An interview with Dr SP Choong, Co-chair RRAAM (Reproductive Rights Advocacy Alliance of Malaysia)
We had just started the interview when his phone starts ringing. He picks it up and the caller is asking him for information on where and how she can terminate an unwanted pregnancy; he gives a short explanation and says she can call back if necessary. It is, he apologizes and explains, that his mobile number is connected to the hotline about abortion that his association has set up. Dr SP Choong is a doctor in Penang, Malaysia, and dedicated defender of abortion rights for nearly 40 years.
The hotline is the only reliable means of information on abortion in Malaysia, as the government does not officially provide such information. A survey in 2007 among 120 health professionals showed that 43% of them did not know the content of the law[1]. In 2008, 41% of women having abortions in a private clinic did not know what is legal and what is illegal in the case of abortion[2]. Abortion remains a subject so controversial that no public hospital openly provides it according to the law, no information campaign has been conducted by the government to know the law, and mifepristone, one of the two drugs for medical abortion (approved by WHO), is still banned from sale in Malaysia.
Still, it has been over 25 years since abortion was decriminalized in Malaysia. Since 1989, it is possible for a woman to have an abortion for reasons of physical or mental health (Penal Code clauses 312-314). It is similar to the law operating in Britain. The concept of risk of injury to « mental health » can be interpreted at the physician’s discretion and, even though it is not legally a woman’s right[3] but in practice, it allows any woman who wishes to have an abortion in Malaysia to have it done legally.
For Muslims, the validity of this law was confirmed by the National Fatwa Committee of Malaysia. Its role is to ensure the application of the sharia (Islamic law). In 2002, the Committee indicated in a fatwa (edict) that the Abortion is a crime only after 120 days of pregnancy[4].
The Ostrich Policy?
Malaysia has a very small number of unsafe clandestine abortions, very few post abortion complications and low mortality rates. Effective access to abortion does not appear among public health priorities. It is more a question of economic inequality. For it is indeed easy to have an abortion in private clinics, if one can pay the price. Some members of the medical fraternity are therefore quite happy running a thriving abortion service in the private sector. On average, in private hospitals, an early abortion may be charged between 2000 and 3000 RM (€ 510-765) and a little less in a day-stay clinic. This is mostly for surgical abortions.
Dr Choong, through the RRAAM hotline, advises women who want an abortion, explains the stages of medical abortion, gives the website address of Women on Web to buy mifepristone, keeps his phone open 24h / 24h to help with any emergency, and provides surgical abortions if necessary. Overall, for women who use the services at his Rakyat clinic, first trimester abortions cost between 300 to 800 RM (€ 76-204) depending on size..
Abortions in Malaysia are mostly performed discreetly, via information circulated through the grapevine, supporting a thriving private sector, with no statistics that may raise any public alarm: is this perhaps then the reason for the lack of mobilization, low involvement by NGOs, women’s associations and social and political movements? Unlike most countries, the decriminalization of abortion in Malaysia was not the result of popular mobilization. It was doctors form the medical association who, in 1989, had negotiated the relaxation of the law with the government, and the law passed through parliament without any publicity. Until today, it remains a struggle to ensure public awareness and effective implementation of this law.
Abortion right in Malaysia: an Unfinished Revolution.
It is the strength of the stigma attached to abortion that is arguably the strongest explanation of the low social mobilization. Because, as observed by Dr Choong, « abortion has everything to do with sexual freedom. The problem of abortion is that it raises the question of sexuality in an unmarried woman, this is not socially acceptable ». Nobody wants to talk about it and even family planning associations refuse to engage the topic. This is what had led Dr Choong with other activists 8 years ago, to create the network RRAAM (Reproductive Rights Advocacy Alliance of Malaysia). He himself once presided over the council of the Federation of Reproductive Health Associations Malaysia, a member of the IPPF, but could not mainstream the abortion issue in its programs.
The RRAAM is an advocacy network, which produces research on the practice of abortion in Malaysia, to lobby for national policies that guarantee access of everyone to safe abortion and at low cost. In 2012, the advocacy by RRAAM paid off because the government finally produced official guidelines for the provision of abortions in public hospitals for dissemination to all their staff including advice on use of appropriate technology.
This is an essential step. But for abortion to be provided in accordance with the law, we must go further, and as Dr. Choong said, the real battle in Malaysia is the fight against stigma. In the absence of national information campaigns, civil society must innovate to address social norms, promote behavior change. The word must be released, starting within its own ranks.
It is urgent because the country is not immune to a backlash, starting with an attempt to establish a more restrictive interpretation of the law. In October 2014, for the first time since the enactment of the 1989 law, a young woman was put in prison following an abortion. Nirmala Thapa is a young Nepalese woman who worked in a factory in Penang. In Malaysia, migrant workers do not have the right to be pregnant, but nothing forbids them to have an abortion. However, for the pregnancy, she was fired. And for having an abortion, she was put in prison. Her appeal is pending, and its outcome will have a major impact on the future of abortion rights in Malaysia.
For further readings:
Increasing Access to the Right to Reproductive Contraceptive Information and Services, SRHR Education for Youth and Legal Abortion (2009), ICPD + 15 Country Report of Malaysia: NGO Perspectives, Reproductive Rights Advocacy Alliance Malaysia (RRAAM) and Federation of Reproductive Health Associations Malaysia (FRHAM). Edited by Rashidah Abdullah
Reproductive Rights Advocacy Alliance of Malaysia
Asia Safe Abortion Partnership – Country Profile Malaysia
[1] RRAAM. 2007. Survey Findings of Knowledge and Attitudes of Doctors and Nurses on Abortion by the Reproductive Rights Advocacy Alliance Malaysia (RRAAM)
[2] Siti Fathilah Kamaluddin. 2008. Rapid Assessment Study of Customer Experiences with Abortion and Contraception in an Urban Health Clinic in Malaysia. Kuala Lumpur: RRAAM
[3] The article of the Criminal Code describes as « exceptions » the grounds for an abortion (physical or mental health), the remaining ban so rule
Charlotte Soulary 