IT’S very disheartening to note that the sale of illegal abortion pills online is proliferating, according to a Dec 27 news report. Clearly it reflects increasingly desperate attempts by women and girls to resolve the crisis when faced with an unplanned pregnancy.

The Health Ministry has been clamping down on such sales but we are concerned that its efforts may be ineffective as these sales are conducted via various temporary e-channels on Facebook, WhatsApp, Twitter, WeChat, etc, that appear and disappear quickly. Many sell fake or adulterated pills that either have no effects or endanger women and girls’ health and lives. Even genuine pills are often given in medically inappropriate doses that further threaten women’s health.

Why the rise in the illegal sale of these pills online?

I believe these are the reasons: Low usage of modern contraceptive methods by women and girls at risk; unplanned pregnancies; stigmatisation of single mothers and premarital sex; lack of childcare support for couples and single mothers; and lack of access to legal, safe abortion when indicated.

This is exacerbated in many settings by stigma, poor knowledge about sexual and reproductive rights as well as persistent discrimination against women and girls.

The unwillingness to address sexuality and sexual healthcare in an open and comprehensive manner is a continuous health threat, especially to vulnerable groups such as adolescents, women with disabilities, girls in forced marriages, victims of violence or abuse, migrants (legal or trafficked) and sex workers, to name a few.

Here are some ideas for solutions.

Behind every abortion is an unplanned pregnancy. Contraceptives clearly prevent unplanned pregnancies and thus abortion. Malaysia’s usage of modern contraceptive has been at a dismal 35% for the past few decades. The Health Ministry and all healthcare providers should redouble our efforts in increasing contraceptive uptake for women and girls who are at risk of unplanned pregnancies.

We need to continually debunk the myths and misconceptions regarding contraceptive and sexual health in the community. Health care workers must be continuously taught and sensitised to the reproductive needs of women and girls.

Should an unplanned pregnancy occur, there must be adequate support for women who are unprepared for any pregnancy. Support must be given in three critical areas: emotional, physical and financial.

Increasing the number of counsellors and social workers, making available facilities for childcare, offering single mothers allowances, offering tax incentives for employers providing childcare facilities, etc, will certainly offer needed support.

The option for adoption should also be streamlined so that qualified couples can adopt in a less emotionally draining and roller coaster process. Also, mothers who opt to give up their child for adoption must be offered full support in all aspects.

Premarital sex and single motherhood are cultural taboos and frequently frowned upon or discriminated against by society. Conser-vative cultures look down on single motherhood and support is rarely forthcoming.

Society, authorities, communities and religious leaders have to be engaged comprehensively in trying to lead a paradigm shift in how we view single motherhood. We need to be more accepting and develop non-judgemental attitudes on how we can offer help rather then reject and ostracise single mothers – which would force women to turn to unsafe options like abortion pills bought online.

When indicated and legally permissible, women or girls need to have access to safe abortion. The World Health Organisation has published updated and comprehensive guidelines on medical abortion based on good evidence from research done globally. The availability of abortion supervised by medical professionals as a safe choice for women will in turn decrease the need for women to resort to illegal and unsafe methods.

Unsafe abortions are a public health crisis that threatens women’s lives and health globally, including in Malaysia.

Clamping down on illegal online sales of abortion pills may hardly make a dent on their availability. We need to address the root causes of why women are resorting to such pills by instituting a holistic approach towards women’s reproductive healthcare.

The democratising of healthcare and offering women and girls real reproductive choices is a universal health right.

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