A social determinant of health can be defined as the distribution of economic and social conditions among a population that influences differences in health status for individuals and groups (Braveman, 2014). When looking at out of wedlock pregnancies in Malaysian youths, I think the most obvious social determinant of health is the lack of social support for these young women. Social support generally is considered the good social relations, strong support systems, and emotional and practical resources available to a group or individual (Marmot, 2005). In the case of Malaysian youths there is a lack of accessibility to youth friendly sexual and reproductive health services, lack of good sexual and reproductive health information, and skills in negotiating sexual relationships (Low, 2009). In addition, discussing sexuality and family planning in something still considered culturally and religiously taboo in the country. A large portion of children are not having these types of conversations with their parents or in school classrooms.
A National Population and Family Development Board study in 1995 found that most of the time adolescents did not discuss matters relating to reproductive health and sexuality with anyone except when talking about puberty changes (Low, 2009). In addition, when they did talk about sexuality or reproductive health, they usually went to friends or media before discussing anything with a parent or adult. Because the topic is so culturally taboo, even teachers are too uncomfortable to talk in any detail about reproductive and sexual health. Sexual education in schools is often times too casual or general for students to really gather the necessary information from them (Talib, 2012). This lack of proper information from schools and parents negatively impacts the supportive network surrounding young people, and is perhaps one cause of the rate of unwanted pregnancies in young unmarried women.
There is a common assumption in Malaysia that most birth only occur or only can occur within marriage. This may be a contributing factor to the unmet need for effective contraception among Malaysian women (Low, 2009). There is a significant proportion of younger women that do not have sufficient knowledge of contraception. Malaysia has a low rate of contraceptive use and unmet needs also contribute to higher demands for abortions. Sometimes women only learn about contraceptive methods when they are in the hospital after the birth of their first child (Kamaluddin, 1998). Emergency contraception is another contraceptive method that is not widely known or used by young women. Women in Malaysia are lacking the practical resources to prevent unwanted pregnancies and make informed decisions about family planning.
When is comes to the sexual and reproductive health of young women, there are many unmet needs in play. Future government and local policies should focus on social support for young people as they begin to enter sexual maturity. This also extends into family life. Children and parents should feel comfortable enough to discuss these types of issues to help prevent more unwanted pregnancies in young unmarried women. Young women in Malaysia are in desperate need of strong supportive networks and access to proper health and educational resources. I believe this will help young women curb the rate of pregnancy in Malaysia.
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