Sexual and Reproductive Health of Adolescents and Youths in Malaysia
WHO Library Cataloguing in Publication Data Sexual and reproductive health of adolescents and youths in Malaysia a review of literature and projects 2005. 1. Sexuality 2. Reproductive medicine 3. Adolescent 4. Malaysia ISBN 978 92 9061 263 6 (NLM Classification: WS 462)
The World Health Organization welcomes requests for permission to reproduce or translate its publications, in part or in full. Applications and enquiries should be addressed to the Office of Publications, World Health Organization, Geneva, Switzerland or to the Regional Office for the Western Pacific, Manila, Philippines, which will be glad to provide the latest information on any changes made to the text, plans for new editions, and reprints and translations already available. © World Health Organization 2007 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the Secretariat of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters.
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Table of Contents Acronyms .................................................................................... 7 Author’s Statement ..................................................................... 8 Executive Summary .................................................................... 9 Preface ...................................................................................... 13 1. Introduction .......................................................................... 15 2. Methodology ......................................................................... 15 3. Key findings .......................................................................... 17 3.1 Demography .....................................................................................................17 3.1.1 General demography .............................................................................17 3.1.2 Age of first marriage .............................................................................21 3.2 Adolescent sexual and reproductive health ..................................................24 3.2.1 Knowledge and sources of information ............................................24 3.2.2 Sexual development ...............................................................................27 3.2.3 Sexual behaviour ....................................................................................28 3.2.4 Pregnancy and childbirth ......................................................................36 3.2.5 Sexually transmitted infections ............................................................39 3.2.6 Sexual violence .......................................................................................42 3.3 Policies and legislation.....................................................................................45 3.3.1 Policies .....................................................................................................45 3.3.2 Legislation ...............................................................................................46 3.4 Interventions ....................................................................................................47 3.4.1 Education and information ..................................................................48 3.4.2 Services ....................................................................................................49
4. Recommendations ................................................................ 51 4.1 Raising awareness .............................................................................................51 4.2 Strengthening sexual and reproductive health education ...........................51 4.3 Strengthening service provision.....................................................................52 4.4 Clarifying polices ..............................................................................................52 4.5 Enforcing existing laws and making new laws.............................................53 4.6 Strengthening interagency partnerships ........................................................53 4.7 Conducting more research..............................................................................53
5. Conclusions .......................................................................... 54 References ................................................................................ 79
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Tables and Figures Figure 1. Percentage distribution of children and young people in Malaysia in selected years ...................................................................................20 Figure 2. Population of children and young people in Malaysia over the years .......................................................................................20 Figure 3. Distribution of adolescents (age 15-24), by gender...............................21 Figure 4. Distribution of young people (age 20-24), by ethnic group and gender ...................................................................................22 Figure 5. Distribution by urban-rural areas and gender for the 10-19 age group ..........................................................................................22 Figure 6. Distribution by urban-rural areas and gender for the 20-24 age group ..........................................................................................23 Figure 7. Percentage of male and female population (15-24 years old) ever married in 1970, 1980 and 1991 ....................................................................24 Figure 8. Singular mean age at marriage by ethnicity, Peninsular Malaysia .................................................................................................25 Figure 9. Percentage of respondents engaged in sexual behaviour during dating, by gender .........................................................................................31 Figure 10. Percentage of births to mothers > 25 years in Peninsular Malaysia, by age of mother .....................................................................................................39 Figure 11. Percentage distribution of pregnancy wastage, by age of mother .....................................................................................................41
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Figure 12. Number of HIV positives detected among 13-19 year olds, by year .......................................................................................................................42 Figure 13. Number of HIV positives detected among 20-29 year olds, by year .......................................................................................................................43 Figure 14. Number of reported cases of rape, by age of the survivors and year ...........................................................................45 Figure 15. Number of survivors of rape who were students, by year .......................................................................................................................45 Table 1. Percentage of currently married women who had ever heard of contraception, by age group .............................................................................26 Table 2. Percentage of respondents with correct responses on reproductive anatomy and physiology and who had heard of contraception, STI and HIV/AIDS, by gender .............................................................................27 Table 3. Percentage distribution of sources of information on sexual and reproductive health among adolescents aged 13-19 years .................................28 Table 4. Percentage of adolescents currently dating, by behaviour practised with dating partner and selected variables ...........................................31 Table 5. Age at first intercourse and sexual activity among adolescents ..............33 Table 6. Percentage distribution of currently married women aged 15-24 years who had ever used and were currently using contraceptives, by current age .....................................................................35 Table 7. Age at first masturbation and percentage who had masturbated ..............................................................................................37 5
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
Table 8. Number and percentage of live births in Peninsular Malaysia, by age of mother .....................................................................................................39 Table 9. Mean number of children born (1974, 1984,1994), by age of mother .....................................................................................................40 Table 10. Number and percentage of maternal deaths and maternal mortality ratios in Peninsular Malaysia and Malaysia in 1995 and 1996, by age of mother .....................................................................41
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Acronyms ASRH ARROW CSW FFPAM FHE FPA HIV/ AIDS HeRDU HUKM IKIM IMR ITM IVDUs KAP KL MOH NGOs NPFDB PROSTAR PWHA SRH STI TWG UKM UM UNICEF UPM UUM WAO WHO WPRO Adolescent Sexual Reproductive Health Asian-Pacific Resource and Research Centre For Women Commercial Sexual Workers Federation of Family Planning Association Malaysia Family Health Education Family Planning Association Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome Health Research Development Unit, University of Malaya Medical Centre National University of Malaysia Hospital Institute of Islamic Understanding Malaysia Institute of Medical Research Mara Institute of Technology Intravenous Drug Users Knowledge Attitude Practice Kuala Lumpur City Ministry of Health Nongovernmental Organisations National Population and Family Development Board Healthy Without Aids Programme For Youth People Living With HIV/AIDS Sexual Reproductive Health Sexually Transmitted Infection Technical Working Group National University of Malaysia University of Malaya United Nation Children Fund University Putra Malaysia University Utara Malaysia Women Aids Organisation World Health Organization Western Pacific Regional Office 7
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
Authors’ Statement This case review and report is the product of the combined efforts of the members of the Review Team: Dato’ Dr. Narimah bt Awin, Director of Family Health Development, Ministry of Health Malaysia, (principal investigator and editor) Dr. Ang Eng Suan, Executive Director, Federation of Family Planning Association of Malaysia (FFPAM) Dr. Sarinah Low Wah Yun, Professor and Head of Health Research Development Unit (HeRDU), University of Malaya Medical Centre, Kuala Lumpur, Malaysia Dr. Mary Huang Soo Lee, Honorary Secretary General of FFPAM, and Associate Professor, Development of Community Health, Faculty of Medicine and Health Sciences, University Putra Malaysia Dr. Mymoon bt Alias, Deputy Director, Family Health Development, Ministry of Health Malaysia Dr. Nik Rubiah bt Nik Abdul Rashid, Principal Assistant Director, Family Health Development Division, Ministry of Health Malaysia. The Review Team members would like to express their gratitude to the WHO Western Pacific Regional Office for inviting Malaysia to participate in the review, which has turned out to be an enriching experience. They also would like to thank the Ministry of Health, Malaysia, representing the Government of Malaysia, for giving permission and support for the review to be carried out. The team/authors would like to dedicate this report to all adolescents and young people of Malaysia. It is hoped that the findings from the review will provide them with the aspiration to actively participate in working towards a bright and promising future, and will enhance their health and quality of life. 8
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Executive Summary From June to September 2003, Malaysia participated in a case study on adolescent sexual and reproductive health, in the form of a review of literature, studies and projects, initiated by the WHO Regional Office for the Western Pacific. A total of 260 documents were reviewed, covering a wide range of concerns in the area of adolescent sexual and reproductive health. There is limited literature available on this important subject, which is hardly surprising given its cultural and religious sensitivity. It was particularly difficult to find accurate information about sensitive and controversial subjects such as premarital sex, contraceptive use by the unmarried, homosexuality and abortion.
Demography The demographic profile of Malaysia is that of a country in transition from developing to developed status, with adolescents (aged 10-19) making up about one-fifth of the total population. Children (aged 10-19) make up 40%. In Malaysia today, young people of both sexes enter marriage later than in previous years, suggesting a delay in sexual activity. In 1984, the average age at first marriage was 26.9 years for men and 24.5 years for women; in 1994 the average age became 28 years for men and 24.9 years for women.
Of the 260 documents reviewed, 178 were published and 82 were unpublished. The review covered six aspects of They covered a range of subjects, which adolescent health: can be grouped into four categories: demography (25); status of adolescent • adolescents’ level and sources of and reproductive health (157); knowledge on sexual and interventions (59); and policies and reproductive health; legislation (30). Most of the documents covered more than one area, with • sexual development; considerable overlap. • sexual behaviour, including dating behaviour;
Adolescent sexual reproductive health status
and
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• pregnancy and childbirth;
abortion, which is illegal, was extremely difficult to find, and the situation can • sexually transmitted infections, only be assessed from anecdotal and including HIV/AIDS; and media reports. • sexual violence. Knowledge on matters related to sexual and reproductive health varies according to several studies, but it is clear that in some areas knowledge is still limited. In areas where knowledge appears adequate, it does not generally translate into behaviour. For puberty changes and similar matters, the usual sources of information are parents and teachers. For sexual relationships, however, the main sources are friends and peers. There is little information on sexual development, and what is available is limited to menarche for girls and wet dreams for boys. Information on sexual behaviour, including dating behaviour, indicates that young people are involved in various types of specific sexual behaviour, including some considered unacceptable according to religious and cultural norms. It is encouraging that the age of first pregnancy has increased and that the number of adolescent pregnancies has decreased over recent years. Maternal deaths are therefore relatively rare in the adolescent age group. Information on 10 The 20-29 year-old age group contributes to a high proportion of cases of STI, especially HIV/AIDS. In 2001, that age group accounted for 27.7% of cases, and in 2002, 30.4%. Intravenous drug use among young people remains the most challenging aspect of HIV transmission in Malaysia. The incidence rate among injecting drug users is about 25%-27%. There appears to be variable levels of knowledge, but more crucially, even when there is knowledge, it is not translated into healthy behaviour. Young people, especially girls, are at risk of sexual violence, and a large proportion of reported rapes are perpetrated against girls below 16 years of age. In about three-quarters of reported cases, the rapist is someone known to the victim, and 13% are victims of incest. There are also reports of adolescents and young people being the perpetrators of sexual crimes. In about 7% of cases, the rapist is a student.
Policies and legislation While there are some general adolescent health policies, few explicitly address sexual and reproductive health, due to
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the sensitivity of the subject. Practices, especially regarding services, follow the religious and cultural realities of the country. Some of these are only based on understandings, with no explicit written policy, such as not making contraceptives available to unmarried people. Malaysia has a National Adolescent Health Policy, but it does not focus on sexual and reproductive health. There are, however, many laws aimed at protecting adolescent sexual and reproductive health, such as a law stipulating a minimum age for marriage, laws against sexual violence and rape, and laws against pornography and obscene materials.
• raising public awareness about the importance of adolescent and reproductive health; • strengthening sexual and reproductive health education for all ages, especially the young; • strengthening service provision; • clarifying policies and reconciling them to meet real needs; • enforcing existing laws and promulgating new ones if needed; • strengthening interagency partnerships; and • conducting more research on adolescents’ sexual and reproductive health. The review was a useful exercise to gather insight into adolescent sexual and reproductive health in Malaysia, and will provide useful information for the strengthening of efforts to improve adolescent health in the country.
Interventions Many government agencies, including the Ministry of Health, have initiated service interventions (mainly counselling and education) for adolescents. Commendable efforts are also being made by nongovernmental organizations to promote adolescent health and provide specific services, including sexuality education. However, the review revealed several gaps and unmet needs.
Recommendations Based on the findings of the review, the Review Team recommends: 11
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Preface
T
his is one of the reviews on the literature and projects of sexual and reproductive health of adolescents and youths in eight Asian countries.* Adolescents and youth make up onefourth of the population in the Western Pacific Region. At least 17 out of 37 countries and areas in the Region have a median age below 25 years. The health of adolescents is, therefore, a key element and an investment for social and economic progress in the Region. Many of the problems adolescents experience are inter-related and should be regarded in a comprehensive manner. However, adjusting to sexual development and protecting their reproductive health are the major challenges for adolescents. Adolescents are vulnerable because they lack knowledge and skills to avoid risky behaviour and lack access to acceptable, affordable and appropriate reproductive health information and services. This is often compounded with environmental disadvantages such as poverty and unemployment. Social norms of sexuality have also changed in the past 2 decades and puberty comes 2-3 years earlier over one century, but the environment to support adolescents has not changed. There is still much to be desired in terms of governments’ institutionalization and allocation of funds. Also families and communities are still unprepared to provide accurate reproductive health information and services necessary for adolescents. Risks
* Cambodia, China, Lao People’s Democratic Republic, Malaysia, Mongolia, Philippines, Republic of Korea, Viet Nam
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Sexual and Reproductive Health of Adolescents and Youths in Malaysia
of unwanted pregnancies, unsafe abortions, pregnancy-related complications, sexually transmitted infections and HIV/AIDS, all of which are important elements of Millennium Development Goals (MDG), continue to threaten adolescents. Since the International Conference on Population and Development (ICPD) in Cairo in 1994, where the importance of adolescent reproductive health was acknowledged, many studies and programmes have been carried out by various national and international agencies and nongovernmental organizations. In order to assist governments to achieve the objectives of ICPD and MDG, the WHO Western
Pacific Regional Office provided technical and financial support to several countries to conduct literature and programme reviews. As a result of these reviews, countries now have evidence-based information for the development of national policies and strategies for adolescent sexual and reproductive health. I appreciate the practical and cost-effective use of existing information for increasing awareness of adolescent reproductive health and for improving our work. Here, I also would like to express my thanks to the governments, the reviewers and researchers for your contributions to improving the reproductive health of adolescents and youths.
Shigeru Omi, MD, Ph.D Regional Director
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1. Introduction Adolescence, the second decade of life, is increasingly recognized as a critical phase in the life course, especially from the health and social perspectives. The most challenging aspect of adolescence is sexual and reproductive health, as it is the area that poses the greatest difficulty in maintaining adolescents’ health and implementing appropriate and effective interventions. For a start, there is a paucity of information and, if there is information, it is often uncoordinated and fragmented and not very useful for policy-making and programme interventions. The Western Pacific Regional Office of the World Health Organization (WHO) conducted a review of the literature and programmes of adolescent sexual and reproductive health in selected countries in the Region. The review was undertaken on the premise that it would be a cost-effective way to collect and exchange evidencebased information that would contribute to reinforcing the alliance towards improving adolescents’ sexual and reproductive health. Malaysia, through the Family Health Development Division of the Ministry of Health, participated in the review.
