This literature review was conducted systematically to identify the gap in knowledge and practice related to the provision of sexual health to adolescents worldwide. The search was limited to peer-reviewed articles published between 2002 and 2018. Thirty-two relevant articles were identified and reviewed for quality assessment by using the Hawker critical appraisal tool. The studies were conducted in Africa, Europe, Asia, Oceania, and the United States of America (USA). The review findings suggested that potential tensions exist between the desire to prevent unwanted pregnancies and the provision of adolescent-friendly sexual health services in societies which disapprove of adolescents' premarital sexual activity, contraception use and abortion services. Healthcare professionals should be aware of comprehensive sexual and reproductive health services as their professional responsibility and the need to manage their own conflicts with regard to fulfilling their role.
Safer sex provision, including contraception information and services, should be made available to adolescents regardless of their marital status in strategies to reduce the incidence of unintended teenage pregnancies and the spread of STIs. In Malaysia, this information is still not being delivered formally to adolescents even though unintended teenage pregnancies and the practice of "baby dumping" are serious public health issues. The aims of this article are to describe the Malaysian context in terms of the need for comprehensive sexual and reproductive health information and treatment for unmarried adolescents. The article presents the key aspects of Malaysian society and the potential influence on the provision and delivery of sexual and reproductive health information and treatment to unmarried Malaysian adolescents that can be a reference for healthcare professionals especially school health nurses. The article also describes the establishment of sheltered homes, baby hatches and unregulated adoption processes as the initiatives being taken to address the issue of unintended teenage pregnancies. This article suggests that the policy and laws that require parental consent for accessing the services need to be reviewed and revised to ensure that specific services are available to adolescents in a safe environment that maintains confidentiality.
Despite increasing calls to integrate and prioritise sexual and reproductive health (SRH) services in universal health coverage (UHC) processes, several SRH services have remained a low priority in countries' UHC plans. This study aims to understand the priority-setting process of SRH interventions in the context of UHC, drawing on the Malaysian experience. A realist evaluation framework was adopted to examine the priority-setting process for three SRH tracer interventions: pregnancy, safe delivery and post-natal care; gender-based violence (GBV) services; and abortion-related services. The study used a qualitative multi-method design, including a literature and document review, and 20 in-depth key informant interviews, to explore the context-mechanism-outcome configurations that influenced and explained the priority-setting process. Four key advocacy strategies were identified for the effective prioritisation of SRH services, namely: (1) generating public demand and social support, (2) linking SRH issues with public agendas or international commitments, (3) engaging champions that are internal and external to the public health sector, and (4) reframing SRH issues as public health issues. While these strategies successfully triggered mechanisms, such as mutual understanding and increased buy-in of policymakers to prioritise SRH services, the level and extent of prioritisation was affected by both inner and outer contextual factors, in particular the socio-cultural and political context. Priority-setting is a political decision-making process that reflects societal values and norms. Efforts to integrate SRH services in UHC processes need both to make technical arguments and to find strategies to overcome barriers related to societal values (including certain socio-cultural and religious norms). This is particularly important for sensitive SRH services, like GBV and safe abortion, and for certain populations.
The United States of America (USA) is one of the largest bilateral donors in the field of global health assistance. There are beneficiaries in 70 countries around the world. In 2015, the USA released US$638 million for the improvement of global health status by promoting family planning services. Unfortunately, in 2017, Trump administration reinstated Mexico City Policy/Global Gag Rule (GGR). This policy prevents non-US nongovernmental organizations (NGOs) from receiving US health financial assistance if they have any relationship with abortion-related services. This restriction pushed millions of lives into great danger due to the lack of comprehensive family planning services, especially lack of abortion-related services. This article has attempted to let the readers know about the impacts of GGR around the world and how global leaders are trying to overcome the harmful effects of this rule. Finally, it proposes some solutions to the impacts of the extension of Mexico City Policy.
Matched MeSH terms: Reproductive Health Services/economics; Reproductive Health Services/legislation & jurisprudence
Providing sexual and reproductive health (SRH) services to migrant workers is key to fulfilling sustainable developmental goals. This study aims to explore key informants' views on the provision of SRH services for migrant women in Malaysia, exploring the provision of SRH education, contraception, abortion, antenatal and delivery, as well as the management of gender-based violence. In-depth interviews of 44 stakeholders were conducted from July 2018 to July 2019. Data were thematically analysed. Migrant workers that fall pregnant are unable to work legally and are subject to deportation. Despite this, we found that insufficient SRH information and contraceptive access are provided, as these are seen to encourage promiscuity. Pregnancy, rather than sexually transmitted infection prevention, is a core concern among migrant women, the latter of which is not adequately addressed by private providers. Abortions are often seen as the only option for pregnant migrants. Unsafe abortions occur which are linked to financial constraints and cultural disapproval, despite surgical abortions being legal in Malaysia. Pregnant migrants often delay care-seeking, and this may explain poor obstetric outcomes. Although health facilities for gender-based violence are available, non-citizen women face additional barriers in terms of discrimination and scrutiny by authorities. Migrant women face extremely limited options for SRH services in Malaysia and these should be expanded.
Matched MeSH terms: Reproductive Health Services/statistics & numerical data*
Early sexual debut, partner violence, pregnancy and sexually transmitted infections contribute to negative health outcomes among adolescents. While the primary care clinics offer accessible sexual and reproductive health (SRH) services to adolescents, it is uncertain whether adolescents are aware of and utilize these services. This study aimed to examine Malaysian adolescents' knowledge, utilization and barriers to primary care services for SRH. A cross-sectional survey was conducted from August to November 2011 among adolescent from five randomly selected schools in Selangor, Malaysia. A self-administered questionnaire was used to assess their knowledge, attitudes, sexual behaviors and utilization of SRH services. A total of 680 adolescents participated in the study. One in ten of the adolescents were aware of the availability of SRH services, and only 6.9% of them had ever visited a primary care clinic for SRH. About 75% of them felt uncomfortable going to a primary care clinic for SRH services. Knowledge and utilization of primary care clinics for SRH among adolescents in Malaysia is poor.
Youth sexuality is a great concern for many. Sexual health issues facing our youths are: premarital sexual intercourse, sexually transmitted diseases, unwanted and unsafe pregnancies and abortions, sexual diversity, HIV/AIDS, and cybersex. Various factors lead to risky sexual and reproductive health behavior, particularly among those unmarried youths: lack of sexual and reproductive health information and skills in negotiating sexual relationships and the inaccessibility of youth-friendly sexual and reproductive health services. Growing peer pressure of pre-marital sex plays a major role in sexual and reproductive health related decision-making among youths. Another factor is the issue of sexuality education which is still considered a sensitive topic and thus impinging on its implementation, due to cultural and religious constraints. Misunderstanding and a lack of information on sexual diversity have caused a concern for many, as there is a tendency for judgments, stereotypes, discriminations and prejudices towards homosexuality in the society. Online sexual activities or cybersex have become the next sexual revolution. Negative consequences are shown for those hooked on cybersex. Healthy youths are fundamental to the prevention initiatives. Promoting the sexual and reproductive needs and rights of our youths is warranted.