Let’s talk about… abortion

Though there are legal grounds for abortion, it is more difficult to obtain one at a public hospital as compared to a private institution.

Abortion is a taboo subject in many parts of the world and Malaysia is no exception. It is a topic that provokes much emotion from both sides of the debate and like all ethical debates, the grey areas are more common than the clear cut, black and white answers.

The practical implications of the hesitance to discuss this topic gives way to misinformation. Misinformation in the medical field is akin to walking blindfolded through a jungle. One wrong step can put one in danger.

Here in Malaysia, the social stigma of abortion encourages people to seek help in secrecy. In this environment, predatory opportunists seek to make money off desperate people and when things go wrong, the victims have nobody to turn to.

Legal lingo

It would be good to start with definitions. The following terms are taken verbatim from a guideline issued by the Ministry of Health Malaysia on the termination of pregnancy (TOP) in 2012.

“Unwanted pregnancy is defined as a pregnancy that was not planned for or not desired by the couple or the mother at the time of conception. Sometimes this may be due to an abnormality of the foetus or of an illness in the mother.”

“Abortion is defined as the expulsion or removal of an embryo or foetus from the uterus at a stage of pregnancy when it is incapable of independent survival (500gms or 22 weeks gestation). It may be spontaneous miscarriage, or induced for medical or social reasons.”

“Termination of pregnancy for the purpose of this document is confined to procedures to remove an embryo or foetus where the pregnancy is less than 22 weeks of gestation or if the gestation is unknown, where the foetus is estimated to be less than 500g.”

“Unsafe abortion has been defined as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills, or in an environment lacking the minimal medical standards, or both.”

With regard to the legality of induced abortions, the same document states the government’s stance on this issue. It states it is illegal to induce abortion under Act 574 of the Penal Code but there is an exception clause which states that TOP can be carried out if:

  • The pregnancy poses a risk to the life of the pregnant woman
  • The pregnancy risks an injury to the mental or physical health of the pregnant woman
  • Is undertaken by a registered medical practitioner

The case of Nirmala Thapa

In October 2014, Nirmala Thapa, who was six weeks pregnant was arrested in Bukit Mertajam for undergoing an abortion. The doctor who carried out the procedure deemed it justifiable due to the mental trauma Nirmala would face from continuing with the pregnancy.

The reasons cited included her losing her job, having to pay her employers compensation, and facing the risk of deportation.

Nirmala was subsequently convicted and was the first woman to be found guilty for an illegal abortion since 1989. After a turbulent year or so which involved her being recharged with the same charges, she was finally acquitted in September 2015.

The case courted controversy as many felt Nirmala was unfairly targeted only because she was an immigrant. Another important takeaway from this case is the prevalent misconception regarding the legal status of abortions in this country.

A survey by Reproductive Rights Advocacy Alliance Malaysia (RRAAM) conducted in 2007, which polled 120 doctors and nurses, found that only 57% of respondents knew the law.

This case also raised the debate on what rights women themselves have with regard to abortion as the law emphasises the role of doctors instead.

Methods of abortion

A TOP can be done either medically or surgically. The options are chosen based on the duration of pregnancy thus far and also takes into account the possible risks of the procedures.

Based on ministry guidelines, the prerequisites for undertaking a TOP include:

  • A setting, either a public or private health institution, that has the support of a gynaecologist specialist
  • A registered medical practitioner to concur that the TOP is necessary. It is recommended that two doctors, one of whom is a specialist, undertake the assessment.
  • An assessment which includes clerking, physical examination and a general mental health assessment.

Medical TOP

This is the method of abortion that does not require surgical intervention which means medicine is either administered orally or vaginally.

The main objective of these medications is to instigate the shedding of the uterine lining and induce contractions to push the foetus out.

The usual combination of medicine is mifepristone and misoprostol. Mifepristone is administered prior to misoprostol. This is the method chosen for a pregnancy that is less than nine weeks old unless there are contraindications.

Mifepristone is also known as RU-486 or “the abortion pill”. Misoprostol is better known as Cytotec in Malaysia. Cytotec is available in pharmacies but requires a doctor’s prescription to be dispensed.

In Malaysia, mifepristone is not available via official channels and public hospitals use other combinations of drugs for the same purposes.

Contraindications to medical TOP

The duration of pregnancy is not the only consideration as to whether a medical abortion is safe to proceed. The list of contraindications include:

An ectopic pregnancy where the product of conception is not implanted in the uterus. This is not a viable pregnancy and the abortion pill isn’t safe for use.

  • A person who has bleeding problems or is on blood-thinning medications
  • A person on long-term steroid therapy or who has problems with the adrenal glands
  • An intrauterine device which has not been removed
  • An allergy to the drugs that are used

What to expect

After the commencement of the pills, the woman should expect to feel cramps in the tummy and to pass blood which may include clots. The shape in which the product of conception appears will depend on how far along the pregnancy is.

The time taken for this process varies from person to person. One may also experience nausea, dizziness, diarrhoea, fever and chills. To deal with the pain, simple painkillers can be taken.

Complications include prolonged heavy bleeding. A good way to tell if you’ve bled too much is if you have soaked more than two pads per hour. Feeling dizzy and lightheaded are also symptoms of heavy blood loss.

Another complication is an incomplete abortion which will require emergency intervention. Finally, one can develop post-abortion infection. If you have a high fever or fever lasting more than 24 hours, this might be the case.

Where to go

Though there are legal grounds for abortion, it is more difficult to obtain an abortion at public hospitals as compared to private institutions. Private institutions also do not advertise openly with regard to abortion due to the stigma.

Scarcity and secrecy of information naturally leads to channels that bloom to exploit a supply gap.

While it is easy to say that one should always seek proper medical advice with regard to an abortion, the availability of these pills at lower prices and the privacy that some may seek, factors into the decision for one to look for them through social media platforms.

Do not do this! We cannot stress enough the importance of getting advice from only qualified professionals.

Advocates

Reproductive Rights Advocacy Alliance Malaysia (RRAAM) is a Malaysian organisation whose aim is to increase awareness and access to a woman’s right to decide on reproductive matters.

This includes having the right to access legal, safe and affordable contraceptive and abortion services. They provide a hotline for which people can call in for advice including information on local providers of abortion.

Whatever your views on abortion are, we advise you to speak to a registered doctor when a situation or question regarding abortion arises. Whether the question concerns you or someone you love, seeking help from the right people will save much misery down the road.

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DISCLAIMER: The information in this article is not a substitute for professional medical advice. You are encouraged to confirm any information obtained here with other sources, and review all information with your physician. Please do not disregard professional medical advice or delay treatment because of something you have read here. FMT is not responsible and liable for any damage caused through information obtained here.