2. Methodology The review in Malaysia was conducted from June to September 2003 by a study team with six members, who were from the Ministry of Health (3), universities (2) and the Federation of Family Planning Association of Malaysia (1). It was a ‘desk review’ and closely followed the guidelines of the WHO Regional Office for the Western Pacific. Before the review commenced, agreement was reached on the scope of “sexual and reproductive health in Malaysia” and the time-frame for the reviewed articles (past 10 years, but earlier studies were also used, especially for comparison). Agreement was also reached on the meanings of the terms “adolescent”, “youth” and “young person” A total of 260 documents were selected from more than 400 for inclusion in the review. Of those, 178 were published documents, including reports of departments and agencies, and 82 were unpublished documents, mainly papers presented at conferences and seminars. 15
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
The 260 documents can be classified using the four broad themes of: demography (25); sexual and reproductive health status (157); laws and policies (30); and interventions (59). The 157 documents on the second theme, sexual and reproductive health status, can be further classified into six sub-themes: knowledge, attitude and practice; sexual development; sexual behaviour, pregnancy and childbirth; sexually transmitted infections (STI) and HIV/ AIDS; and sexual violence. Very often the articles address more than one of the sub-themes, with considerable overlap. The sources reviewed included the following: (1) Annual reports on vital statistics, published by the Department of Statistics, provided most of the demographic and general health data. (2) Reports of the Ministry of Health provided data on incidence and prevalence and selected indicators on fertility and pregnancy outcomes. Some of the information on diseases, especially STI and HIV/AIDS was also from reports of the Ministry of Health. The Second National Health and Morbidity 16
Survey of the Ministry of Health (1996) provided some information on risky behaviour among adolescents. (3) Surveys carried out by the National Population and Family Development Board (NPFDB) and the Federation of Family Planning Associations of Malaysia (FFPAM) provided most of the information on sexual and reproductive health. Since 1966, four major surveys have been carried out in Peninsular Malaysia (1966, 1974, 1984 and 1994), with similar surveys carried out in Sabah and Sarawak in 1989. Other studies conducted by both or either one of those two agencies also provided a considerable volume of information for the review. (4) Several studies carried out on young people in the past two decades by some local universities and the FFPA were also sources of information. (5) For violence and sexual crimes, much of the information came from the Police Department and the Department of Social Welfare.
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(6) Information on interventions, policies and legislation was obtained from reports and
papers written by relevant government agencies, including the Ministry of Health.
3. Key findings The demographic profile shows a relatively “young nation”, with a sizeable population between the ages of 10 and 24. The population of young people is shown as a percentage in Figure 1 and in absolute numbers in Figure 2. While the 3. 1. Demography percentage has remained almost stable, Two aspects are presented – general the absolute numbers of 0-24 year-olds demography and the age at marriage, the have increased over the years. latter being relevant as a proxy indicator for sexual and reproductive health Young people (15-24 years of age) make activities and especially for risk of up a fifth of the population, while pregnancy and its consequences for younger children (0-14 years of age) make up about 40%. On a population young females. pyramid, Malaysia’s population shows what is often termed a “youth bulge”, 3.1.1. General demography which has clear implications for the social Malaysia comprises thirteen (13) states and economic fabric of the nation, and three (3) federal territories in three especially in terms of creating more regions – Peninsular Malaysia, Sabah and demands for specific services for that age Sarawak. The country’s population has group. This is important since it provides more than tripled over the last four policy-makers with evidence of the decades and, in 2002, was 24.5 million. importance of the health of adolescents, The average annual rate of population a group that used to be considered less growth is 2.6%. The per capital income important simply because their mortality in 2002 was RM13 781 (US$ 3626), and morbidity rates are low. The fact that placing Malaysia among middle-income they contribute to a sizeable proportion economies. The health profile of of the population is enough reason for Malaysia resembles that of a country in attention to be accorded to adolescents. transition from developing to developed national status. The findings of the review are described under four main themes: demography; sexual and reproductive health status; policies/legislations; and interventions.
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Figure 1: Percentage distribution of children and young people in Malaysia in selected years
Source : Social Statistics Bulletin Malaysia
Figure 2: Population of children and young people in Malaysia over the years
Source : Social Statistics Bulletin Malaysia
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The gender distribution of young people aged 15-24 years is shown in Figure 3. Each account for 9%-10% of the population, thus together comprising about 20% or a fifth of the population as a whole. There are slightly more male than female young people. Figure 4 shows that the major ethnic groups in Malaysia have maintained the same distribution. However, among the 20-24 year-old age group, there was an increase in non-citizens in 1995, followed by a decline between 1996 and 1999, and an upsurge in 2000. This may be explained by the flow of foreign workers, especially in the labourintensive sectors, which employ mainly young workers. It also reflects the economic realities of Malaysia during these years. There was rapid
socioeconomic development in the late 1980s and early 1990s, followed by the financial crisis in 1997 and 1998, and the recovery in 2000. The presence of foreigners among the older young population as a result of labour market forces in the country calls for specific strategies in terms of health services for younger people, including sexual and reproductive health. The Malaysian Government has a policy of requiring health screening of all foreign workers before they enter the country, and annually thereafter. One of the conditions screened for is HIV/AIDS. Another implication of the presence of foreign workers is that they contribute significantly to patronization of sex workers. There have also been incidences of violence and crimes, including sexual crimes, committed by foreign workers.
Figure 3: Distribution of adolescent population (age 15-24) by gender
Source: Social statistics bulletin 1995, 1997, 1999, 2000 and 2001.Department of Statistics, Malaysia.
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Sexual and Reproductive Health of Adolescents and Youths in Malaysia Figure 4: Distribution of young population (aged 20-24) by ethnic group and gender
Source: Vital statistics Malaysia 1995, 1997, 1999; Population distribution and basic demographic characteristics; Population and Housing Census of Malaysia 2000. Department of Statistics, Malaysia. Figure 5: Distribution by urban-rural areas and gender for the 10-19 age group
Source: Vital statistics Malaysia 2000: Education and social characteristics of the population. Department of Statistics, Malaysia.
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The distribution of young people in urban and rural areas from 1995 to 2000 is shown in Figure 5 (10-19 years) and Figure 6 (20-24 years). There were more younger adolescents in rural areas than in urban, but the opposite was true for older adolescents, who are more likely to move to towns for higher education and employment. The findings on adolescent demography with respect to the above variables are useful in formulating further actions to improve adolescents’ sexual and reproductive health.
3.1.2. Age at first marriage The proportion of young people ever married declined for both males and females aged 15-24 years between 1970 and 1991 (Figure 7). Age at first marriage is used as a measure of entry into sexual activity for both boys and girls, as well as exposure to risk of pregnancy and childbirth for girls. Besides the biological aspect, marriage also has significant social and economic repercussions. Marriage includes formal
Figure 6: Distribution by urban-rural areas and gender for the 20-24 age group
Source: Vital statistics Malaysia 2000. Department of Statistics.
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marriages, such as civil and registered marriages, religious marriages, customary weddings and common law marriages. Under the Malaysian Shari’ah law (for Muslims), the minimum age for marriage for women is 16 years and for men it is 18 years. Under the Civil Marriages law (for non-Muslims), the minimum age at first marriage for both women and men is 18 years of age.
The mean age at first marriage has increased. From below 20 in 1970 it rose The overall trend in age at first marriage to 23.3 years in 1990. In 1984, it was may be explained by a multitude of 26.9 years for men and 24.5 years for factors, but rapidly expanding women, increasing to 28 years for men Figure 7: Percentage of male and female population (15-24 years old) ever married in 1970, 1980 and 1991
and 24.9 years for women in 1994. The change in mean age at first marriage for the three major ethnic groups in the last five decades is shown in Figure 8. An increase in age at first marriage was observed among all ethnic groups, with Chinese women marrying much later than Malays or Indians. The interethnic differential was greatest in the 1950s and for the 15-19 year-old cohort. While the same trend was observed for the older cohort, the interethnic difference was less dramatic. Age at first marriage was also higher in urban areas.
Source: Population Census Report 1970, 1980, 1991. Department of Statistics, Malaysia.
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educational opportunities, especially for girls, may have resulted in the postponement of marriage. Other reasons include female independence and work participation away from home before marriage, and increasing freedom in the choice of marriage partner. The socioeconomic and educational basis behind the rising age of marriage is further strengthened by ethnic difference: Malay and Indian girls, as opposed to Chinese girls, had early marriages some three or two decades
ago, but that difference has decreased considerably. This single demographic profile is a significant contributor to better health for young people, especially girls and young women. The delay in marriage also has implications for family structures and population growth. As young people delay marriage, they also delay childbearing until they are older. Thus families tend to comprise older parents with fairly young children, and such couples are more likely to establish nuclear families.
Figure 8: Singulate Mean Age at Marriage by Ethnicity, Peninsular Malaysia, 1957, 1970, 1980 and 1991
Source: Leete R. Malaysia’s demographic transition: rapid development, culture and politics. Kuala Lumpur, Oxford University Press, 1996.
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3.2. Adolescent sexual and 3.2.1. Knowledge and sources of information reproductive health status This relatively broad theme is discussed under six sub-themes: knowledge, attitude and practice; sexual development; sexual behaviour; pregnancy and childbirth; STI and HIV/AIDS; and sexual violence. There is, as might be expected, considerable overlap among these sub-themes. The literature reviewed showed varying levels of knowledge among young people on various aspects of sexual and reproductive health. The Family Life Surveys, conducted from 1966 to 1989 (see Table 1), show that family planning knowledge has increased substantially and is widespread. Almost
Table 1:Percentage of currently married women who had heard of contraception, by age group; Peninsular Malaysia, 1966 and 1984;Sabah, 1989; and Sarawak, 1989 Survey All methods Efficient (Hormonal, IUD, sterilization and condoms) Inefficient (Natural and traditional methods) -
WMFS, 1966-67 (1) All respondents Age group: 15-19 years Age group: 20-24 years MPFS, 1984 (2) All respondents Age group: 15-19 years Age group: 20-24 years Sabah PFS, 1989 (3) All respondents Age group: 15-19 years Age group: 20-24 years Sarawak PFS, 1989 (4) All respondents Age group: 15-19 years Age group: 20-24 years
}
82.0 80.6
99 96 99 -
98 95 97 Lowest: vasectomy Highest: pill 35.4 – 87.9 8.7 – 75.0 28.6 – 86.0 Lowest: vasectomy Highest: pill 36.1 – 96.8 16.7 – 96.1 26.4 – 98.8
92 84 92 Lowest: abstinence Highest: rhythm 40.3 – 62.5 23.9 – 53.5 39.8 – 54.4 Lowest: abstinence Highest: rhythm 31.0 – 55.5 10.3 – 24.4 28.3 – 48.8
-
Sources:(1) West Malaysian Family Survey 1966-1967; (2) Marriage and family formation in Peninsular Malaysia: analytical report of the 1984/85 Malaysian Population and Family Survey, 1988; (3) Population and Family Survey in Sabah 1989; (4) Population and Family Survey in Sarawak, 1989.
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all the women interviewed reported that they had heard of family planning and were able to name at least three contraceptive methods. Adolescents aged 15-19 years knew less than young people aged 20-24 years. Another study in 1998 (see Table 2) showed that unmarried adolescents’ knowledge on various aspects of sexual and reproductive health was variable.
understanding of the whole reproductive process, especially pregnancy. Knowledge on HIV/AIDS was more prevalent than on STI, possibly due to the extensive media coverage of HIV/ AIDS, which could also explain the higher prevalence of knowledge on condoms among both sexes.
Table 3 illustrates that young people talk to mothers, teachers and friends about Generally, girls knew more than boys equally regarding puberty changes, about oral contraception pregnancy and contraception. However (66.7% compared with 57.1%) but they for male-female and sexual relationships, were equal in terms of awareness on most of them talk with friends rather condoms. Both had a poor than mothers and teachers. Table 2: Percentage of respondents with correct responses on reproductive anatomy and physiology and who had heard of contraception, STI and HIV/AIDS, by gender Sex Boys Girls Male reproductive anatomy 20.9 10.6 Female reproductive anatomy 25.3 23.3 Reproductive physiology – foetal development 47.8 61.0 Reproductive physiology – birth canal 36.0 44.6 Pregnancy – through sexual intercourse 85.3 Pregnancy – most likely at mid-cycle 18.7 Contraception – condoms 67.7 63.3 Contraception – pills 57.1 66.7 STI – ever heard of 65.3 AIDS - ever heard of 98.1 HIV Transmission – random sex 95.6 HIV Transmission – sharing needles 96.5 Source: National study on reproductive health and sexuality of adolescents, 1994/1995. NPFDB, 1998. Knowledge
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Table 3: Percentage distribution of sources of information on sexual and reproductive health among adolescents aged 13-19 years Source of information (ever discussed with) priority First Second Third Mothers Teachers Friends (31.5%) (31.5%) (29.4%) Friends Mothers Teachers (41.6%) (11.2%) (4.4%) Friends Teachers Mothers (21.1%) (8.1%) (5.7%) Friends Teachers Mothers (14.5%) (11.9%) (11.0%) Friends Mothers Teachers (11.2%) (8.8%) (7.5%)
Never (20.9%) (35.5%) (62.0%) (58.0%) (64.8%)
Puberty changes Male-female relationships Sexual relationships Pregnancy Contraception
Source: Report of the National Study on Reproductive Health and Sexuality of Adolescents, 1994/95. NPFDB, 1998.
