CHALLENGES IN SETTING

UP SUPPORT FOR
UNMARRIED PREGNANT
ADOLESCENTS

Assoc. Prof. Dr. Harlina Halizah Siraj

UKM Medical Centre
Jamaah Islah Malaysia (JIM)
 `The more our work makes us specialists, the
more we must strive to remain or become
generalists in other matters, to perceive the
interconnections between science, esthetics,
and ethics, to avoid becoming lopsided.

All of humanity's pursuits are connected, after all,

and we remain ignorant of those connections
at our peril. The surgeon, the CEO, the
account executive, the broker all need to
know as much as they can about everything if
they are to understand anything.’

Warren Bennis, 1989

( Why Leaders Can’t Lead)
CONTENTS :
| Introduction :
y Concealed pregnancies
| Setting up support system for unmarried
pregnant adolescents
Raudhatus Sakinah Shelter Home for
Adolescents
 `Of all the rights of women,
the greatest is to be a MOTHER’…..
Lin Yu Tang
 BEAUTIFUL EXPERIENCE
REWARDING
ENRICHING
FULFILLING
SELF-DEFINING MOMENTS

s on C Y
en d N A N
D e p RE G
o f P
T IO N
E N
INT

DEPRESSED
FEELING GUILTY
SCARY
HUMILIATING EXPERIENCE
 Intended and
Wanted Pregnancy
Confirmation of a
wanted pregnancy
News shared among
relatives, friends
Register for an
antenatal care
Attend regular ANC

HEALTHY & SAFE

PREGNANCY OUTCOME
 Unplanned, Unintended,
Unwanted Pregnancy

There are an estimated 200 million

pregnancies around the world each year.
Approximately one-third of these, or 75
million, are unwanted.

N. Sadik, The State of World Population 1997. UNFPA

 UNWANTED PREGNANCY:
Why ?
| Not being ready to raise a child
| Problems with (or absence of) a male partner
| Poverty, lack of social support
| Need to care for other young children
| Need to get an education or keep a job
| Health problems
| Diagnosis of fetal abnormalities
| Pregnancy by rape or incest

Fact Sheet on Unwanted Pregnancy

Childbirth by Choice Trust 1999
 Unwanted, Unplanned &
Unintended Pregnancy

Abortion Childbearing
& adoption

Childbearing
& motherhood

Concealed & abandonment

Outcome of unwanted pregnancy
INDUCED ABORTION
Unwanted Pregnancy
Marital status & Outcome

| Married women with unintended

pregnancy:
y Childbearing & motherhood
y Abortion
y Childbearing & adoption

| Unmarried women:
y abortion
y concealed pregnancy
CONCEALED PREGNANCY :
Definition

A concealed pregnancy is where a

female, through fear, ignorance or denial,
does not accept, or is unaware of, the
pregnancy in an appropriate way.

Lincolnshire Multidisciplinary Taskforce on

Concealed Pregnancies, 1998
 Lincolnshire Multidisciplinary Taskforce
on Concealed Pregnancies, 1998

| 174 out of 2,648 deliveries ( 6.57%)

| Classification of concealed pregnancy:
y until late antenatal booking
y up to the onset of labour
y those whose pregnancy only became
apparent after labour at assisted or unassisted
delivery.
 Lincolnshire Multidisciplinary Taskforce
on Concealed Pregnancies, 1998

Most significant issues - whether the baby is

intended to survive or not.
y A baby born unassisted delivery, left wrapped
warmly in a public place is intended to survive
y In contrast, a newborn inappropriately
wrapped and hidden from public view in a
potentially harmful situation, it is meant to die.
Disparities in pregnancy outcomes according to
marital and cohabitation status.
Luo ZC, Wilkins R, Kramer MS
Obstet Gynecol. 2004 June;103(6):1300-7.

| A birth cohort-based study of 720,586 births in Quebec (1990

to 1997)
| Cohabitation vs. traditional marriage ( Adjusted odd ratio):
y Preterm birth - 1.14 (95% CI 1.11, 1.17)
y Low birth weight - 1.21 (95% CI 1.18, 1.25)
y Small for gestational age - 1.18 (95% CI 1.16, 1.20)
y Neonatal death - 1.07 (95% CI 0.97, 1.19 )
y Post-neonatal death - 1.23 (95% CI 1.04, 1.44)

| Pregnancy outcomes are worse among mothers in

cohabitation versus traditional marriage relationships but
better than among mothers living alone.
Single motherhood and neonatal survival of twins
among blacks and whites.
Salihu HM, Chatman LM, Alio AP, Aliyu MH, Kirby RS, Alexander GR.
J Natl Med Assoc. 2004 Dec;96(12):1618-25.

