Whither women's reproductive health in Asia Pacific

Shobha Shukla *

While the world has made many advancements in healthcare, millions of women and girls in low- and low-middle income countries are still far away from having bodily autonomy and are not able to make informed decisions regarding their sexual and reproductive health. Even in countries like Taiwan, Japan, Malaysia, or Thailand where total fertility rate is relatively low, despite such commendable progress, there are challenges yet to be overcome.

Progress on women's health but challenges remain

Data from the FP2030 Measurement Report 2022 does offer some consolation by way of more than 141 million unintended pregnancies, 29 million unsafe abortions, and nearly 148,000 maternal deaths being averted in countries of Asia Pacific during 2021-2022 due to an increase in the number of women using modern contraceptive methods.

However, there are an estimated 140 million women in the Asia Pacific region who still lack access to modern methods of contraception, despite wanting to avoid or delay pregnancy. Over 60% of unintended pregnancies end in abortion and an estimated 45% of all abortions are unsafe, accounting for upto 13% of all maternal deaths recorded, as per the State of World Population 2022 report. Maternal mortality in Asia Pacific region is high, with 10 women dying every hour in pregnancy and childbirth. Harmful practices such as child marriage and preference of having a son, still abound.

CNS spoke with some leaders from the field of obstetrics and gynaecology in the Asia Pacific region on the status of women’s reproductive health in their countries.

Taiwan

At 1.08, Taiwan’s current fertility rate is the lowest in the world. “As more and more women are getting higher education and entering the workforce, they prefer their career over raising a family. They postpone marriage as well as child birth or even prefer not having children at all”, said Prof Yi Yung Chen, Director, Taiwan Association of Obstetrics and Gynaecology, and Senior Attending Physician, Department of Obstetrics and Gynaecology, Mackay Memorial Hospital.

Chen shared that Taiwan’s national health insurance scheme covers all health-associated expenditures of its people, including fertility-related problems. All Taiwanese couples where the wife is under 45 years old, can get reimbursement of all expenses incurred for in-vitro fertilisation (IVF) technique to help people with fertility problems have a baby.

There are education programmes for high school students to avoid unintended pregnancies. Condom use is promoted not only for contraception but also to prevent sexually transmitted infections (STIs), which are an emerging problem in Taiwan. That is why, most hospitals provide anonymous testing for them.

Preconception check-up programmes for women check for anaemia and other blood-related diseases and also for STIs like syphilis, HIV and chlamydia. Pregnant women are offered free HIV tests, to control vertical transmission of HIV. They are also checked for syphilis as part of the antenatal care programme and given free treatment if needed, added Chen.

Thailand

The country’s fertility rate has come down to 1.2. Its maternal mortality ratio is low at 37, and unintended pregnancy rate per 1,000 women is 38. With more than 70% married couples now using modern contraception methods, Thailand has a successful family planning programme. However, there is still a group of population that is underserved, and these are the adolescents, cautioned Dr Unnop Jaisamrarn, Chief of the Family Planning and Reproductive Health Unit in the Department of Obstetrics and Gynaecology, at Chulalongkorn University, and Secretary General of Royal Thai College of Obstetricians and Gynaecologists.

“We are trying to bring down the rate of unintended pregnancies in adolescents. We need strong leadership of government departments, and cooperation of partners like academic institutions, universities, and NGOs, to address this problem. Most important is education and awareness around unintended pregnancies and providing easy access to family planning and contraceptive services throughout the country. We also need to have a very good referral system for clients who need these services”, he said.

Reinforcing the importance of integrating reproductive health and family planning services in the healthcare system, he shared that “In Thailand we have integrated family planning, maternal healthcare and reproductive health services, into the national healthcare or universal healthcare system and all Thai citizens have access to all these services."

Japan

Despite a low fertility rate of 1.34, even a developed country like Japan is facing the problem of unintended pregnancies.

“Abortion rate is high at 17%. Japan’s sexual education is focussed on avoiding unintended pregnancies. We are also promoting use of oral contraceptive pills whose current usage for birth control is less than 10%. They are mostly used for control of menstrual disorders”, shared Professor Tadashi Kimura, Professor of Gynaecology and Obstetrics, Osaka University School of Medicine, and Chair of Executive Board of Japan Society of Obstetrics and Gynaecology.

However, the country has practically eliminated vertical transmission (mother to child transmission) of HIV, with only such case being reported in 2022, he added.

Malaysia

Malaysia’s fertility rate is 1.9; maternal mortality ratio is low at 29 and all births are attended by skilled healthcare personnel. Unintended pregnancy rate per 1,000 women is 62.

Dr K Balanathan, Head of Department of Obstetrics and Gynaecology, Hospital Seberang Jaya, Malaysia, and President of Obstetrical and Gynaecological Society of Malaysia, said that Malaysia has made a lot of progress in the field of family planning and the contraception prevalence has increased dramatically. However, despite the progress made, the current modern contraceptive usage is only 57% in women aged 15-49 years, as per UNFPA data.

Adolescent and unintended pregnancies remain a challenge in Malaysia. 2022 Sexual Health and Intimate Wellness Survey of Malaysian youths revealed that although more Malaysian youths are sexually active today than they were in the past, their knowledge about STIs and pregnancy is poor and misconceptions abound. Given that more and more Malaysian youth are becoming sexually active at a young age, Balanathan strongly advocates for helping them in a constructive manner, by way of providing comprehensive sexual education to youngsters from secondary school level so that they know about reproductive sex and behave responsibly.

“Both males and females need to be advised to avoid unintended pregnancies. We want the young ladies to complete their education rather than get pregnant and become mothers, thus disrupting their own progress. We have to educate the youth to take precautions and not have unprotected sex to not only avoid unintended pregnancies but also prevent STIs, including HIV.”

In our next article next week, we will look at countries where progress on women's reproductive and sexual health and rights is sub-optimal.