Besides these surveys, a 1986 study of 1200 mostly single adolescents aged 15-21 years in Kuala Lumpur city evaluated their knowledge of virginity, pregnancy, contraceptive methods, need for information and sources of information. About half of the respondents knew how virginity was lost, although 20.8% did not know. There was a significant difference between males and females, with 70% of males compared with 30% of females saying that “sexual intercourse” was how virginity was lost. About 50% of respondents scored “above average” on a set of six questions pertaining to pregnancy, while only 2.0% answered correctly, with female respondents faring better than their male counterparts. On 26
the whole, adolescents were not very knowledgeable about the various contraceptive methods apart from the pill and condoms, where 72% and 47.8% respectively were able to name the methods. Yet another study involving older respondents (average age 22.6 years) at a university in the Klang Valley found that knowledge was low. Of the 114 medical students (year 4), 81 nursing students (years 2 and 3), and 85 students who registered for a Sexual Health Course, the average score was only 39.84 out of 72. The students were asked about physiological, psychological and social aspects of sexuality through the Sex Knowledge and Attitude Test Form
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II. Male students scored higher than female students, and medical students did better than non-medical students, scoring 60.6% on average. A baseline survey of 100 students aged 15-17 years in the State of Melaka found that friends were the main source of social support and information, followed by teachers, magazines (girls only) and the Internet. On the other hand, family problems were discussed within the family. When asked to name information sources for sexual and reproductive health topics, about one-third to two-fifths answered “do not understand the meaning” and a quarter said “nobody.” Newspapers and magazines were the primary sources for information about family planning, abortion and STI. The varying, but generally low levels of knowledge in some areas of sexual and reproductive health is a cause for concern. Other disturbing features are the fact that this appears not to have improved over time, and that whatever little and often inaccurate information they have comes from sources that are not very reliable (such as from one another). The fact that young people do not, as a preference, approach parents and teachers for information on sexual relationships needs to be studied carefully. The reasons could reside in any number of possible areas, such as cultural norms, failure of parents/
teachers to communicate, or their own attitudes and lack of knowledge. This is relevant because interventions will need to be guided by the reasons. It is also significant that large number of adolescents (73%) expressed the need for more knowledge, indicating that they were aware of their own lack of information. This is a positive finding that needs to be used optimally in the formulation of polices, strategies and activities.
3.2.2. Sexual development The review could find very little literature on sexual development. Information was only found on menarche for girls and wet dreams for boys. For menarche, the 1994/1995 National Study on Reproductive Health and Sexuality showed that the overall mean age at menarche among the 706 female respondents (now aged 13-19 years) was 12.6 years. The range was from younger than 10 years (2.7%) to 14 years (5.4%). The majority (68.2%) had their first menstruation at the age of 11 or 12. When asked about their feelings at first menstruation, slightly more than half (54.0%) indicated that they had expected the event. Of those who had expected it, 48.2% said they had ”felt afraid.” That percentage rose to 77.4% for those who had not expected the onset of menstruation. 27
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
In terms of wet dreams, the NPFDB study reported that 63.2% of the 673 male respondents had had a wet dream, and the mean age at first experience was 13.8 years. Slightly more than half of the respondents (51.0%) had expected the event, and the majority (73.9%) had not been afraid. By comparison, 53.4% of the male adolescents who had not expected the event had also not been frightened by the experience, indicating that expectation is not associated with absence of fear.
perceived as “dating”. The frequency of dating increased from 55.5% among the 13-15 year-old age group to 72.7% for the 16-17 year-olds and 88.7% for those aged 18-19 years. The main venues for dating were shopping complexes, fastfood centres and lake gardens. Around 72% admitted that they had held hands, about 22% said they had kissed, and 11% said that they had engaged in “petting” (Table 4). A higher percentage of males than females reported that they had engaged in petting.
In a 1995 study in Kuala Lumpur, 1181 unmarried respondents were 3.2.3. Sexual behaviour interviewed about their dating behaviour. Four aspects of sexual behaviour were The results are shown in Figure 9. In the discussed in the literature: dating study, 44% of the 1181 unmarried behaviour; sexual debut; safe and unsafe respondents (15-21 years old) had dated. sex, including contraceptive use; and The incidences of the various types of behaviour engaged in during dating masturbation. varied between male and female respondents for “kissing and necking”, (1) Dating behaviour “petting” and “sexual intercourse”, with The 1994 -1995 National Study on males reporting a higher level than girls. Reproductive Health of Adolescents Female respondents reported a higher found that 73.5% of adolescents who level of “no physical intimacy” than male had a special friend of the opposite sex respondents. (21.6%) had engaged in what they
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A Review of Literature and Projects 2005 Table 4: Percentage of adolescents currently dating, by behaviour practised with dating partner and selected variables
Holding hands Kissing All Sex Male Female Age 13-15 years 16-17 years 18-19 years Residence Urban Rural 71.8 78.3 65.8 51.6 68.8 84.1 76.0 67.2 21.8 26.1 47.6 9.7 12.5 34.9 26.7 16.4
Petting Total number of adolescents 11.3 142 18.8 4.1 6.4 8.3 15.9 14.7 7.5 69 73 48 63 75 67
Source: National Study on Reproductive Health and Sexuality of Adolescents, 1994/95. NPFDB, 1998
Figure 9: Percentage of respondents engaging in sexual behaviour during dating, by gender
Distribution of Behaviour Performed During Dating by Sex
Source: Zulkifli SN, Low WY, Yusof K. Sexual activities of Malaysian adolescents. Medical journal of Malaysia, 1995, Vol 50 No 1 March 1995:4-10.
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Sexual and Reproductive Health of Adolescents and Youths in Malaysia
The FFPAM Youth Sexuality Survey covered 1303 respondents aged 15-24 years of age from four states. Students (in-school adolescents) began dating at age 15, and the highest frequency was at age18, for both girls and boys. For out-of-school young people, the first age for dating was between 18 to 20 years. The majority of in-school females (62.4%) had dated one to three males. A third had only dated one person. A maximum record of 10 partners was reported by 4.7% of the respondents. Some reported having 4-10 partners. Of the out-of-school young people, 40.4% of the females and 23.7% of the males had dated only one partner. The majority of those who had dated claimed “liking a person and wanting to know him/her better.” It was reported that “couples tended to be circumspect on their dates,” with the major physical contact being “holding hands”. Few had engaged in sexual intercourse. The findings regarding dating behaviour cannot be assumed to be very accurate, considering the sensitivity of the questions. Dating is an anathema to the old tradition of arranged marriages, which used to be common among all ethnic groups in Malaysia. The sensitivity becomes more apparent when the differentials between boys and girls are noted. Boys tend to claim they have been involved in such dating behaviour as 30
necking and petting, while girls tend to deny such behaviour. The differences reported are not likely to be the pattern in reality, since they involve reciprocal behaviour involving both sexes. The urban-r ural difference and the age-specific pattern are as expected, with more urban and older youngsters involved in each type of dating behaviour. The challenge to policymakers is obvious; if such types of behaviour are to be sanctioned based on cultural/religious grounds, and yet there is evidence that young people are engaged in them, what is the most appropriate response? To disallow such behaviour would require the very arduous task of putting in place sanctions to be enforced and monitored, let alone assessing their consequences. However, freely allowing such behaviour and taking a liberal approach is also not appropriate or acceptable. (2) Age at sexual initiation (sexual debut) and sexual activity Data on age at first intercourse and incidence of sexual activity among adolescents are summarized in Table 5. The age at first intercourse (sexual debut) ranged from 9 to 24 years, with the highest frequency at 17-18 years. The percentage of young people who were sexually active ranged from 1% of adolescents aged 13 to 19 years
A Review of Literature and Projects 2005
interviewed in a household survey, to 54% of inmates in drug rehabilitation centres. The NPFDB National Study found that only about 1% (13 of 1379 adolescents) admitted they had ever engaged in sexual intercourse. The FFPAM Youth Sexuality Survey found Title of study National Study on Reproductive Health of Adolescents 1994/95. (NPFDB, 1998) Household Survey Media Survey Respondents
that age at first intercourse was as young as nine years for male and female in-school respondents. Female out-of-school respondents and male outof-school respondents reported their sexual debut took place between 15 and 25 years of age. Age at first intercourse (range) Percentage sexually active Ever had sex 0.94 (13 cases) 27.2 In-school Male: 11.2 Female: 14.5 Out-of-school Male: 27.0 Female: 6.5 All respondents 8.9 Ever dated 20.1 Male: 26 Female: 5 Students: 6 Inmates: 54 -
Table 5: Age at first intercourse and sexual activity among adolescents
Report on FFPAM Youth Sexuality Survey 1994. (Chiam HK, 1995)
Sexual activities of Malaysian adolescents (Zulkifli, Low WY, Yusof K. Medical journal of Malaysia, Vol 50, No 1 March 1995. Adolescents and AIDS (Ramaja Dan AIDS) (Samsuddin AR, Iran H, 1996) Sexual behaviour and HIV knowledge among dermatology cum genitourinary clinic attendees (Choon et al, Medical Journal of Malaysia, Dec 1997, 52(4): 318-324.) JOICFP Project: Baseline Survey on Sexual and Reproductive Health of Adolescents and Youth (FFPAM, 2000) Sexual practices in Malaysia. (Zulkifli SN, Low WY. Journal of adolescent health, 2000, 27:276-280)
Male: 673 Female: 706 N = 1379 Male: 1242 Female: 654 N = 1896 In-school Male: 277 Female: 352 Out-of--school Male: 337 Female: 337 N = 1303 Male: 792 Female: 408 N1 = 1200 N2 = 1181 (Unmarried) 3462 students 885 youths in rehabilitation centres
15-17 16.4 In-school Male: 10-21 Female: 11-21 Out-of-school Male: 15-25 Female: 9-24 n.a.
Percentage who had intercourse before age of 20 years: Males: 22.5 Females: 30.9 School-based (15-17 years) Male: 50 Female: 50 Male: 242 Female: 225 n.a.
School-based 2 (2 cases)
All: 13 Male: 18.2 Female: 7.1
Sources: As listed under column 1.
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Sexual and Reproductive Health of Adolescents and Youths in Malaysia
The place for first sexual intercourse was “the bedroom” in about half of the responses, and male respondents reported “a hotel” as a close second choice. The survey also reported that, in most cases, the partner for the first sexual intercourse was a “date” or “steady girlfriend/boyfriend.” About 15% of inschool males and almost 27% of outof-school males reported that their first sexual encounter was with a “prostitute.” For out-of-school females, 10 out of 22 reported that their first experience was coerced, with a “stepfather,” “conman” or “others.” Besides the above surveys, the National Health and Morbidity Survey 1996 also asked 30 000 school-going respondents about their sexual behaviour, and 1.8% said they had had sexual intercourse, with male students twice as likely to be sexually involved than female (2.5% versus 1.2%). Of that number, 63.2% were heterosexual, 19.9% were homosexual, and 9.4% had sex with prostitutes. A comparative study of students and drug rehabilitation centre inmates found that 6% of students and 54% of inmates had had intercourse before the age of 20. A study of attendees at one clinic reported that 22.5% of males and 32
30.9% of females had had intercourse before the age of 20. Another study of 100 students aged 15-17 years found that the incidence was only 2%. The mode age of sexual debut, 17-18 years, is probably not different from other similar countries. Whether or not this has changed over the years is not clear, since not many studies on sexual activity have been conducted on a longitudinal basis. The common assumption that “most, if not all births occur within marriage” may not be true. Evidence shows that the mean age at first childbirth is 21 years; while the mean age at first marriage for females is 23.5 years (1980) and 25 years (1998). There are also data on births that record the ages of mothers as “unknown”. From anecdotal and media reports on the incidence of abandoned babies, it is reasonable to postulate that many of those mothers of “unknown” age are unmarried young women who have no recourse to family and other institutional support, and therefore abandon their babies hoping that someone will take better care of them. Inherent in this phenomenon is the deep sense of shame related to the societal sanction placed upon illegitimate births. As, in almost all cases, the identity of a woman who has given birth and abandoned her baby is not known, such events take place under clandestine circumstances.
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(3) Contraceptive use and safe/ unsafe sex
The results of the fertility and family/ population surveys carried out by the NFPB generated infor mation on contraceptive use among married women. The rate increased almost seven times over four decades, from 8.8% in the mid-1960s to 55.8% in 1994 (Table 6). There was also an In another study, conducted in Kuala increase among younger age groups. Lumpur, only 37% of the sexually active teenage respondents said they used some The prevalence of contraceptive use form of birth control, even although the among the population is variable. In the majority knew about birth control NPFDB study, one-fifth of respondents methods. By far the most common said they had used condoms method used was the condom (21.5%), with lower rates for other (51%), followed by oral contraceptives methods: pills (6.1%); spermicides (18%) and withdrawal (15%). Among (2.2%); intrauterine devices (1.3%); and those who did not use any injectables (1.1%). In the Youth Sexuality contraceptives, about half explained that Survey, when sexually active females were sex was not much fun with Table 6: Percentage distribution of currently married women aged 15-24 years who had ever used and were currently using contraception, by current age Survey WMFS 1966-67 MFFS 1974 MPFS 1984/85 Sabah PFS 1989* Sarawak PFS 1989* MPFS 1994 Ever used contraception All 15-19 yr 20-24 yr 10 14 53 23.7 45.4 77 72.0 41.3 58.1 77.7 52.6 71.3 Na Na Na Currently using contraception All 15-19 yr 20-24 yr 5.0 9.1 35.3 21.2 38.2 52.2 31 53 50.1 21.7 34.5 57.9 37.2 51.6 41.5 55.8
asked about “precautions to prevent pregnancy,” 90% of the in-school females questioned admitted to not taking any measures, but 60% of the outof-school females said that they did. On the other hand, about 30% of in-school males and 15% of out-of-school males said they took precautions to prevent pregnancy.
Sources:(1) Report on the West Malaysian Family Survey 1966-1967. NFPB, 1968; (2) Malaysian Family and Fertility Survey 1974. NFPB; (3) Marriage and family formation in Peninsular Malaysia: analytical report of the 1984/85 Malaysian Population and Family Survey. NPFDB, 1988; (4) Population and Family Survey in Sabah 1989. NPFDB, 1992; (5) Report of the Population and Family Survey in Sarawak, 1989. NPFDB, 1992. (6) Population profile Malaysia. NPFDB, 1998.
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Sexual and Reproductive Health of Adolescents and Youths in Malaysia
contraceptives or that they found contraceptives too difficult to use. One out of the two students in the Melaka study reported using contraception. A concern, therefore, is that most sexual encounters are unsafe, with no protection against unwanted pregnancies or STI. From the various data sources, it is quite fair to estimate that that is the case for about 10%-20% of young people, and it appears that the issue of teen sexuality is not being adequately addressed by the relevant sectors. Contraceptive use is a sensitive issue for which accurate information is not easy to obtain. Indeed the only reliable information is that for married women, for which the trend over time is very encouraging. Of course married couples practice contraception mainly for child spacing and family size limitation. The very few studies on unmarried young people suggest a relatively low usage rate. The condom is the most common method, probably due to easier availability, being available at retail outlets, and to increased awareness about safe sex since the spread of the AIDS epidemic. There were some respondents who cited “too difficult to use” as the reason for not using contraceptives. In countries where policies do not disallow or criminalize contraception in 34
unmarried people, education on using various methods is carried out. In Malaysia, this is clearly out of the question. This review gives ample evidence that young people know about family planning, yet many of them do not access such services, citing reasons like being unprepared. The barriers to service utilization may also be service policies affecting family planning services in the country. Generally family planning is promoted for health reasons, with emphasis on child spacing and avoidance of risky pregnancies, and clinical services in the country’s public sector are targeted at married couples. Those who are not married usually obtain services from the private sector and FPA clinics, while hormonal pills can be obtained from pharmacy retail outlets and condoms from general goods outlets. The FFPAM and other nongovernmental organizations are increasingly advocating for the promotion of sexual and reproductive health of adolescents, primarily through prevention education and also through provision of selected clinical services. However, it is feared that such services are unlikely to be utilized fully in view of the social sensitivity and religious sanctions against many matters related to sexuality.
