Law related to Abortion :
Brief history of the law :
Malaysian Penal Code sections 312 -315 covers abortion; originally taken from the Indian Penal code 1871 which made abortion totally illegal. In 1971, an amendment made it legal to save the life of the woman. In 1989, under pressure from the medical fraternity, another amendment was made to allow an exception.
The Penal Code (Amendment) Act 1989 (Act 727), which came into force in May, 1989, widened the criteria for carrying out abortions.
Before the amendments came into force, the only grounds for an abortion were “for the purpose of saving the life of the woman” (Section 312). Now, an abortion may be carried out if the practitioner is of the opinion, formed “in good faith”, that continuation of the pregnancy would constitute a risk of injury to the “mental or physical health of the pregnant woman, greater than if the pregnancy were terminated”.
Short summary of conditions within the law :
The present law clearly permits abortion to be performed by a registered medical practitioner under conditions 1-3; however, some legal opinions conclude that where conditions 4 and 5 exist i.e rape, incest or fetal impairment, they would also be covered by condition 3.
- To save the life of the woman
- To preserve physical health
- To preserve mental health
- Rape or incest
- Foetal impairment
- Economic or social reasons
- Available on request
Analysis of it being restrictive if at all :
Current climate of opinion seems to favour a stricter interpretation of the law where the phrase ‘injury to mental health’ is regarded as requiring a psychiatric opinion of mental illness needing treatment before such indication is accepted. Thus government medical facilities do not generally provide abortions except where there is a serious threat of medical complications such as hypertension or severe diabetes.
The private sector on the other hand will usually provide abortions where they have suitable facilities but consider these procedures as a clandestine. Most will not let it be known that they provide such services in their clinics. Thus, while there are many safe providers, the problem of finding a service provider at short notice is a problem. The lack of openness also leads to exploitation and exorbitant fees charged by some doctors.
(Government policy enabling for the law, enabling beyond the law in practice etc such as population control policy, pro- natalist policy, anti sex selection policy, two child family norm) The Government had previously adopted a pro-natalist policy in the 1980’s which had a deleterious effect on the contraceptive services in the country. This was designed to boost economic activity to enlarge the workforce and consumer base. The contraceptive prevalence rate (CPR) is therefore quite low compared to other countries in the region (48% in 2005)
(Providers trained, willing, enabling) The lack of interest in making abortion safe and more accessible has prevented the adoption of modern technology in the medical fraternity eg. Manual vacuum aspiration and medical abortions. Training in medical schools also lacking.
Reproductive Health Perspective Signatory to ICPD, CEDAW :
Yes/No, any conditions.
Signatories to both but with reservations on abortion and sexual diversity.
Abortion Statistics :
No official data are collected on abortions. Mortality from unsafe abortions is < 5 per year. Statisticians, in reviewing our data which shows a low Contraceptive Prevalence Rate (CPR) of 48% for all methods (but only 32% for modern methods) and low Total Fertility Rate (TFR) of 2.5 children, consider the rate of abortions to be in the range of 1 in every 5 pregnancies based on patterns found in other countries with a high Human Development Index (HDI). They feel more comprehensive data should be collected to ascertain the real situation on the ground.
Public sector :
Abortion services available.
Basically, there is no official guideline from the Ministry of Health on indications for provision of abortions in a government facility. However, as mentioned earlier, where there is a serious medical condition which can be considered life-threatening; termination is usually provided. There is no specific maximum length of gestation but 24 weeks is considered age of viability.
Private sector :
Abortion services in the private sector are not regulated by the government. Almost all specialist gynaecologists in the private sector will provide surgical abortion except a few who have religious objections. Many general practitioners with minor surgical facilities will also do so. The safety of the procedure is excellent but the quality of service considered mandatory in comprehensive abortion care (CAC) is variable e.g. with regards to pre-abortion counseling and post abortion care. Fees are also variable; an early first trimester abortion can cost from US$60 – 800/-.
