Abortion in Malaysia

From The Star, a Malaysian newspaper. Malaysia is a Muslim country. Note the difference between their definition of abortion and the way the Roman Catholic Church might do so - Malaysia forbids any abortions after the third trimester. I believe that Islam has no opinion on abortion before the quickening, or the fetus' first movement. Singapore allows abortion on demand before 24 weeks, or any time the life of the mother is threatened.

Thursday, April 17, 2003
The process of elimination
By LI EE KEE

ABORTION is defined as the expulsion of the conceptus – the product of conception at any point between fertilisation and birth – before the 24th week or the loss of a foetus weighing 500gm or less.

While abortion is traditionally seen as being induced, it can also be spontaneous. When a mother suffers a miscarriage, her situation is medically termed as an abortion but when dealing with patients, obstetricians and gynaecologists refer to it as a miscarriage.

Malaysia’s Abortion Act 1967 makes abortion or termination of pregnancy illegal. However, there are circumstances in which it is permissible. According to Pantai Medical Centre consultant obstetrician and gynaecologist (OBGYN) Dr Nor Ashikin Mokhtar, a pregnancy may be terminated if two registered medical practitioners are of the opinion, formed in good faith, that continuation of pregnancy will endanger the mother’s life.

“For instance, if she has breast cancer, cancer of the womb or renal failure. The mother’s safety and well-being is always priority because we have to take into consideration her family and existing children whom she has to care for. If the pregnancy were to continue, it would deprive them of a mother,” she says.

Termination of pregnancy is also advised to prevent grave permanent injury to the physical and mental health of the mother.

“Victims of rape or incest who become impregnated as a result are permitted to abort their child as long as there is a mental assessment from a psychiatrist that shows if the girl were to continue with her pregnancy, it would affect her psychologically, maybe causing her to lose her mind.

“Also, if the foetus is diagnosed with gross physical or mental abnormalities, like severe anencephaly where the baby is without a brain or skull, or part of it is missing, an abortion is advised. Because when the baby is born, it may only live for a few hours,” she adds.

Various techniques are employed in an abortion procedure, all of which depends on the stage of gestation. They can be grouped as either medical or surgical termination.

Medical termination is for pregnancies less than nine weeks old. This can be done with a Mifepristone tablet (a hormone tablet that blocks production of progesterone produced by the mother’s body to maintain early pregnancy). It causes bleeding, pain and expulsion of the conceptus within 24 to 48 hours. The tablet is not available in Malaysia.

“With oral medication, the abortion can be incomplete and has to be supplemented with a surgical technique like curettage. Again depending on the period of gestation, if it was between five to six weeks, it may come out with the menses. Between eight to nine weeks, the abortion may be incomplete and a surgical termination like D&C (dilatation and curettage) is needed.”

Under surgical termination, pregnancies less than 12 weeks old can be aborted via a suction curettage or D&C.

Beyond 12 weeks, the procedure for termination of pregnancy is more complex, where it’s almost like an induction of labour. All surgical termination procedures are done under general anaesthesia because the patient is relaxed, making the cervix easier to dilate.

Only doctors who have undergone obstetrics and gynaecology training/posting and have been taught or have performed these procedures, as part of their training supervised by the consultant OBGYN is capable of performing an abortion surgery safely.

Although abortion appears to be a minor operation – if done correctly, it takes only 10 to 15 minutes – Dr Nor Ashikin says that complications can and do occur anytime, anywhere.

“A life is at stake, particularly if you are talking about teenagers. It might affect them and their future pregnancies. The worse case scenario is death because if it is a forceful rather than gradual dilatation of the cervix, the girl can go into shock. Bear in mind that the cervix for those who have not delivered before is the size of a pinhole and you are trying to dilate it to about six to seven millimetres in diameter. If it is forceful dilatation or performed by someone untrained, it can tear the cervix where the immediate effect of which is haemorrhage. Uncontrolled and if the clinic is not properly equipped with blood supply for instance, the girl can die.”

Dr Nor Ashikin adds that in the long term, the muscles of the cervix will become weak or damaged.

“She must be prepared for the reality that she might not be able to conceive when she wants to because when there is tear or perforation resulting in continuous bleeding or severe infection, sometimes the uterus has to be removed. Should she get pregnant, she’ll find that she is likely to have recurrent spontaneous miscarriages or go into pre-term labour.”

An incomplete abortion without supplementation can lead to prolong bleeding, causing infection and damage to the ovaries, fallopian tubes, uterus and eventually resulting in infertility.

Uterine perforation can also take place because the uterus is usually anteverted (tilted forward) and instruments like the curette are stiff. As it is inserted, it might perforate the cervix or the wall of the uterus, which can result in a haemorrhage; perforate the bladder, which can cause urine leakage; or puncture any of the intestines, as they are located behind the uterus.

Between a D&C and suction curettage, the latter is safer because it uses a plastic tube, which is softer and thus able to follow the curve of the uterus. The degree of complication also depends on period of gestation with complications less likely to occur if the pregnancy is still in its early stages. And an abortion conducted legally in a hospital will have a smaller percentage of complications.

“These are the risks girls have to know they are taking and whether it’s worth taking them. Many think it’s an easy way out, as contraception. But I don’t think they actually realise what they are in for. They are desperate people who try to solve the problem with desperate measures,” says Dr Nor Ashikin.

“Youth must be more responsible, in the sense if they feel they are sexually active, they should understand the consequences and be prepared to take the risk, although I don’t think that is the right attitude. Abortion is not the answer and this is where sex education is important for teenagers.

“It’s hard making these comments but as a parent, I feel that moral and religious guidance are very important to guide our teenagers because of exposure to the media and Westernisation.

“Any girl who finds herself pregnant, should first go to her parents and discuss it with them. I know as teens, they’re at that rebellious stage where they think their parents are their worst enemy. But your parents are your best friends who always have your best interest at heart. If not, talk to counsellors who can understand and help you,” she advises.