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(4) Masturbation Three studies included questions about masturbation (see Table 7). The age at first masturbation was usually about 13-15 years, but a few respondents reported the first occurrence at 7-9 years for boys and 9-12 years for girls. All the studies show that more males than females engage in masturbation. The NPFDB media survey reported that adolescents started masturbating at a mean age of 13.7 years. Two-thirds had masturbated, with a higher incidence among male (91.0%) than female respondents (61.2%). Slightly more than half masturbated one to three times per week. In the FFPAM study, the age at first masturbation ranged widely from seven to 23 years. The incidence of
masturbation among girls was less than 10%, compared with over 50% for boys. It should be noted, however, that 42.4% of in-school and 60.5% of outof-school female respondents responded “do not know the meaning” or “no response” to the question. In-school males often masturbated to release tension (35.2%) and 29.2% had guilty feelings. For the in-school females, 23.1% had feelings of guilt. Some male and female respondents, 13.4% and 15.4% respectively, were “fearful it might harm the body.” Among the out-ofschool subjects, 35.1% of males and 50.0% of females felt guilty. Another 16.0% and 25.0%, respectively, were fearful that it might harm the body. About a quarter of the out-of-school males reported that masturbation was for releasing tension. None of the female
Table 7: Age at first masturbation and percentage who had masturbated Age at first masturbation Percentage who had (range) masturbated Ever Masturbated 13.7 (mean age) All: 70.0 Male: 90.0 Female: 61.2 In-school In-school Males: 9-21 Males: 55.6 Females: 9-19 Females: 7.4 Out-of-school Out-of-school Males: 7-23 Males: 68.5 Females: 12-23 Females: 5.0 Male: 14.4 Females: 15.5
Sources: As listed under column 1.
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Sexual and Reproductive Health of Adolescents and Youths in Malaysia
respondents reported feeling good after of guilt indicates that they are aware of masturbation. the “wrongness” of the practice, but it does not stop them from practising it. An analysis of the sexual practices of the 1181 adolescents in the 3.2.4. Pregnancy and childbirth Kuala Lumpur study found that more males masturbated than females. Also, Adolescents are not ready to start a males started masturbating relatively family, from both a biological and a social early (at a mean age of 14.4 years, perspective. Pregnancy and childbirth are compared with 15.5 for females). Almost high-risk events for young women half of those who masturbated were because they are not physiologically or worried, especially the females. psychologically mature. This sub-theme is presented under three aspects: births/ Like dating and contraception, Islam safe deliveries, abortions and maternal does not allow masturbation. The review deaths shows that boys, and to a lesser extent girls, of all religious and ethnic groups (1) Births and safe deliveries do masturbate despite sanctions and rulings, and it is a difficult issue for The number of births to adolescent policy-makers. It is extremely difficult mothers in Peninsular Malaysia (but not impossible) to reconcile decreased from religious/cultural standards and rulings to actual adolescent behaviour that is a 23 113 in 1980 to 12 320 in 1998. (see natural outcome of biological and Table 8 and Figure 11). Births to mothers psychological changes. The fact that in the 20-24 year-old age group decreased Malaysia consists of many communities from about 101 685 births in 1980 for a with different religions and cultures period of about 10 years, but have makes the issue even more complex. stabilized at about 86 000 births annually. In both the below-19 and the 20-24 yearThe sense of guilt and fear of bodily old age groups, total births declined har m among adolescents who between 1980 and 1998. The fact that masturbate is also a matter of concern. so many mothers below 19 years of age Such feelings in themselves indicate poor still give birth is a cause for concern. mental health (anxiety and fear) for However, the fact that the trend is adolescents and their quality of life will declining is encouraging. The high be compromised by them. The sense proportion of safe deliveries (more than 36
A Review of Literature and Projects 2005
97%) is another encouraging trend, if it can be assumed that this does not differ among the age groups. There are reports that indicate that “safe deliveries” increased from 85% in 1995 to almost Age Group <15 years
97% fifteen years later, and that “unsafe delivery” has been reduced to 0.8% in Peninsular Malaysia and 2.06% in Sarawak.
Table 8: Number and percentage of live births in Peninsular Malaysia, by age of mother
1980 1985 1990 1995 1998 165 130 133 164 132 (0.05) (0.03) (0.03) (0.04) (0.03) 15-19 years 22 948 17 645 13 433 13 110 12 188 (6.61) (4.33) (3.40) (3.08) (2.87) 84 810 88 627 86 517 20-24 years 101 685 103 288 (29.30) (25.39) (21.45) (20.80) (20.40) > 25 years 221 926 284 975 296 526 323 496 323 112 ( 63.95) (70.05) (75.01) (75.95) (76.18) Unknown 291 768 419 542 2208 ( 0.08) (0.19) (0.11) (0.13) (0.52) Total 347 015 406 806 395 321 425 939 424 157 (100.0) (100.0) (100.0) (100.0) (100.0) Source: Vital statistics reports (various years). Department of Statistics, Malaysia. Figure 10: Percentage of births to mothers <25 years in Peninsular Malaysia, by age of mother
Percentage of Births to Mothers, Peninsular Malaysia By Age of Mother, 1980-1998
Source: Vital statistics reports (various years). Department of Statistics, Malaysia.
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Sexual and Reproductive Health of Adolescents and Youths in Malaysia
Another useful statistic is the number of children born to mothers in different age groups. Table 9 shows the mean number of children born, by age of the mother, in four surveys covering almost 30 years. As expected, the number of children born increased with the increasing age group. (2) Abortions There is a paucity of data on abortions in the country, especially for the unmarried and adolescent population. Of the 3866 women surveyed in 1984, 16.3% had experienced at least one spontaneous abortion and 5.8% at least one induced abortion. Figure 13 shows the percentage distribution of the different types of abortion, by three age groups.
Lack of information is a major barrier to making any meaningful situational analysis. However, whether more data would lead to more meaningful interventions is questionable, given the religious and cultural sanctions against abortion. Even although “hard” data are not available on rates of abortion, observations and anecdotal reports suggest that the rates are not as low as might be expected. (3) Maternal deaths The Report on the Confidential Enquiries into Maternal Deaths in Malaysia in 1995 and 1996 states that only 3.6% of all maternal deaths were in women aged 15 to 19 years. That figure rose to 12%-13% for women aged 20 to 24 years (Table 10).
Table 9: Mean number of children born (1974, 1984 and 1994), by age of mother
Survey 15-19 years 20-24 years All women 1.9 WMFS 1966 4.1 MFFS 1974 0.8 1.7 4.2 MPFS 1984 0.9 1.5 3.6 MPFS 1994 0.7 1.2 3.4 Source: Population profile Malaysia. NPFDB, 1999.
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Figure 11: Percentage distribution of pregnancy wastage, by age of mother (MFFS 1984)
Source: Marriage and family formation in Peninsular Malaysia: analytical report of the 1984/85. Malaysian Population and Family Survey. NPFDB, 1988.
Table 10: Number and percentage of maternal deaths and maternal mortality ratios in Peninsular Malaysia and Malaysia in 1995 and 1996, by age of mother Peninsular Malaysia Malaysia Age 1995 1996 1995 1996 No % MMR No % MMR No % No % All 189 100.0 44.4 159 100.0 36.7 251 100.0 220 100.0 15-19 4 2.1 30.5 4 2.5 29.4 9 3.6 8 3.6 20-24 31 16.4 34.9 20 15.9 22.1 45 17.9 29 13.2 Source: Report on the confidential enquiries into maternal deaths in Malaysia, 1995-1996. Ministry of Health, Malaysia, 2000.
The low rates in these groups correspond to the lower levels of fertility. A significant finding of the study was that almost two-thirds of women who died had never practised family planning. While the number of pregnancies in these age groups is also lower than in older age groups, it must be remembered that the risk of maternal death is highest
at extremes of age, and all efforts should be made to discourage births in young women.
3.2.5. Sexually infections
transmitted
Two aspects are presented in this review – the incidence of sexually transmitted 39
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
infections, and the knowledge, attitudes detected in those aged 20 to 29. There were only eight HIV-positive people and practices related to them between the ages of 13 and 19 years (see Figures 12 and 13). In 2001, 4.6% (1) Incidence of HIV-infected persons seen at Figures on the incidence of sexually government clinics were in the transmitted infections (STI) among 13-19 year-old age group, and 27.7% in adolescents were difficult to obtain. An the 20-29 year-old age group. In analysis of 5485 visits by adolescents to 2002, the percentages were 4.0% in eight government clinics found only 13-19 year-olds and 30.4% in 20-29 yearseven cases (0.1%) had gone for olds. treatment for urethral discharge and another 12, or 0.2%, for urinary tract HIV/AIDS in Malaysia is closely linked infections. While such ailments cannot to the drug epidemic. HIV rates among be construed as synonymous with STI, intravenous drug users were 21% in it is known that adolescents with sex- 1998, 27% in 1999 and 25% in 2000. It related problems often shy away from is also well known to be linked with public clinics, where confidentiality is not factors associated with infection, included frequenting sex workers and the well maintained. use / non-use of condoms. A study in HIV/AIDS was first detected in Malaysia 1995 showed that 80% of those infected in 1986, with the number of infected did not use condoms, compared with Malaysians increasing to 51 256 by the 63.4% of non-positive respondents. end of 2002. In 1990, 364 cases were Figure 12: Number of HIV-positives detected among 13-19 year-olds, by year
Source: Ministry of Health, Malaysia
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Figure 13: Number of HIV-positives detected among 20-29 year-olds, by year
Source: Ministry of Health, Malaysia
(2) Knowledge, attitudes and practices From the many studies reviewed, findings on knowledge, attitudes and practices regarding STI and HIV/AIDS include the following: • Knowledge of HIV/AIDS is generally high and has improved over the years. HIV is better known than AIDS. A large proportion of young people know that there is no cure for AIDS. Those who are older and have had more years of formal education are more knowledgeable. Those who are older and/or better educated are more likely to acknowledge the fact that they need to take special precautions against HIV infection.
• The main modes of transmission (sex, needle sharing and blood transfusion) are known to almost all young people, but some mistakenly believe that mosquito bites and blood donations can also transmit the virus. Most young people know that befriending people living with HIV/AIDS, kissing on the cheek, sharing utensils and dishes, sharing toilets and holding or shaking hands are not modes of transmission. • Some adolescents do not realize that people living with HIV/AIDS may not show symptoms until the later stages of their lives and that it is impossible to identify those with HIV/AIDS except through testing. Still, many are not willing 41
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
to mix with them. Knowledge of HIV/AIDS is positively correlated to acceptance of people living with HIV/AIDS. In general, adolescents are sympathetic towards those living with HIV/AIDS and believe in protecting their rights, but they are not able to translate that attitude into behaviour change within themselves. • Young people do not see themselves as vulnerable, even although they know how the virus is spread. Perceived susceptibility, severity of HIV/AIDS and ability to protect from HIV infection are positively related to attitudes towards HIV/AIDS. Only perceived severity of HIV/ AIDS and subjective norms (peer pressure) tend to have influence over behaviour. • Knowledge and use of condoms is low, even among vulnerable groups like drug addicts, which is a worrying trend considering three-quarters of HIV/AIDS cases in Malaysia are among injecting dr ug users. Many adolescents would not insist on using a condom to protect themselves from HIV/AIDS. 42
3.2.6. Sexual violence Large numbers of young men and women face risks to their sexual and reproductive health, such as HIV, STI, sexual violence, and drug and alcohol abuse. Young women face particular risks because of their biology, discrimination regarding access to information and services, and constraints imposed by society (see Figures 14 and 15). While violence against women has been hotly debated in the last few years, violence against adolescents, specifically adolescent girls, has been neglected. In a study of 616 paramedic students, it was found that 8% of the women and 2% of the men had reported sexual abuse. This was defined as “vaginal or anal penetration, or unsolicited sexual contact and witnessing exhibitionism before the age of 18”. In another study of 214 female dental nursing students, 1.4% of the respondents reported that they had been raped when they were five or six years old. The data suggest that sexual abuse is more common than is being reported to the police. The 2002 Rape Report quoted a local study by a doctor at the General Hospital in Kuala Lumpur, who estimated that only one in ten rape survivors report their rape.
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Figure 14:Number of reported cases of rape, by age of the survivors and year
Sources: (1)Rastam A, ed. The rape report: an overview of rape in Malaysia. AWAM and SIRD, 2002; (2) The Royal Malaysian Police.
Figure 15: Number of rape survivors who were students, by year
Sources: (1)Rastam A, ed. The rape report: an overview of rape in Malaysia. AWAM and SIRD, 2002; (2) The Royal Malaysian Police.
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Little information about the perpetrators is available. However data for 2000, 2001 and 2002 reveal that 6.4%, 6.6% and 7.4%, respectively, were students. Thus there seems to have been an increase in the number of adolescent perpetrators. Findings indicate that the rapist is often known to the victim, and that many cases of rape occur, not in isolated places, but in places assumed to be safe by the victims, suggesting an element of gullibility, and perhaps fear among the victims. This is also a clear indication of breach of trust, and suggests that the number of cases reported to the police is likely to be much lower than actual incidence, since many of the victims, especially the young, would be coaxed or coerced into keeping their silence. The fact that some perpetrators of rape are young people themselves, albeit not a very large proportion, is in itself a reflection of unhealthy behaviour among young people. Contrary to belief, only 20% of rapes took place in isolated places and 67% took place in the home or buildings (not hotels), places generally regarded as safe by women. Using 1988 data, analysis of the relationship of the perpetrator and the rape survivor revealed that 16% were strangers and 8% were new
acquaintances. The rest of the survivors knew the person who raped them, with 35% being colleagues or people from the same village, 19% boyfriends, 13% were cases of incest, 7% family members, and another 8% employers, teachers or the “Bomoh” (traditional medicine man). Incest is defined as being raped by a blood relative, and involves a severe breach of trust. The impact is often longlasting. Victims are often children and the violation has often occurred over a long period of time before being reported. Victims are forced into silence or, in some cases, made to take the blame. Because the Royal Malaysian Police classify suspects into specific categories, it is not possible to differentiate a blood relative from one who is related by marriage. Incest is assumed to be more serious than rape, not only from the point of view of unhealthy familial dynamics, but also the likelihood that it can be perpetrated over a longer period of time, especially if the girl is coaxed or coerced into silence. Further, the psychological effect of incest is more severe than rape considering the family relationships and the complexity of the factors that lead to incest and help to maintain it, including in many cases, the role and knowledge of the victim’s mother.