| Retrospective cohort analysis on 446,570 twin live births

in the United States (1995-1998)
| CONCLUSION:
y Single motherhood was a risk factor for neonatal
mortality among twins
y Disparity in survival was more accentuated among
whites.
y The association between single motherhood and
neonatal mortality was explained by the
preponderance of preterm births among twins of
unmarried gravidas.
Management of Concealed
Pregnancy

Principle of management
y To ensure good outcome for both
mother and baby
y To prevent neglect, abandonment
and murder of newborn
 Management of Concealed
Pregnancy

| Multi-professional teamwork – O&G, Paediatrics &

Medical Welfare Dept.
| O&G – Assessment and management of obstetric
risk factors
| Paediatrics – Assessment and management of
neonatal problems, child care after discharge.
| Medical Welfare Dept. – Social and financial
support, arrangement for child adoption
STIGMATIZATION of pregnant women
with single marital status

| Health system in Malaysia is open to all and

does not discriminate women based on their
marital status
| Health providers – to provide best medical care
to prevent mortality and morbidity, regardless
of whether the patient is married or not
| Providing support system for pregnant single
women = condoning the rising trend of
extramarital sex ?
| Support mainly provided by concerned
members of the society – through non-
governmental organizations (NGOs)
The SEXUAL REVOLUTION of
Malaysian YOUTHS
today……
The STAR, Feb 27th, 2007
 Sex on Campus
(NST, August 18th, 2006)

| KAP study on Sexual & Reproductive Health among

Malaysian college & university students (2005)
y 727 respondents from 2 IPTA & 2 IPTS
y 50% sexually active
y 80% did not practice contraception
y 27% thought condom can be used more than once
y 34% thought condoms cannot help prevent HIV
spread
y 25% thought HIV can be transmitted through
mosquito, bed bug or flea bites
y 60% thought a man could tell when a woman has STD
 Sex on Campus :
Saying Yes, Saying No

Percentage students (aged 18-25) who agree

with the following statements bc All

I believe that it is all right for boys and girls to kiss, 59.4 45.0 50.6
hug and touch each other

I believe that there is nothing wrong with 33.6 20.0 25.3

unmarried boys and girls to have sexual
intercourse if they love each other
A girl loses her self-respect and dignity if she has 41.7 60.4 53.1
sex before marriage

A boy loses his self-respect and dignity if he has 19.1 29.6 25.5
sex before marriage
 Sex on Campus

CONCLUSION
Physical pleasure seems to outweigh the
risk of pregnancy & STDs among
Malaysian university & college
students

Mazlin Mohamad Mokhtar

Faculty of Medicine UiTM
RAUDHATUS SAKINAH (RS)
SHELTER HOME FOR
ADOLESCENTS
Wanita Pertubuhan Jamaah Islah Malaysia (JIM)
Lot 300.2 Lorong Selangor, Pusat Bandar Melawati
53100 Kuala Lumpur
 A GLIMPSE at
Raudhatus Sakinah Shelter for Adolescents

| Pregnancy out of wedlock :

y Beyond parental control 45.2%
y Cohabitation 12.9%
y Raped 3.2 %

| Runaways from homes, free sex, 22.6%

cigarette, alcohol & cannabis
| Truancy, cigarette & cannabis 9.7%
| Free sex,cigarette & alcohol 3.2%
| Prostitution 3.2%
 Objectives of RS
Assisting adolescents to practise Islamic
ways of life

Facilitating adolescents to rebuild their self-

esteem and confidence

Enabling adolescents to lead healthy and

meaningful life
 Organizational Chart of RS
WANITA JIM

RS Board of Directors
Chair : Prof Madya. Dr Harlina Halizah Hj Siraj

Director
(Pn. Rosmawati Zainal)

RS PULAU PINANG
RS SELANGOR RS KELANTAN
Chairperson
Chairperson Chairperson
(Pn Mardiana Abd Rahim)
(Dr. Ruziaton Bt Hasim) (Dr Zaharah Sulaiman)
RAUDHATUS SAKINAH

