This is the first of a two-part article on pregnancies out of wedlock involving teenage girls.
Research has shown that an average of 18,000 teenage girls in Malaysia get pregnant each year. Out of this number, 25 percent or about 4,500 cases involve pregnancy out of wedlock.
Citing the Health Ministry's 2015 statistics, experts from UM Specialist Centre (UMSC) said while the latest figures for 2018 have not been released, they believe teenage pregnancy is on the rise.
"These numbers could be the tip of the iceberg as many cases are likely unreported," UMSC obstetrician and gynaecologist Dr Aizura Syafinaz Ahmad Adlan told Bernama during a joint interview with her sister, UMSC psychiatrist Dr Aida Syarinaz, recently.
The data also showed that around 14 in every 1,000 underage girls in Malaysia fall pregnant every year, which add up to an average of 18,000 girls per year. In comparison, Singapore’s rate is four pregnancies for every 1,000 underage girls, and Hong Kong's, three out of every 1,000.
Aizura Syafinaz said in Malaysia social acceptance of teenage pregnancy was still poor, restricted and secluded. It is regarded as a taboo as premarital sex, incest, rape, sexual abuse and teen marriage come as a precursor.
Malaysia's Penal Code defines statutory rape as sexual activity with a girl under the age of 16, who is unable to understand the nature and consequence of giving consent. According to the World Health Organisation (WHO), teenage pregnancy is one in which the mother’s age is between 13 and 19.
The age of consent in Malaysia is 16. The age of consent is the minimum age at which an individual is considered legally able to give consent to sexual activity.
Individuals aged 15 or younger in Malaysia are not legally able to give consent to sexual activity, and such activity may result in prosecution for statutory rape or the equivalent local law.
"Therefore, I question parents who allow teenage marriages (to take place); should they be 'charged' for consenting to statutory rape?" asked Aizura Syafinaz.
She said studies also showed that most teen pregnancy cases in Malaysia involved girls from among the urban poor, that is, the lower socio-economic income group comprising single mothers with children, as well as parents who work double shifts or have two jobs and leave their children unsupervised at home.
"Sadly, these sectors are large groups where their teenage daughters end up pregnant. Predominantly, these young girls lack attention and are left alone with a lot of free time in their hands. It's like a vicious cycle. As it stands, they hail from a low-income group and regrettably end up with pregnancy," she added.
Citing a Malay proverb, 'Biar mati anak, jangan mati adat' (loosely translated, it means 'let the child die but not tradition'), she said the parents would be livid after realising that their daughter had lost her innocence, but instead of resolving the issue, their mindset is more of how to handle the embarrassment caused by their daughter.
"In many cases, the girl would be sent to a halfway house to deliver the child. Some parents would want their daughter to come home alone without the baby as they believe an illegitimate child would bring shame to the family," said Dr Aizura Syafinaz.
More often than not, unwed mothers are not accepted by their own parents, which results in the practice of dumping or abandoning newborn infants by their mothers. Data has shown that an average of 100 babies are dumped nationwide in Malaysia every year.
She said the idea of using condoms or oral contraceptives was still a taboo among the conservative society as it was often seen as promoting "free sex" and encouraging promiscuity.
"For instance, I wanted to regulate a teenager's period by recommending oral contraceptives, but her mother was against the idea for fear that people might think her daughter was sexually active.
"While information on teenage pregnancy has been available on the health ministry's myHEALTH portal since 2012, it only saw 34 visitors as of the end of November this year, reflecting the poor outreach among youths," she pointed out.
Dr Aizura Syafinaz opined that there was a need to review sex education in secondary schools, which presently only emphasised the basic biology of the human body's reproductive system.
"The approach to sex education is too academic and still indirect as most people shy away from discussing the topic of ‘sexuality’. Schools are teaching the usage of the intrauterine contraceptive device (IUCD) at Form 1 level. IUCD is something that we teach our medical students in our medical school curriculum.
"When statistics showed that teenage pregnancy was higher among the 15-year-olds, we simply decided to educate students earlier, in Form 1, when they are 13 years old. How is this thoroughly thought? Schools don't teach about the sex act per se and highlight the pros and cons. The eventuality of not knowing the consequences of having unsafe sex deceives the girl into pregnancy, and enduring the problems thereafter," she added.
She noted that there was a lack of knowledge on sexual reproductive health among Malaysians.
According to a 2015 survey backed by the Health Ministry, 35 percent of Malaysian female youths believed that having sex for the first time would not lead to pregnancy, and one in five Malaysians believed that sexually transmitted infections (STIs) could be transmitted by mosquitoes – which is an alarming interpretation.
Dr Aizura Syafinaz said parents are to blame for not filling the gaps in their children's understanding of the birds and the bees, noting that cultural taboos and upbringing prevented them from doing so.
Studies have shown that many teenagers below 16 become pregnant as a result of premarital consensual sexual activity.
Dr Aida Syarinaz shared that the attachment theory affirms that the bond between the child and the caregiver would determine their future relationship.
"Attachment is an emotional bond with another person. The earliest bonds formed by children with their caregivers have a tremendous impact that continues throughout life.
"Children who are securely attached tend to develop better self-esteem and self-reliance as they grow older. Usually, they are more independent, have successful social relationships and experience less depression and anxiety. Failure to form secure attachment earlier in life can have a negative impact on their adult life, " she said.
Dr Aida Syarinaz said in situations where their daughter is pregnant, parents need to learn to accept the fact and address the problem in the best possible way. Being in denial does not help in dealing with the pregnancy.
"Parents tend to get uncomfortable discussing sexual issues with their teenage children, leaving them to seek such information from the media and their peers,” she added.
Citing the case of a 14-year old girl whose father was an alcoholic and mother was the main breadwinner, Dr Aida Syarinaz said: "Her parents were hardly at home and the girl spent a lot of time with her then boyfriend who gave her a lot of attention. She was not well informed about sexual intercourse and did not realise that she was repeatedly being raped by her boyfriend, who described the intercourse as an 'act of love'.
"She was scared that if she did not do what the boyfriend wanted, she will lose his love, even though the intercourse was painful for her. She is still getting treatment as she was very much traumatised by it."
Dr Aizura Syafinaz added that in many cases and especially among the low-income families, their adolescent children come home and are greeted by packed food on the dining table instead of a home-cooked meal and dinner with the family. Their parents are probably at work and doing double shifts.
Unattended, the girl may feel lonely and end up spending her free time with her boyfriend, who will be waiting within the vicinity with his motorbike.
Dr Aida Syarinaz said youths today were exposed to negative sex exposure through pornographic materials. Without effective and comprehensive sex education, youths tend to learn and understand the distorted versions of sex, and some upload nude photos of themselves via social media platforms such as WeChat.
"Should the girl decide to indulge in sexual activities, then she must practice ‘safe sex’ to protect herself, that is the harm reduction approach. The consequences of prohibited sexual affairs can lead to pregnancy. Remember, you have the right to say 'No' to sex," she stressed.
While sex abstinence should be promoted to avoid teenage pregnancy, she highlighted that proper parental supervision, a safe environment at home, staying in school and having a healthy relationship with family and peers may reduce the risks of unwanted pregnancy.