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3.3. Policies and legislation 3.3.1. Policies
(2) The National Adolescent Health Policy Malaysia is one of the first few countries in the WHO Western Pacific Region to have formulated a specific health policy for adolescents. In 2001, the National Adolescent Health Policy was launched. The policy is designed to “encourage and ensure the development of adolescents in realizing their responsibilities for health and empower them with appropriate knowledge and assertive skills to enable them to practice healthy behaviour through active participation.” It is a health policy, but it also addresses issues related to other sectors, such as social sectors, which involve the family, society, employment and the law.
The review revealed some very encouraging trends in terms of the overall policy environment concerning adolescent general health. However, it is also apparent that sexual and reproductive health is not being addressed as extensively as other areas of adolescent health, especially in government policies, which is a reflection of the sensitivity of the subject due to religious teachings and rules governing sexuality. From the literature reviewed, policies in Malaysia that address adolescent health can be divided into three areas: the overall policy environment; the National Adolescent Health Policy; and other, less specific (3) Other supporting policies policies that contribute to adolescent There are other specific policies in the health. health and health-related sectors that address adolescent health. The (1) Overall policy environment 1990 National Social Welfare Policy In the social sector, the three main emphasizes social integration, social agencies (health, education and social cohesion, community participation, welfare) have clear and deliberate policies social education, social development and that enhance the well-being and care of special groups to ensure optimal development of children, adolescents realization of potential and and young people. National policies opportunities. Among the special groups support the positive development of served are children, adolescents and children through education. However, women who are in difficult the literature suggests that little is being circumstances. The Education done regarding sex education in schools. Development Plan aims to ensure that
45
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
all citizens have access to 12 years of quality education. The National Youth Development Policy 1997 is designed for young people aged 18 to 25 years and advocates several health-promoting activities among young people. However, sexuality is still not explicitly addressed. There are also other initiatives to improve the health of young people. For example, Muslim couples intending to marry are required to undergo formal training to enhance their knowledge of the responsibilities of married life and parenthood before they can obtain a license to marry. Efforts have begun to introduce such a practice to the other religious groups in the country.
included, receive their sexual initiation upon marriage. Laws setting a minimum age for marriage are almost universal. The Malaysia civil law (Family Law on Marriage) states that a person must be at least 18 years of age, and the consent of parents/ guardian must be obtained for those older than 18 but younger than 21 years of age. Under Muslim law, the minimum age for girls to marry is 16 years, and for boys it is 18 years. Consent is a requirement for all girls and women, irrespective of age. (2) Abortion Laws authorize abortion only where the life or the health of the woman is threatened, Section 312 of the Penal Code allows ”medical practitioners registered under the Medical Act 1971 to terminate the pregnancy, if he/ she is of opinion, formed in good faith, that continuation of the pregnancy would pose a greater risk to the life, or mental or physical health of the pregnant woman than if the pregnancy were terminated”. The fatwa (Muslim ruling) on termination of pregnancy allows it with no conditions within 40 days of conception, and between 40 and 120 days on the condition that continuation of the pregnancy would endanger the health or life of the mother and fetus.
3.3.2. Legislation The protection of children, adolescents and young people is addressed by various laws. In many areas of sexual and reproductive health, especially those related to marriage, family and inheritance, there are different laws for Muslims (subject to Shari’ah law) and non-Muslims (subject to civil law). (1) Marriage, sexual relations In many societies, sexual relations and pregnancy are socially and legally acceptable only if they occur within marriage. Many individuals, adolescents 46
A Review of Literature and Projects 2005
(3) Protection against abuse and (4) Access to obscene materials exploitation The sale of obscene objects to young The Child Act 2001, which covers persons is addressed in Section 293 of persons under the age of 18 years and is the Penal Code. It states that “whoever in line with the Convention on the Rights sells, lets to hire, distribute, exhibits or of Child, provides protection for circulates to any person under the age children against abuse, exploitation and of 20 years any such obscene objects or violence. It is a promulgation of three offers or attempts so to do, shall be acts: the 1947 Juvenile Court Act; the punished with imprisonment for a term 1973 Protection of Women and Girls which may extend to five years or with a Act; and the 1991 Protection of Children fine or with both.” While the control of Act. The Penal Code (Act 574) addresses obscene material on the Internet is a very a minimum age for specific offences. The challenging issue, there are several cyber law protects children from being sold or laws that can be applied to protect young bought for the purpose of prostitution: people from such negative influences. “Whoever buys, hires or otherwise obtains possession of any person under (5) Access to and use of substances the age of 21 years with intent that such (drugs and tobacco) person shall be employed or used for the purpose of prostitution or illicit It is common for adolescents who use intercourse shall be punished with drugs and alcohol to engage in risky types imprisonment for a term which may of behaviour, including sex. Pertinent to extend to ten years and shall be liable to this is the law governing the sale of a fine.” A section addresses kidnapping tobacco products, by which a seller of a minor from lawful guardianship. It commits a crime if he sells tobacco to states that “whoever takes or entices any persons below 18 years. minor under 14 years for male, and 16 years for female, out of keeping of 3.4. Interventions the lawful guardian of such minor, without consent of such guardian, is said The review revealed that some to kidnap such minor from lawful interventions have been put in place to guardianship”. Regarding consent for respond to adolescent sexual and sexual relationships, the age of consent reproductive health needs. While there is 16 years for females and 13 years for are many kinds of intervention, two males. Any sexual relationship below the major types are described: education and age of consent is statutory rape
47
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
information; and services, especially education classes. Since 1994, elements health services. of FHE have also been introduced to primary-school children through physical 3.4.1. Education and information and health education. The aim of FHE is to help students learn about the While there are no laws requiring schools physical, educational and social changes to include sexuality education in their they undergo. FHE also gives them skills curricula, some efforts have been made to cope with those changes and maintain to address other aspects of adolescent healthy relationships with family health. The slow and uncertain uptake members, friends and other members of of sex education is due to the cultural the community. and religious realities of the country. Informal sex education has also taken At the same time, curricular materials and place outside the school setting, carried teaching strategies are tailored to suit the out by both governmental and special needs of schools in high-risk areas. Special projects, such as the nongovernmental agencies. Healthy Lifestyle Pilot Project and Preventive Education on HIV/ AIDS, (1) Formal (school) education are intervention programmes aimed at The Ministry of Education’s Family equipping both teachers and students Health Education programme provides with specific skills. For Muslims, sexual education and training to encourage and reproductive health is taught in healthy lifestyles and responsible living. Islamic Education, which is a Sex education or adolescent reproductive compulsory subject. It includes the health is called Family Health Education internalization of Islamic values and (FHE) in Malaysian schools, and is an good conduct, as well as practices educational programme designed to give contained in the instructions for the students accurate, up-to-date knowledge Muslim way and duties of life. about human sexuality — its biological, psychological, sociocultural and moral The Ministry of Education faces several dimensions. Since the implementation of challenges with FHE and Islamic the Integrated Secondary School Education. FHE, despite being around Curriculum in 1989, elements of FHE for many years, has not been as effective have been taught in secondary schools as was hoped. Monitoring efforts have through physical and health education, found that teachers either shy away from science, biology, moral and Islamic teaching the component or do not have 48
A Review of Literature and Projects 2005
the skills to deal with sensitive subjects. Such situations are lost opportunities because schools have the resources and facilities to make educational programmes work. (2) Infor mal education (out-of-school)
sign language, to ensure balanced coverage for all ethnic groups and the disabled. Another concern is the training of teachers, trainers, facilitators and counsellors to deliver effective sexuality education. Several training modules have been developed for health care workers, including one on health problems commonly encountered among adolescents and how to manage them, a module focusing on mental health of young people, and another on counselling techniques. There is also a document on standard operating procedures for managing adolescents’ clinics. More innovative approaches have been designed for education on sexual and reproductive health. For example, the FFPAM has developed the electronic Reproductive Health of Adolescents Module (e-RHAM), which will enable wider coverage and a more current mode of learning.
Several other agencies, in both the government and non-government sectors, have started programmes to address adolescent health. These are carried out through youth activities, the majority of which are community-based. Under the AIDS Prevention Programme, there is a special activity targeting young people on how to live a life free from HIV/AIDS using peer education. Other agencies involved in developing and implementing training modules related to adolescent health are NPFDB, the Muslim Religious Council, the Malaysian AIDS Council, FFPAM and other nongovernmental organizations. Education materials produced by religious government agencies do not cover topics related to sexuality and do not mention sexual harassment. The products of nongovernmental organizations are often more creative and explicit when compared with those produced by government agencies. There is concern about the availability of materials in multiple languages, including Braille and
3.4.2. Services Adolescents need a wide range of services, especially health services. While health care is the core function of the Ministry of Health, other government agencies also provide health care to young people. In addition, many nongovernmental organizations provide adolescent health services. 49
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
(1) The providers
• responding to the real needs of adolescents and young people;
Several government ministries are actively involved in activities related to • availability of and access to adolescent sexual and reproductive youth-friendly services; health, including the Ministry of Health, the Ministry of Education, the Ministry • active participation by adolescents in health-related of National Unity and Welfare Services, the Ministry of Women and Family activities; Development, and the Ministry of Youth and Sport. The police and local • intersectoral collaboration to authorities are also involved. The address the spectr um of FFPAM is a nongovernmental biological, social, economic, organization that provides family cultural and political factors that planning and reproductive health affect adolescents’ sexual and services to everyone, including young reproductive health; people. With branches in all the states, FFPAM provides static, as well as • community participation; outreach reproductive health services throughout the country. Other active • consideration of cultural nongovernmental organizations include sensitivity; and the Women’ Action Society Malaysia, the Women AIDS Organization (WAO), and • encouraging research to improve the Malaysian AIDS Council. The private services. sector provides curative and rehabilitative care at private hospitals and doctors’ (3) The content offices for those with illnesses related to sexual and reproductive health. Much of the reviewed literature emphasizes that services related to (2) The approach and principles contraception are only available for married young people through the family The review found several key principles planning services offered by the of adolescent health, most detailed in the respective agencies. However, it is Ministry of Health’s National Adolescent probable that unmarried young people Health Policy, including: avail of such services from the private sector and also from nongovernmental 50
A Review of Literature and Projects 2005
organizations. The situation appears ambiguous – while it is a religious ruling that disallows contraceptives from being provided to unmarried couples, it is most often taken to be an understanding that this should be so. There is no explicit policy to that effect and no laws to provide for it. Thus in non-government service outlets, young unmarried individuals may get advice and other services related to family planning. (4) Information system
Some of the literature reviewed mentions the need for an information system to capture relevant and useful information. A comprehensive national information system on adolescent health is especially important in planning, monitoring and evaluating activities, so that remedial action can be taken. Sharing and optimal use of data are also important for further research in relevant areas. There is also a need for better coordination of all parties involved, including community participation and active involvement.
4. Recommendations Based on the findings and the discussions on this review of adolescents’ sexual and reproductive health, the following seven recommendations are put forward: information about adolescent health. Bearing in mind the sensitivity of the subject, it will require innovation to identify effective approaches for public education and information.
4.1. Raising awareness
4.2. Strengthening sexual and Policy-makers should be better informed reproductive health education about the importance of adolescent health and sexual and reproductive health. They should also understand the serious consequences if this important issue is not addressed adequately. The general public plays an important role in supporting policies and programmes for adolescents. There is a need to use the mass media optimally, and to ensure that there are many avenues for disseminating The review found that many young people had expressed a need for more sexual and reproductive health knowledge. Current efforts in sexual and reproductive health education should therefore be scaled up. Two of the most significant findings from the review were: adolescents’ uneven knowledge on sexual and reproductive health; and, 51
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
where knowledge was high, the fact that it was not being applied by following safe practices. Sexuality education must also be designed to ensure that knowledge can be accompanied by skills. There appears to be a good amount of teaching material, but it is not being used optimally. The proposals for sexual and reproductive health education for those outside the school system, including very young children and pre-schoolers, should also be actively pursued. It is also recommended that current educational efforts and methods be evaluated, so that weaknesses and strengths can be identified and necessary improvements made.
Health care providers need to be aware of their own attitudes towards adolescents’ sexual and reproductive health. Health care workers will also need training in how to be sensitive to adolescents’ needs and concerns while still respecting cultural beliefs. Several reports state that services provided by the Ministry of Health are not adolescent-friendly. This is postulated to contribute to the underutilization of health services. In addition to the attitudes of service providers, the design and layout of clinics may also be discouraging young people from using them.
4.3. Strengthening ser vice It is challenging to reconcile ideal goals provision While the Ministry of Health and several other agencies have begun to provide adolescent health services, the content emphasis is less on sexual and reproductive health and more on general health. It will require motivated health service providers to carry out sexual and reproductive health services, including counselling. However, many health providers do not have enough knowledge and skills to do so. Efforts begun by the Ministry of Health to develop modules for health providers should be continued and strengthened. 52
4.4. Clarifying policies
with what happens in reality with respect to service provision regarding such areas as pre-marital sex and non-use of contraceptives among young people engaged in sex. Such a difficulty, however, should not be seen as an insurmountable barrier. More efforts should be made to consult with religious leaders and other community leaders. It is suggested in some of the literature that not enough effort has been made to reconcile educational and other policies with social and religious values and rulings.
A Review of Literature and Projects 2005
4.5. Enforcing existing laws and partnership, and these must be pursued actively by all agencies, such as by making new laws
for ming a task force involving all There are laws protecting young people, concerned. such as those prohibiting sexual violence. However, several reports claim that 4.7. Conducting more research enforcement may not always be optimal. Some studies suggest that the rate of There are several gaps in current reporting is low, and that there is likely knowledge on adolescents’ sexual and to be a higher incidence of sexual abuse reproductive health in Malaysia. For than reported. Therefore it is example, there is little information about recommended that the reporting system abortion, and such knowledge could be be improved. Efforts should be made to useful in making policies and designing identify new areas for legislation, such intervention strategies. It could also as a stronger, more explicit policy on highlight the impact of current policies. There is no information about sexual sexuality education. development, except concerning wet 4.6. Strengthening interagency dreams and onset of menarche. Research is needed to identify the best approaches partnerships for adolescents’ sexual and reproductive health education, and to evaluate the Since it is clear that many agencies need impact of such education. There is also to be involved in adolescents’ sexual and a need to improve and standardize reproductive health, interagency research methods to obtain reliable partnership and coordination is crucial. infor mation. Non-threatening Some studies suggest that schools have approaches should be used to gather been unable to carry out sexual and information from and about adolescents. reproductive health education because It is also recommended that all agencies of a shortage of trained teachers, but that should coordinate their research, so that they have not tried to get support from important areas are covered and other agencies or nongovernmental duplication is avoided. organizations. Several approaches can be identified to strengthen interagency
53
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
5. Conclusions Adolescent health is increasingly being recognized as an important component of a country’s well-being and of health services provision. Like many other countries, Malaysia will need to increase efforts in this area, based on adequate information and evidence. There are several studies and much literature produced by many sectors and individuals interested and involved in adolescent health. However, while they contain useful information, it is scattered and fragmented. This review has managed to bring together some of that information, and the analyses carried out have provided an impetus for more work to be done towards improvement of adolescent health in terms of policies, strategies, activities and interventions.