RS SELANGOR
RAUDHATUS SAKINAH

RS KELANTAN
RAUDHATUS SAKINAH

RS PULAU PINANG
 RS : Pre-requisites
Adolescent and young girls between 12
to 25 years of age
Muslim Malaysian citizens
Involved in social problems such as
sexual misconduct, abuse, neglect,
sexual violence, incest etc.
Free from chronic diseases
Own free will to change and to undergo
rehabilitation in RS for at least 12
months
 References
Dept. of Social Welfare
Royal Police Force (PDRM)
State syariah courts
Hospitals
Schools
Colleges / Universities
Family members
FLOWCHART FOR RS NEW ENROLMENT
APPLICATION
APPLICATION

INTERVIEW
INTERVIEW

DECISION
DECISION REJECTED
REJECTED

ACCEPTED
ACCEPTED

REGISTRATION
REGISTRATION

ENROLMENT
ENROLMENT
 RS : Enrolment Data
1998-2007

70 66

60 54
50 44
Number

40 33
28 30
30
18
20 13
10 4 6

0
Tahun
98

99

00

01

02

03

04

05

06

07
19

19

20

20

20

20

20

20

20

20
 RS : Activities
Pregnancy care
– Antenatal care, delivery & postnatal care
Spiritual Guidances
– Fardhu Ain, AlQuran, Hadith, Akhlaq, Seerah
Self-Help
– Individual & Group counseling, Motivational talks
Outdoor recreational activities
– Physical exercises, Rehlah, Outdoor Games and Nasyid
Skills training
– Computer, Culinary, Tailoring and Handicrafts
Outreach Programmes
– Campaigns to schools & colleges, universities
FLOWCHART : REHABILITATION
New
NewTrainee
Trainee

Induction
Induction

First
FirstAssessment
Assessment

Rehabilitational
Rehabilitational Failed
Programme
Programme

Second
Second Discussion
Assessment Discussion
Assessment
with
with
Passed Family
Failed Family
Upgrading
Upgrading
Testimonial
Testimonial

Assessment Completion
Assessment Completion

Passed
Update
Update&&F-up
F-up
RS Training : Spiritual & Skills
 RS :
Outdoor Activities
Visits to RS
Community
Assistance
Self-Help
OUTREACH
PROGRAMMES
RS : MEDIA
COVERAGE
Babies of RS mothers
Biological
Family
20%

Adoption
80%
 RS babies :
Strict Adoption Procedures
Objectives:
– To provide safe and appropriate environment
for child nurture and upbringing
Process :
– Application (Waiting list)
– Interview
– Selection of RS mother
– Agreement
– Adoption process with JKM
– Follow up
Gathering of RS babies &
adopted parents
Objectives :
o Maintaining good relationship between
RS and the babies, including their
adopted parents
o Providing inputs on child-upbringing, legal
and psychological aspects of adoption
o Following-up the progress of RS babies
MAJLIS SUMBANGSIH RS

2006

2004
 Outreach
Campaign
ANDA BIJAK JAUHI ZINA

To increase public
awareness on the
adverse effects of
adultery, especially
among adolescents
and youths
To garner public and
http://ummiroses.blogspot.com

COMPILATIONS
of RS trainees’
experiences
RS : Challenges Ahead
1. To maintain high quality of care and
rehabilitative programmes for the
trainees
2. To attract as many volunteers as possible
3. To garner financial support from
governmental agencies and private
sectors
4. To minimize stigmatization from public
‫ن‬
َ ‫ﺨ ْﻴ ِﺮ َو َﻳ ْﺄ ُﻣﺮُو‬
َ ‫ن ِإﻟَﻰ ا ْﻟ‬َ ‫َو ْﻟ َﺘﻜُﻦ ﻣﱢﻨ ُﻜ ْﻢ ُأ ﱠﻣ ٌﺔ َﻳ ْﺪﻋُﻮ‬
‫ﻚ ُه ُﻢ‬
َ ‫ﻦ ا ْﻟﻤُﻨ َﻜ ِﺮ َوُأ ْوﻟَـ ِﺌ‬
ِ‫ﻋ‬
َ ‫ن‬ َ ‫ف َو َﻳ ْﻨ َﻬ ْﻮ‬
ِ ‫ﺑِﺎ ْﻟ َﻤ ْﻌﺮُو‬
‫ن‬
َ ‫ا ْﻟ ُﻤ ْﻔِﻠﺤُﻮ‬

“ And let there be (arising) from you,

a nation inviting to (all that is) good,
enjoining what is right and forbidding
what is wrong, and those will be the
successful”
Surah Ali
‘Imran: 104
 Thank you
for your kind attention
harlina.siraj@gmail.com