Medical abortion is not widely available and usually consists of providing only misoprostol tablets to be taken at home. Methotrexte is available but rarely used and mifepristone is not registered but some supplies are available on the ‘black market’. Generally, medical abortion is also not well known and the private sector considers surgical abortion less ‘troublesome’ and ‘convenient’ to both the client and the clinic in terms of follow-up assessment (also more ‘profitable’?)
For surgical abortions
1 st Trimester : US$80/- to $120/-
2 nd Trimester : US$ 150/- to $800/-
For Medical abortion: US$60/- to $120/-
Methods used :
For first and early 2 nd trimester abortions as covered in above para.
2 nd Trimester with Ethacridine lactate , Misoprostol, D&E, Hysterotomy.
Hysterotomy under GA in maternity homes and hospitals for US$800/- to $1000/-
Provider level allowed for surgical and medical abortion (Ob Gyn, MBBS,Nurses,Other) :
Only registered medical practitioner can perform abortions. Does not need to be a specialist.
Abortion related morbidity mortality statistics :
Extremely low; less than 5 per year in the last 3 years.
Manufacture and/or availability through import of abortion equipment (MVA syringes, EVA equipment) :
All abortion equipment is imported. Ipas and Rocket are major suppliers of MVA sets.
Manufacture/ import of Mifepristone, Misoprostol :
Misoprostol is sold as Cytotec is imported; mifepristone is not registered but limited quantities are available from India.
Facility and provider certification norms in brief :
Only certification required is a general degree in medicine from a recognised university locally or abroad.
Information available in national service delivery standards :
There are no standards set for service delivery of abortion services as it is not recognised as a standard service.
Informal / illegal providers – if present who are they :
Very few informal providers practice in the urban areas but traditional massage (Urut) and herbs (Jammu) are used in many rural communities.
Population urban/ rural – Demography of the country, with an analysis of availability of abortion services ratio to population :
Total population is 28 million; East Malaysia is more rural and West Malaysia is more urbanised. Overall, urbanisation is about 36% of the population. Generally, the most inaccessible rural areas are in East Malaysia where medical emergencies need to be transported by airlifts. We don not have information on abortion access in rural areas in Malaysia but most probably they resort to traditional massage and herbs.
Role of government :
Supportive, enabling, creating barriers, provides adequate funding to run training and service delivery programmes.
The Government has so far given a very low profile to abortion laws and services; each state medical dept seems to give its own guidelines on policy and practice. RRAAM is the only NGO trying to open up the issue amongst the stake-holders e.g. NGOs, Government and the health professionals.
Role of religion/ religious leaders :
Enabling, supportive, neutral, restrictive.
The Catholic Doctors’ Association has expressed strong objections to permitting abortion. Different Islamic groups have varying views; the more take liberal groups recognise that ‘ensoulment’ of the fetus takes place only after 100-120 days after conception and thus permits an abortion before that date. The Sisters-in-Islam, which promotes Muslim women’s rights through theological arguments, have been a strong promoter of the latter position.
Local Ob Gyn societies :
Supportive, conscientious objectors.
Most members of the O&G fraternity take a conservative view in interpreting the law but a more permissive view in practice. Thus most providers still keep a very low profile preferring not to discuss the issue in public. RRAAM has arranged a symposium on abortion laws and rights during the coming AGM of the O&G Society of Malaysia in June 2009.
Current status and potential of research :
No direct data has ever been collect by the Ministry of Health on abortion; providers are not required to report this to the government. Small surveys of abortion clients from a private clinic have been done to gauge their experiences, knowledge and attitudes. Much more comprehensive need to be collected in order to plan appropriate policies to increase contraceptive use and facilitate access to safe early abortions.
Awareness amongst community members :
Seminars with NGOs have revealed widespread ignorance of the law on abortion. This includes members of the medical and legal professions.
Role of member organization/ individual :
Reproductive Rights Advocacy Alliance is a group of NGOs and individuals supporting a need for advocacy on the issue of Reproductive Rights for women. Our work involves research and evidence-based advocacy with all relevant stake holders.