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A Review of Literature and Projects 2005
Annex 1. List of literature search on adolescent sexual and reproductive health in Malaysia No Title 1 2 Remaja dan AIDS (Adolescents and AIDS) Penilaian Intervensi Sosial PROSTAR Terhadap Kesedaran AIDS di Kalangan Remaja (Evaluation of PROSTAR as Intervention for increasing awareness on AIDS among adolescents) HIV /AIDS: the realities, the challenges Malaysian Health and Lifestyle Survey 1992 Consensus report on STI, HIV/AIDS epidemiology, Malaysia Prevalence survey of STD among sex workers and women attending antenatal clinics 19992000 HIV/AIDS epidemic in Malaysia HIV AIDS situation, Malaysia HIV seroprevalence and behaviour among long distance drivers HIV seroprevalence and behaviour among inmates in Pusat Serenti Behavioral survey of commercial sex workers in Kuching HIV seroprevalence survey of commercial sex workers in Kuala Lumpur HIV seroprevalence among pregnant women in KL HIV seroprevalen dan factor yang mempengaruhi nya di kalangan nelayan (HIV seroprevalence and factors affecting it among fishermen) Family profile Organization/s AIDS Unit, Ministry of Health, Malaysia HIV AIDS Unit, Ministry of Heath, Malaysia Source Individual/s Rahim SA, Herman I Year 1996 Published or Not Yes/ Type No Yes Text Yes Text Theme reproductive health status. Intervention (services)
3 4
Ministry of Health, Malaysia AIDS Unit, Ministry of Health, Malaysia Ministry of Health, Malaysia WHO Western Pacific Regional Office/ Ministry of Health, Malaysia AIDS Unit, Ministry of Health, Malaysia AIDS Unit, Ministry of Health, Malaysia AIDS Unit, Ministry of Health, Malaysia AIDS Unit, Ministry of Health, Malaysia AIDS Unit, Ministry of Health, Malaysia AIDS Unit, Ministry of Health, Malaysia AIDS Unit, Ministry of Health, Malaysia AIDS Unit, Ministry of Health, Malaysia
Riji HM, PatakiSchweizer KJ -
2002 1992
Yes Yes
Report/ Monograph Report
5 6
-
2001 2000
Yes Yes
Report Report
Reproductive health status, challenges Reproductive health status demographic profile Reproductive health status Reproductive health status
7 8 9 10 11 12 13 14
Kasri AR Kasri AR -
2002 2001 1998 2001 2000 1999 1997
No No No No No No No No
Ministry of Health Report/ Updates Ministry of Health Report Report Report Report Report Report Report
Reproductive health status Reproductive health status Reproductive health status Reproductive health status Reproductive health status Reproductive health status Reproductive health status Reproductive health status
15
National Population and Family Development Board, Malaysia (NPFDB)
1999
Yes
Report
Reproductive health status Demographic profile
55
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
No Title 16 Population profile
Organization/s NPFDB
Source Individual/s -
Year
Published or Not Yes/ Type No Yes Report
Theme Reproductive health status Demographic profile Reproductive health status, KAPB, Problems, Challenges & Recommendations Intervention (Services)
17
NPFDB National Study on Reproductive Health and Sexuality of Adolescents in Malaysia
Karim R
1996
Yes
Executive summary
18
19
V2F Project: Study of reproductive health of adolescents in MalaysiaAnnual report 1996 The rape report 2002
NPFDBM, FFPAM, Ministry of Health, Malaysia Royal Malaysian Police
-
1997
Yes
Report
-
2002
No
Report
20 21
Penal Code (Act 574) Sexual and reproductive health education in schools – Family health education and Islamic education: the curriculum, implementation and challenges Laporan Kumpulan Kerja Teknikal Mengkaji Isi Kandungan Bahan Pendidikan Kesihatan Reproduktif / Seksualiti (Report of TWG on content for sexual and reproductive health education) Study on health and behavioral problems of adolescents: a schoolbased intervention program Predictors of high-risk adolescents to sexual behaviour
Legal Research Board Curriculum Development Centre, Ministry of Education, Malaysia
Maimunah SZ
2000 2003
Yes No
22
Kementerian Pendidikan Malaysia (Ministry of Education)
2002
Yes
Reproductive health status Demographic Profile Text Laws & policies Paper presented Intervention at Seminar on (Education) National Problems, Advocacy On Challenges & Educating Young RecommendaPeople About tions. Sreproductive health Rights 23-24 March 2003 Technical Intervention Working Group (Education) Report
23
Public Health Dept, HUKM
Hanafiah MS et al
1996 – Yes 1999
24
Public Health Dept, HUKM
Hanafiah MS et al
Aug 1992
No
25
Adolescent problems and Public Health Dept, HUKM parental roles- A case study Induced abortions among Public Health Dept, HUKM women in KL (Epidemiological features and reasons for induced abortions among women in KL)
Hanafiah MS et al
Feb 1992
Yes
26
Hanafiah MS et al
1989
Yes
Public Health Intervention, Bulletin 2000 KAPB, (Special Edition) Areproductive health concerns & needs Paper presented Reproductive at HUKM health status of women, reproductive health concerns & needs Proceedings of Areproductive 2nd National health needs & Conference on concern Caring Society, Reproductive ISIS, Malaysia health status Research Priority Reproductive health status of women
56
A Review of Literature and Projects 2005
No Title 27 Psychosocial problems among female adolescents from two schools in KL An important predictor of potential child neglect among adolescents Contraception practices among unmarried women versus married women Study on health and behavioural problems of adolescents: a school based intervention programme Perbandingan perilaku pelajar di antara Sek. Men. Agama dan Sek. Men Kebangsaan (Comparative study on the behaviour of students in religious school and secular school) Masalah disiplin remaja: hubungannya dengan status interaksi remaja dengan ibu bapa di kalangan remaja sek. men. di Gombak (Adolescent disciplinary problems associated with parental interaction, in Gombak District) Cabaran-cabaran dalam melakukan intervensi terhadap remaja (Challenges in carrying out interventions among adolescent) Faktor risiko dan perilaku berisiko tinggi di kalangan remaja awal perbandingan etnik (Risk factors and high risk behaviours among early adolescence by ethnic) Kajian perbandingan antara remaja berisiko dan remaja normal mengenai kaedah keibubapaan (Comparatve study on parenting method between high risk and normal adolescents) Kajian terhadap keluarga yang mempunyai remaja berisiko tinggi, terhadap intervensi bersandar komuniti (Study on families with high-risk adolescents)
Organization/s Public Health Dept, HUKM Public Health Dept, HUKM Public Health Dept, HUKM Public Health Dept, HUKM
Source Individual/s Hanafiah MS et al
Year 1993
Published or Not Yes/ Type No Yes Medical journal of UKM, 1993, 15(2):143-149 Yes
Theme
28
Hanafiah MS et al
1994
29 30
Hanafiah MS et al Hanafiah MS et al
1989 1999
Yes
reproductive health status reproductive health status 10th International Reproductive health status Congress on Child Abuse and Neglect Reproductive health status IRPA Report Reproductive health status
31
Public Health Dept, HUKM
Hanafiah MS et al
2000
Yes
National Education Seminar Proceedings
Reproductive health status
32
Public Health Dept, HUKM
Hanafiah MS et al
2000
Yes
National Education Seminar Proceedings
Reproductive health status and reproductive health concerns and needs Intervention Reproductive health status Intervention
33
Public Health Dept, HUKM
Hanafiah MS et al
2002
No
Report paper
34
Public Health Dept, HUKM
Hanafiah MS et al
NA
N A Report paper
Reproductive health status, Concerns and needs
35
Public Health Dept, HUKM
Hanafiah MS et al
2003
Yes
IRPA Report
Reproductive health status, Concerns & needs
36
Public Health Dept, HUKM
Hanafiah MS et al
2003
Yes
Report
Reproductive health status
57
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
No Title 37 Comparison of parenting practice Between High Risk Adolescent and Low Risk Adolescent in Selayang Selangor Cabaran Remaja di Alaf Baru: Dari Perspektif Ibu Bapa (Adolescent challenges in the new era: from parents' perspective) Challenges in school and community-based Interventions for highrisk adolescents Perbandingan persepsi interaksi antara anak remaja, ibu dan bapa bagi remaja berisiko tinggi (Comparative study on the perception of interaction between highrisk adolescents and their parents) Status of Islamic religiosity among early adolescents with high-risk behaviours in a secondary school in Gombak district Pengetahuan Amalan dan Penghayatan Agama Islam Di Kalangan Remaja Awal Berisiko Tinggi Dalam Satu Program Intervensi Khemah Ibadat (Knowledge, practice and Islamic religiosity among high-risk adolescents in a religious intervention programme) Adolescents academic achievement and family factors Perbandingan status interaksi remaja dan ibubapa di kalangan bangsa (Comparative study on status of interaction between adolescents and parents by ethnics) Perbandingan status fungsi keluarga di kalangan bangsa (Comparative study on status of family function by ethnicity)
Organization/s Public Health Dept, HUKM
Source Individual/s Hanafiah MS et al
Year 2000
Published or Not Yes/ Type No Yes Paper presented at IRPA Conference NA Report
Theme Reproductive health status, KAPB Reproductive health status, Concerns and needs Intervention, Reproductive health concern and needs Reproductive health status concern & needs
38
Public Health Dept, HUKM
Hanafiah MS et al
1998
39
Public Health Dept, HUKM Public Health Dept, HUKM
Hanafiah MS et al
2003
Yes
Report
40
Hanafiah MS et al
2002
Yes
Colloquium
41
Public Health Dept, HUKM
Hanafiah MS et al
2002
Yes
Colloquium
42
Public Health Dept, HUKM
Hanafiah MS et al
2002
Yes
9th National Public Health Colloquium
Reproductive health status, Reproductive health concerns and needs Reproductive health status
43
Public Health Dept, HUKM Public Health Dept, HUKM
Hanafiah MS et al
2002
Yes
44
Hanafiah MS et al
2001
No
Symposium Family Health and Family Lifestyle Poster presentation
Reproductive health status Reproductive health status
45
Public Health Dept, HUKM
Hanafiah MS et al
2001
No
Poster presentation
Reproductive health status
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A Review of Literature and Projects 2005
No Title 46 Perbandingan status kemahiran keibubapaan di kalangan bangsa (Comparative study of parenting skill status by ethnicity) Adolescents risk behaviours and relationships with family background and parenting technique The promoting and preventing factors towards negative behaviour among school adolescents Perbandingan teknik keibubapaan antara Melayu dan bukan Melayu di kalangan remaja berperilaku negatif (Comparison of parenting technique in Malays and non Malays among adolescent with negative behaviours) Kajian terhadap pengetahuan dan sikap pelajar yang merokok mengenai masalah merokok dan bahayanya (Study on knowledge and attitude of students who smoke on problems and dangers of smoking) How much change could be seen if counselors were used to doing family counselling activities in the community? Masalah disiplin remaja: hubungannya dengan status interaksi remaja dengan ibu bapa di kalangan pelajar sekolah menengah di daerah Gombak (Disciplinary problems and their relationship with parents among secondary school in Gombak district)
Organization/s Public Health Dept, HUKM
Source Individual/s Hanafiah MS et al
Year 2001
Published or Not Yes/ Type No No Poster Presentation
Theme Reproductive health status
47
Public Health Dept, HUKM
Hanafiah MS et al
2001
Yes
Reproductive 1st Asean health status, Conference on Medical Sciences Intervention Conference Reproductive health status, Intervention Reproductive health status, Intervention
48
Public Health Dept, HUKM
Hanafiah MS et al
2001
Yes
49
Public Health Dept, HUKM
Hanafiah MS et al
2001
Yes
Conference
50
Public Health Dept, HUKM
Hanafiah MS et al
2001
Yes
2nd National Public Health Conference
KAPB, Reproductive health status
51
Public Health Dept, HUKM
Hanafiah MS et al
2001
Yes
Malaysian journal Intervention of public health (services) medicine, 2002, Vol 2(2): 27-31 National Education Seminar Proceedings Reproductive health status, KAPB, Intervention
52
Public Health Dept, HUKM
Hanafiah MS et al
2000
Yes
59
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
No Title 53 Ciri-ciri remaja berisiko tinggi dan persepsi mereka tentang interaksi mereka dengan ibu bapa, keterampilan keibubapaan dan status fungsi keluarga (Characteristics of highrisk adolescents and their perception towards interaction with their parents, parents' personalities and family functions) Masalah disiplin remaja dan kaitannya dengan faktor amalan keibubapaan : kajian di kalangan remaja Sekolah Menengah di Daerah Gombak (Discipline problems among adolescents and relationship with parenting styles; study among adolescents in a secondary school in Gombak district) Perbandingan perilaku pelajar diantar sekolah menengah agama dan sekolah menengah kebangsaan (Comparative study on students behaviour in secondary religious and secular schools ) Kajian terhadap keluarga yang mempunyai remaja berisiko tinggi (Study on families with high-risk adolescents) Kertas kerja cabaran remaja di alaf baru (Adolescent challenges in the new era) Remaja dan undangundang pemahaman dan penerimaan di kawasan Bandar dan Luar bandar (Adolescent and Laws, the understanding and acceptance in the Urban and Rural areas) PenganiayaankKanakkanak suatu bahagian yang diabaikan : sekolah (Child Abuse: a neglected area in school)
Organization/s Public Health Dept, HUKM
Source Individual/s Hanafiah MS et al
Year 2000
Published or Not Yes/ Type No Yes 7th National Public Health Colloquium
Theme Reproductive health status, KAPB, Intervention
54
Public Health Dept, HUKM
Hanafiah MS et al
2000
Yes
