assistant director of the Adolescent Health Unit, Family Health Development Division in the Ministry of Health. Jovial, warm and a tireless advocate for teen health and good parenting, Dr. Nik has been passionately involved in policy making and transforming the policy into actionable plans for practical implementation ever since the Unit’s inception more than twenty years ago.
Adolescent health programmes
“Just because teenagers look healthy on the outside, we think they don’t have issues,” Dr. Nik Rubiah said. “But this is the most critical period in life as many habits like smoking, substance abuse and other risky behaviours can be traced back to the teen years,” she added. Psychiatric morbidities (mental health issues) in children and adolescents have also increased from 13% in 1996 to 20.3% in 2011. In the National Adolescent Health Plan of Action 2016-2020, mental health, sexual and reproductive health, high risk behaviour, nutritional health and physical health make up the five priority areas of adolescent health. These issues are often interrelated, producing a myriad of challenges concerning teens.
Adolescent health programmes were established in 1996 as an expanded scope of the Maternal and Child Health Programme of the Family Health Development Division at the Ministry of Health.
Since then, the Ministry has developed various guidelines, SOPs and health education materials to train healthcare providers on providing adolescent friendly health services. Currently, adolescent health services are integrated into all of the approximately 3,000 government healthcare facilities nationwide. Services provided include promotive, preventive, curative and rehabilitative services through multidisciplinary teams of healthcare providers.
Pregnant, with fear
Of all the health issues that teens face, teenage pregnancy remains one of the most sensitive topics as its consequences are serious and life-changing. The girls often face anxiety, fear of discovery and most of them stop schooling due to self-stigma. In response, the Ministry has trained healthcare providers with soft skills and equipped them with tools to talk to troubled teens in an environment of trust and safety to intervene positively in their lives.
There were 18,652 teen pregnancies recorded in 2011. In 2016, it dropped to 12,492. However, the gravity of the situation remains because there’s a higher chance of pregnant teens dropping out of school.
Of the many teen problems, pregnancy is particularly challenging simply because higher morbidities for both the teen mother and child are often the case along with other health complications and psychosocial issues.
The teen is advised to inform her family or guardian as family involvement is crucial for the welfare of both the girl and the baby, financially and emotionally. The teen also has a choice of going to a safe venue where she can carry the baby to term. Counselling is provided so the girl knows she has the option of either keeping the child or choosing adoption. Abortion is the last resort as it involves risky complications unless the pregnancy endangers the girl’s life.
Verbal confidentiality contract
Due to the shame and fear surrounding a pregnant teen’s situation, the verbal confidentiality contract (VCC) is practiced by healthcare providers to create a safe space for teens to open up about their issues, especially as their emotional and mental burdens could lead them to harm themselves, or their babies. However, if an external party is harming the teen, or if she is in danger of harming herself or others, the healthcare provider will have to waive the confidentiality with the teen’s safety and best interests in mind and refer the case to relevant child protectors. For girls who have stopped schooling due to self-stigma, the division has created a discreet referral letter template which the girls can pass to their schools so that they can continue schooling.
Screening tool for silent screams
About 48% of teens go to government health facilities due to identifiable health symptoms, mainly, common respiratory-related problems. However, the second most common cause of going to the health clinics is due to non-specific signs and symptoms; for instance, headaches, tummy aches and other psychosomatic symptoms. This is why the Ministry has introduced several screening tools to help train healthcare providers with soft skills to further explore any underlying psychosocial issues and to detect risk and protective factors that may contribute to the teen’s issues.
The Ministry also produces health educational materials which can be found on www.infosihat.gov.my. Teenagers could also submit their queries to ‘Ask the Experts’ forums at the MyHEALTH portal – www.myhealth.gov.my. An informative YouTube channel is also available under the account “Kesihatan Keluarga”.
Training teen-friendly healthcare providers
The Ministry regularly trains healthcare providers at the national, state and district levels to be sensitive and non-judgmental while engaging with teens using detailed standard operating procedures (SOP) and guidelines. Dr. Nik Rubiah had a hand in developing the training module based on the HEADSS psychosocial framework widely used in adolescent health centres in Australia and New Zealand.
“Healthcare providers learn how to ask questions with the screening tool and to listen. We engage them in role play about counselling teens. There’s even a segment on facing their fears and attitudes when dealing with teens,” Dr. Nik shared.
The Ministry would like to relay this message, she said, “To teenagers, parents and the public, if you or any family members have any problems related to children and adolescents, please come to the nearest government clinic for assistance.” (locations at www.moh.gov.my under the Directory’s Kelinik Kesihatan Kerajaan)
It takes a village
It takes many parties to raise a stronger and healthier generation. Seeing the need for more shelters where pregnant teens can receive holistic help, the Ministry launched the Generasiku Sayang Programme (GKS) in 2015 to create awareness and support pregnant teenagers through inter-agency collaborations to ensure holistic intervention with regards to health, education, welfare, safety, spiritual and other social support. The Sultanah of Johor, DYMM Raja Zarith Sofiah binti Almarhum Sultan Idris Al Mutawakkil Alallahi Shah is Generasiku Sayang’s national patron. The first “Pusat Jagaan GKS” was established in Johor followed by Kelantan in 2016. Other states are initiating the GKS programme in varying phases.
The Ministry works together with major agencies to tackle various social determinants which affect adolescents’ health such as the Ministry of Health, Ministry of Education, Ministry of Youth and Sports, Ministry of Women, Family and Community Development, Jakim, the police and NGOs like the Federation of Reproductive Health Association Malaysia the Malaysian Medical Association, Malaysian Mental Health Association, Malaysian Association for Adolescent Health and other agencies.
Dr. Nik Rubiah said, “We can’t do it alone because having healthy teens is everyone’s shared responsibility.”
What is HEADSS*?
Using HEADSS, health care providers can assess a teen’s psychosocial background based on the following categories and detect underlying health concerns and risk factors.
H = home
E = education, eating, exercise, employment
A = activities and peer relationships
D = drugs, cigarettes, alcohol
SS = sexuality, safety, spirituality or suicide/self-harm.
(*Cohen and Goldenring, 1988)