7th National Public Health Colloquium
KAPB, Intervention
55
Public Health Dept, HUKM
Hanafiah MS et al
2000
Yes
7th National Public Health Colloquium
Reproductive health status, KAPB, Intervention
56
Public Health Dept, HUKM
Hanafiah MS et al
2000
Yes
IRPA Technical Report
Reproductive health status, Demographic profile Reproductive health status Policies and legislation
57
Public Health Dept, HUKM Law Faculty, UKM
Hanafiah MS et al
1998
No
Paper presentation Thesis
58
Mohamed ARB
1994
No
59
Law Faculty, UKM
Noh ABA
1993
No
Thesis
Reproductive health status
60
A Review of Literature and Projects 2005
No Title 60 Undang-undang kanakkanak di Malaysia: hak dan tangunggan di bawah undang-undang torts, kontrak dan jenayah ( Laws on children in Malaysia) Pusat perlindungan wanita dan gadis (masalah gadis bawah umur) masalah perlindungan dari segi undang-undang dan cara penyelesaian. Kajian khas di Taman Seri Puteri, rembau, negeri sembilan (Protection homes for women and girls, protection problem from the legal perspective and its solution) Welfare of the child: the role and effectiveness of child welfare homes Penderaan kanak-kanak di Malaysia: Kajian dari segi sosio undang-undang (Child abuse in Malaysia : study from social legal perspective) Child abuse: How far does the law protect the abused, with special reference to the Federal Territory of Kuala Lumpur Penahanan juvana dibawah akta Mahkamah Juvana 1947: Kajian Khusus di W. Persekutuan (Juvenile detention under the Juvenile Court Act 1947: specific study in Federal Territory) Laporan Persidangan Nasional Mengenai Kaum Remaja Di Malaysia ( Report of the National Conference on Adolescents in Malaysia) Buletin Perangkaan Kebajikan 1999 ( Welfare Statistics Bulletin 1999) Laporan tahunan 1990 ( Annual report 1990) Laporan tahunan 2001 (Annual report 2001)
Organization/s Law Faculty, UKM
Source Individual/s -
Published or Not Yes/ Type No 1991- No Thesis 1992 Year
Theme Policies and legislation
61
Law Faculty, UKM
Mustapha MA
1995
No
Thesis
Policies and legislation
62 63
Law Faculty, UKM Law Faculty, UKM
Abdullah MB Yusuf RB
1991 1994
No No
Thesis Thesis
Intervention Policies and legislation
64
Law Faculty, UKM
Kamaruzzaman SB
1989
No
Thesis
Policies and legislation
65
Law Faculty, UKM
Rose SC
1995
No
Thesis
Policies and legislation
66
Education Faculty, University Malaya (UM)
-
1982
Yes
Conference report
Demographic profile, Reproductive health status, KAPB Demographic profile, reproductive health status Demographic profile, Reproductive health status Demographic profile, Reproductive health status
67
Dept of Social Welfare, Malaysia Dept of Social Welfare, Malaysia Dept of Social Welfare, Malaysia
-
1999
Yes
Annual Report
68
-
1990
Yes
Annual Report
69
-
2001
Yes
Annual Report
61
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
No Title 70 71 Juvana era Gglobalisasi (Juveniles in the globalization era) Dasar Kebajikan Masyarakat Negara (National Social Welfare Policy) Remaja dan strategi penyelesaian masalah (Adolescents and problem-solving strategies) Bohsia mengenal punca dan permasalahanya (Causes and solution of “Bohsia” problem among adolescents) Tingkah laku lepak di kalangan remaja (Loafing behaviour among adolescents) Gaya hidup remaja masakini (Adolescent current lifestyles) Seksualiti manusia keharmonian jalinan antara jantina (Human sexuality by gender) Juvenile delinquency: a study report
Organization/s Dept of Social Welfare, Malaysia and UNICEF Ministry of Social Welfare and National Unity, Malaysia -
Source Individual/s -
Published or Not Yes/ Type No Tiada Yes Dept. Report Year Tiada Yes National Policy
Theme Intervention (Services) Policy
72
Siraj S
2000
Yes
Text
73
Islamic Religious Dept., Prime Minister'sDept., Malaysia Ministry of Youth and Sports, Malaysia ITM
-
1994
Yes
Text
74
Rahim SA
1994
Yes
Text
75
Shah AI et al
1999
Yes
Text
Reproductive health concerns and needs, Intervention Reproductive health status, Challenges and recommendations Reproductive health status, KAPB . Reproductive health status, KAPB Reproductive health status
76
-
Sidi H, Shaharom MH, Hassan R
1999
Yes
Text
77 78
Malaysian Crime Prevention
Kasmini K et al Majzub RM
2001 1998
Yes Yes
Report Text
Memahami jiwa dan minda remaja (Understanding the soul and mind of adolescents) Jenayah remaja permasalahan dan penyelesaian (Adolescent crimes: problems and solutions) Membina kesejahteraan remaja (Developing adolescent well-being) Titian remaja kearah kedewasaan (From adolescent to adulthood) -
79
Ghani HB, Rahman MSA
1995
Yes
Text
80
-
Noor ABM, Herman I Sherina
1995
Yes
Text
KAPB, Reproductive health status Reproductive health status, Challenges and recommendations Reproductive health status, Adolescent reproductive health, Concerns and needs Reproductive health status Reproductive health status, Adolescent reproductive health, Concerns and needs Adolescent reproductive health, Concerns and needs, Intervention
81
-
1996
Yes
Text
82
Panduan membimbing remaja (Guideline for adolescents)
-
Hamzah RK
1995
Yes
Text
62
A Review of Literature and Projects 2005
No Title 83 Remaja dan cabaran hidup (Adolescent and life challenges)
Organization/s -
Source Individual/s Hamzah RK
Year 1994
Published or Not Yes/ Type No Yes Text
Theme Adolescent reproductive health, Concerns and Needs,Interven tion (Education) Intervention Reproductive health status, Adolescent reproductive health concern and needs. Intervention (Services) .
84 85
Rakan Muda Yakin Boleh Ministry of Youth and Sports, Malaysia Masalah Remaja Daripada Keluaga Tunggal (Problems of adolescents in the single family) Laporan Tahunan Institut Kefahaman Islam Malaysia (IKIM) (Institute of Islamic Understanding Annual Report) Perangkaan pendidikan Malaysia 2001 (Education statistics 2001) Perangkaan pendidikan 2003 (Education statistics 2003) Malaysia educational statistics: Quick facts 2002 Nilai Keadaan Jenayah Di Malaysia Bagi Tahun 1995 (Crime situation in Malaysia 1995) Data Jenayah Rogol 1991-1998 & 2000-2003 (Data on rape 1991-1998 and 2000-2003) Epidemiology of substance use among urban secondary school children in Kuala Lumpur Risk factors of cigarette smoking among secondary school adolescents in Kuala Lumpur Adolescent health and development policy: Country case study Malaysia's experience in capacity building in adolescent health (including RH) IKIM
Hussin S, Omar CZ
2000 2002
Yes Yes
Report Text
86
-
2001
Yes
Annual Report
87
Ministry of Education, Malaysia Ministry of Education, Malaysia Ministry of Education, Malaysia Royal Malaysian Police
-
2002
Yes
Report
Intervention (Education) Intervention (Education) Intervention (Education) Reproductive health status
88
-
2003
Yes
Report
89 90
-
2003 1995
Yes Yes
Report Report
91
Royal Malaysian Police
-
2003
No
Report
Reproductive health status Reproductive health status
92
Institute of Medical Research
Hanjee K et al
1995
Yes
93
Institute of Medical Research
Hanjeet K et al
1995
Yes
94 95
Ministry of Health, Malaysia Ministry of Health, Malaysia
Awin N, Norbaya S Awin N
2002 2000
Yes Yes
Drugs: Education, prevention and policy, Vol 4, No. 2, 1997 Journal of international medical research, (2001); 5(2), 5963 Report of case study by Ministry of Health Paper presented at National Congress of Perinasia & International Symposium, Semarang Indonesia 18-21 Nov 2000
Reproductive health status
Policy Interventions, Problems, challenges and recommendati ons
63
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
No Title 96
Organization/s
Source Individual/s Awin N
Year 2002
Sexual and reproductive Ministry of Health, health of young people in Malaysia Malaysia- The national perspective Prevention strategies in adolescent health National Adolescent Health Policy Summary of reports related to adolescentfriendly services Enhancing the quality and improving the accessibility of schoolgoing adolescents to the health services they need Program Kesihatan Remaja Daerah Jasin Melaka 2002 (Adolescent health programme in Jasin District, Melaka, 2002) Perlaksanaan Projek Kesihatan Remaja, Klinik Kesihatan Bukit Waha, Kota Tinggi, Johor (Implementation of theAdolescent Health Project in Bukit Waha Health Clinic, Kota Tinggi, Johor) .Laporan Program Kesihatan Remaja Daerah Kesihatan Kluang (Report on the Adolescent Health Programme in Kluang District, Johor) Laporan Latihan Kesihatan Remaja (Adolescent health training report) Faktor-faktor yg menyebabkan berlaku masalah juvana di kalangan remaja: kajian kes di Asrama Rusila, Terengganu (Factors related to juvenile problems in Rusila Hostel, Trengganu) Penghayatan agama dan kesejahteraan sosial. Kajian mengenai remaja Melayu di Sek. Tunas Bakti Sg Lereh, Melaka (Religious adherence and social wellbeing: A study among Malaya adolescents in Tunas Bakti Sg Lereh School, Melaka) Ministry of Health, Malaysia Ministry of Health, Malaysia Ministry of Health, Malaysia Ministry of Health, Malaysia
97 98 99 100
Awin N -
2001 2000 2000
Published or Not Yes/ Type No Yes Seminar Paper; National Youth Seminar, Kuala Lumpur, 9 August 2002 Yes Report Yes Yes No Policy
Theme Reproductive health status
Interventions (Services) Policy
Interventions Report by FHDD, Ministry (Services) of Health Interventions Project report (Services) . Project report Interventions
101
District Health Office, Jasin Melaka
-
2002
No
102
Ministry of Health, Malaysia
-
1999
No
Project report
Interventions (Services)
103
Ministry of Health, Malaysia
-
1999
No
Programme report
Intervention (Services)
104
National Health Institute, Ministry of Health, Malaysia Public Health Department, UUM Taib A
1999
No
Programme report Thesis
Intervention (Services) Reproductive health status, needs and concerns, Qualitative study
105
November 2002
No
106
Public Health Department, UM
Musa M
1997
No
Thesis
Reproductive health status, KAPB, Qualitative study
64
A Review of Literature and Projects 2005
No Title 107 Pengaruh gaya asuhan ibubapa terhadap personality remaja: Satu kajian di dua buah pusat pemulihan akhlak dan di dua buah sekolah menengah luar Bandar (Influence of parenting styles on adolescent personality : A study in two moral rehabilitation centres and two secondary schools) 108 Kajian penerimaan terhadap remaja di Pusat Pemulihan Akhlak:Kajian kes dari perspektif pelajar sekolah Tunas Bakti, Teluk Air Tawar, P.Pinang ( A study on the acceptance of adolescents in rehabilitation centres: Ccse study from the inmate's perspective) 109 Perlakuan jenayah remaja lelaki di Malaysia: Kajian kes di Sekolah Tunas Bakti, Sg Besi (Criminal acts among male adolescents in Malaysia) 110 Pendidikan dan Amalan Keagamaan di kalangan remaja perempuan delinkuen dan bukan delinkuen (Education and religious practice among female delinquent and nondelinquent adolescents) 111 Persepsi Juvana Delinkuen terhadap keberkesanan Program Rawatan Pemulihan Akhlak di Sekolah Tunas Bakti Telok Air Tawar, Butterworth (Juvenile delinquents' perceptions of the effectiveness of the rehabilitation programme at Tunas Bakti School in Butterworth) 112 Dinamika keberkesanan program pemulihan dari perspektif penghuni pusat pemulihan akhlak: Satu kajian kes (Dynamics of the effectiveness of rehabilitation programmes at rehabilitation centres from the inmates' perspective)
Organization/s Public Health Department, UPM
Source Individual/s Selamat S
Year 1993
Published or Not Yes/ Type No No Thesis
Theme Interventions, Psychology, KAPB, Needs and concern s, Qualitative study
Public Health Department, UPM
Ibrahim NM
2001
No
Thesis
Reproductive health status, KAPB
Public Health Dept. UKM
Ahmad H
2002
No
Thesis
Reproductive health status, KAPB
Public Health Dept. UPM
Sulaiman N
1998
No
Thesis
Intervention KAPB
Public Health Dept. UPM
Salleh SR
1999
No
Thesis
Reproductive health status, KAPB, Qualitative study
Public Health Dept. UKM
Soaid M
2003
No
Thesis
Intervention, Adolescent reproductive health, Needs and concerns
65
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
No Title 113 Faktor kenakalan remaja lelaki, kes kajian di Sekolah Tunas Bakti lelaki, Jerantut, Pahang (Delinquent factors of male adolescents in Tunas Bakti School, Jerantut, Pahang) 114 Hubungan faktor pendorong remaja lari dari rumah dgn konsep kendiri (Relationship between self esteem and factors that prompt adolescents to run away from home) 115 Perangkaaan Penting Malaysia (Edisi Khas) 2000 (Vital Statistics Malaysia, Special edition 2000) 116 Laporan Persidangan Tinjauan Kesihatan dan Morbiditi Kebangsaan Kedua (2nd National Health Morbidity Survey Report) 117 Annual Report Ministry of Health 118 Family Health Sub System, Health Management Information System, 2001 119 Report on the confidential enquiries into maternal deaths In Malaysia 1995-1996 120 Perkembangan Pertimbangan Moral di Kalangan Kaum Remaja Melayu di Pulau PinangSatu Kajian Perkembangan (Moral development among Malay adolescents in Penang) 121 Youth problems and the role of public opinion research in Malaysia 122 Knowledge of sex education, sexually transmitted diseases and contraception among undergraduates of University Malaya 123 Knowledge and attitudes of Malaysian adolescents towards family planning
Organization/s Public Health Dept. UUM
Source Individual/s Idris NA
Year 2002
Published or Not Yes/ Type No No Thesis
Theme Reproductive health status, KAPB
Public Health Dept. UKM
Sharip S
1995
No
Thesis
Reproductive health status, Adolescent reproductive health, Needs and concerns Demographic Profile
Statistics Dept. Malaysia -
2000
Yes
Report
Ministry of Health
-
1997
Yes
Report
Ministry of Health Ministry of Health
-
2000 2001
Yes Yes
Report Report
Reproductive health status, Adolescent reproductive health, Needs and concerns Demographic profile, Intervention Reproductive health status
Ministry of Health
-
1996
Yes
Report
Reproductive health status Demographic, cultural, ethnic and geographic influences
FSKK, UKM
Noor AM et al
1992
No
Thesis
The School of Ahmad M Communication, University of Washington, Seattle, USA Dept. of Pharmacy, Rusli RA Faculty of Medicine, UM
1976
No
Thesis
Reproductive health status, Cultural, ethnic and geographic influences
2003
No
Thesis
HeRDU, Faculty of Medicine, UM
Low WY, Zulkifli SN, Yusof K
1994
Yes
Singapore Journal Reproductive health status, of Obstetrics. and Gynaecology, KAPB Nov 1994:25(3): 279-288
66
A Review of Literature and Projects 2005
No Title 124 Dating Behaviour and premarital intimacies 125 Sexual health education for youths A Malaysian experience
Organization/s HeRDU, Faculty of Medicine, UM HeRDU, Faculty of Medicine, UM
Source Individual/s Low WY, Yusof K Low WY, Zulkifli SN
Year 1988 1999 /2000
Published or Not Yes/ Type No No Thesis Yes Asia-Pacific journal of public health, 2000; 12(Supp): S58S66 Singapore journal of obstetrics and gynaecology, July 1987; 18(2): 59-66 Thesis
Theme Reproductive health status Intervention
126 A cross-cultural study of HeRDU, Faculty of Medicine UM sexual knowledge and attitudes toward sexuality 127 Review of the importance of family planning with reference to high-risk pregnancies in Malaysia 128 Emerging issues in sexuality in Malaysia HeRDU, Faculty of Medicine, UM
Low WY
1987
Yes
Reproductive health status, KAPB Intervention
Low WY, Yusof K
1988
No
HeRDU, Faculty of Medicine, UM
-
1997
Yes
129 Sexual activities of Malaysian adolescents 130 SexualpPractices in Malaysia: determinants of sexual intercourse among unmarried youths 131 Socio-medical aspects of transsexuals in Kuala Lumpur 132 Sexual behaviour and HIV knowledge among Dermatology cum Genitourinary Clinic attendees in Johor Bahru, Malaysia 133 Adolescents sexuality in Kuala Lumpur City 134 Sexuality and sexual problems in the Malaysian context 135 K.A.P study of family planning among Orang Asli women of Kuala Langat District, Selangor D. Ehsan 136 Family planning and sex education in sexually transmitted diseases (STD)
HeRDU Zulkifli SN, Faculty of Medicine, UM Low WY, Yusof K HeRDU Zulkifli SN, Faculty of Medicine, UM Low WY HeRDU Low WY, Yong YL, Faculty of Medicine, UM Yusof K
1986
Yes
2000
Yes
1997
Yes
HeRDU Choon SE et al Faculty of Medicine, UM
1997
Yes
Report International Conference On Expanding Choices For Women, 2-4 April 1997 Ed. J.Mbarker; pp 27-34 Medical journal of Malaysia Mar.1995; 50(1): 4-10 Journal of adolescent health 2000; 27(4); 276280 Singapore journal of obstetrics and gynaecology, July, November 1997; 28(2-3): 64-69 Medical journal of Malaysia Dec. 1997; 52 (4): 318-324 Project Report Data Analysis for sample surveys Medical journal of Malaysia Mar 1995; 50(1): 1-3 Malaysian Journal of Reproductive Health, 1990;8(2): 72-76. Malaysian Journal 0f Reproductive Health, Dec 1989; 7(2): 92-158
Reproductive health status
Reproductive health status Reproductive health status Reproductive health status, Cultural, ethnic & geographic influences Reproductive health status
HeRDU Low WY, Zulkifli Faculty of Medicine, UM SN,Yusof K Medical Library Faculty Medicine, UM Medical Library Faculty Medicine, UM Deva MP Yahya Baba
1988 1995 1998
Yes Yes Yes
Reproductive health status Reproductive health status Reproductive health status, KAPB
Medical Library Faculty Medicine, UM
Suan AE
1988
Yes
Medical Library 137 Characteristics of patients referred for HIV Faculty Medicine, UM pre-test counselling at University Hospital Kuala Lumpur 1991-1994
Yen B, Teng CL, Shajahan MYM
1994
Yes
Intervention, Problems, challenges & recommendations Medical Journal Reproductive health status, of Malaysia, Sept 1996; 51(3): Problems, challenges & 317-322 recommendations
67
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
No Title 138 Knowledge, attitude and behavioural tendency regarding AIDS in lower secondary schools in Petaling District, Selangor 139 A study of knowledge and attitudes towards contraception among health care staff in Kelantan (Malaysia) 140 The problem teenager
Organization/s Medical Library Faculty Medicine, UM
Source Individual/s Lokman AR Osman A, Kasmini K
Year 1994
Published or Not Yes/ Type No Yes Medical Journal of Malaysia, Sept 1996; 51(3): 372379 Yes
Theme Reproductive health status, KAPB
Medical Library Faculty Medicine, UM
Suhaimi H, Monga D, Siva A
1996
Reproductive Singapore Medical Journal health status, 1996;Vol 37:51-54 KAPB Medical Journal of Malaysia, Oct 2002; 57 (Supp D): S 73 Medical Journal of Malaysia, Oct 2002; 57 (Supp D); S73 Medical Journal of Malaysia, Oct 2002; 57 (Supp D): S75 Malaysian Journal of Reproductive Health, 1986; 4(1): 6-11 Malaysian Journal of Reproductive Health, 1986; 4(2): 57-64 Malaysian Journal of Reproductive Health, 1986; 4(2): 65-71 Malaysian Journal of Reproductive Health, 1986; 4(2): 91-96 Report Department of Psychological Medicine University Malaya Malaysian Journal of Reproductive Health, June 1990; 8(1): 21-29 The Family Practioner (Journal) April and August, 1988; 11 (1&2): 18-21 Reproductive health status Reproductive health status Reproductive health status Reproductive health status Reproductive health status Reproductive health status , KAPB Reproductive health status Reproductive health status
Medical Library Faculty Medicine, UM Medical Library Faculty Medicine, UM Medical Library Faculty Medicine, UM Medical Library Faculty Medicine, UM Medical Library Faculty Medicine, UM Medical Library Faculty Medicine, UM
Toh CL
2002
Yes
141 Sexual and reproductive health: a youth's perspective 142 The physician's perspective 143 Pregnancy after contraceptive use 144 Predictors of contraceptive use among women in Kuala Lumpur and Petaling Jaya 145 Socioeconomic correlate of contraceptive knowledge among women in KL and PJ, Malaysia 146 Teenage birth on the decline
Netto AA, Shalince N
2002
Yes
Aili HH
2002
Yes
Suan AE, Arshat H.
1986
Yes
Salleh NM, Peng TN, Arshat H Salleh NM, Peng TN, Arshat H
1986
Yes
1986
Yes
Medical Library Faculty Medicine, UM
Peng TN
1986
Yes
147 The family influence on Zaaba Library, UM sexual identity of adolescents: an overview
Woon TH
1984
Yes
Medical Library Arshat H et al 148 A study of the Faculty Medicine, UM acceptability and effectiveness of Norplant contraceptive implants in Kuala Lumpur Malaysia Medical Library Kasmini K 149 Adolescent problems Faculty of Medicine, UM
1990
Yes
Intervention
1988
Yes
150 The mother's emotional reaction to a child's abnormal sexual pattern a case study
Medical Library Kasmini K Faculty of Medicine, UM
1987
Yes
Reproductive health status, Problems, challenges & recomendations Malaysian Journal Reproductive of Reproductive health status Health, 1987; 5(2): 117-119
68
A Review of Literature and Projects 2005
No Title
Organization/s
Source Individual/s Peng TN, Tan Boon A, Arshat H Low WY, Zaliha O, Sandiyao S Sebestian
Year 1985
Medical Library 151 Profiles of family planning acceptors in the Faculty Medicine, UM National Programme 152 A survey of sexuality and HeRDU, Faculty of Medicine, UM the physically disabled.
1995
Published or Not Yes/ Type No Yes Malaysian Journal of Reproductive Health, 1985; 3(1): 20-30 Yes Book. University Malaya, Kuala Lumpur
Theme Reproductive health status
153 A cross-cultural study of sexual knowledge and attitudes towards sexuality 154 Human sexuality (A Malaysian study)
HeRDU. Faculty of Medicine, UM
Low WY
1994
Yes
Population Study Unit, Faculty of Economy & Administration, UM Population Study Unit, Faculty of Economy & Administration, UM Population Study Unit, Faculty of Economy & Administration, UM Population Study Unit, Faculty of Economy & Administration, UM
Yusof K et al
January 1984
Yes
155 A study of marital patterns in Peninsular Malaysia 156 Pregnancy wastage
November 1981 Tey Nai Peng,Philomena 1987 Ganga Siti Rohani Yahya Noor Laily Binti Dato' Abu Bakar & Tan Boon Ann 1986
Yes
Reproductive health status, Adolescent reproductive health, Concerns & needs Thesis M.Sc.Med. Reproductive health status, Psychology. Cultural, ethnic University of Surrey, England and geographic influences Reproductive Report Population Study health status, Unit, University Cultural, ethnic and geographic Malaya influences Demographic Report profile (Trend) Seminar Report, Shangrila- Inn, Pulau Pinang, 25 Feb 1Mac 1987 Article: Population Policy & Family Planning: 91-105 Report Reproductive health status Demographic profile (Trend) Demographic profile KAPB
Yes
157 Country Monograph Series No 13: Population of Malaysia 158 Malaysian Fertility and Family Survey- 1974 (Fertility and contraceptive knowledge and practice) 159 Sexuality and counselling
Yes
Department of Statistics Chander R et al & National Family Planning Board Malaysia, KL Main Library of University Malaya Ahmad Amin Mohd. Sulaiman
April 1977
Yes
April 1995
Yes
160 Knowledge and use of contraception 161 162
163
164
Population Study Unit, Faculty of Economy & Administration, UM. Maternal health and early FFPAM pregnancy wastage, Peninsular Malaysia 1974 “ Report on the National Study on Reproductive Health and Sexuality, 1994/1995 “ Report on Youth Sexuality Survey by Prof. Chiam Heng Keng, October 1995 “ JOICFP: Report of the Baseline Survey on Sexual and Reproductive Health of Adolescent and Youth
Tan Boon Ann, Chak Choy Sim -
1987 1977 1997
Yes Yes Yes
Intervention Problems, challenges & recommedations Seminar Report Reproductive health status, KAPB FFPAM Reports Reproductive health status Book. Ahmad Amin Mohd. Sulaiman, Serdang Selangor. LPPKN 1998/2002 FFPAM 1996 FFPAM 2002 Reproductive health status Reproductive health status Reproductive health status
-
1995
Yes
-
2002
Yes
69
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
No Title 165 Ford Foundation/IPPF Project on Empowerment of Young Women from Underserved Communities: Report of the Baseline Survey on Sexual and Reproductive Health [HER Initiative] 166 Ford Foundation /IPPF Project on Empowering Young Women from Underserved Communities in Reproductive Rights (RR) and Reproductive Health (RH) [HER Initiate]. Process documentation report 167 Ford Foundation/IPPF Project on Empowerment of Young Women from Underserved Communities in RR and reproductive health [HER Initiate]. PostIntervention evaluation report. 168 Ford Foundation/IPPF Project on Empowerment of Young Women from Underserved Communities in RR and reproductive health [HER Initiate] 169 Louis and Herald Price Foundation report on operational research on promotion and provision of sexual and reproductive health services 170 Louis and Herald Price Foundation report on needs assessment and baseline survey 171 IPPF i3 Indicate Project: Improving the Quality of Sexual and Reproductive Health Services for Young People through Operational Research 172 IPPF Project/BMZ Funding: Educating Young People about Sexual and Reproductive Health Rights in Malaysia. (Recommendations only)
Organization/s “
Source Individual/s -
Year 2001
Published or Not Yes/ Type No Yes FFPAM 2001
Theme Intervention
“
-
2001
Yes
FFPAM 2002
Intervention
“
-
2001
Yes
FFPAM 2002
Intervention
“
-
2001
Yes
FFPAM 2002
Intervention
“
-
2002
Yes
FFPAM 2002
Intervention
“
-
2002
Yes
FFPAM 2002 FFPAM 2001
Reproductive health status Intervention
“
-
2001
Yes
“
-
2003
Yes
FFPAM 2003
Intervention
70
A Review of Literature and Projects 2005
No Title 173 e-RHAM for Youth Project: Providing Sexual and reproductive health Knowledge and Responsible Living Skills to Adolescents. Report on impact study: Preproject Survey. 174 UNFPA Project MAL/98/P02: Promoting Adolescent Reproductive Health and Healthy Living. Operational research and intervention strategies three service Models. 175 Knowledge, attitude and practice of reproductive health among unmarried women: a study among dental nurse trainers 176 Knowledge, attitudes and practices regarding HIV/AIDS among Punjabi youths in The Klang Valley 177 Knowledge and attitude towards family planning among students from UPM and factors related to it. 178 Konsep Kendiri dan Tahap Pengetahuan dan Sikap Terhadap HIV/AIDS di Kalangan Pelajar Tingkatan 4 Sek. Men Tarcisian Convent Ipoh. 179 Relationship between knowledge, attitude and practice on healthy lifestyle among students of Sekolah Menengah Sulaiman Bentong, Pahang. 180 The level of knowledge, attitude and practice of young adults towards AIDS 181 Promoting advocacy for adolescent reproductive and sexual health through effective communication: a training programme for media practitioners 182 Adolescents' health: challenges of the 21st century
Organization/s “
Source Individual/s -
Year 2003
Published or Not Yes/ Type No Yes FFPAM 2003
Theme Intervention
“
-
2003
Yes
FFPAM 2003
Intervention
Umi Kalsom Abd Majid Oct Medical Library 2000 Faculty of Medicine & Health Sciences, University Putra Malaysia (UPM) Medical Library. Faculty Suresh Kumar Dhawan 1998 1 of Medicine & Health Sciences, UPM Medical Library Faculty of Medicine & Health Sciences, UPM Medical Library Faculty of Medicine & Health Sciences, UPM Tan Chee Hoon 2001
No
Thesis
Reproductive health status, KAPB Reproductive health status, KAPB Reproductive health status KAPB Reproductive health status, KAPB
No
Thesis
No
Thesis
Ong Hooi Bee
1997
No
Thesis
Medical Library Faculty of Medicine & Health Sciences, UPM
Siti Sabariah Buhari
1998
No
Thesis
Reproductive health status, KAPB
Medical Library Faculty of Medicine & Health Sciences, UPM.
Tee Guan Chong
1998
No
Thesis
Reproductive health status, KAPB Intervention
Asian- Pacific Resource and Research Centre for Women (ARROW)
1999
Yes
AIDCOM (monograph)
ARROW
Sinniah B, Rajeshwari B
1996
Yes
Malaysian Society Reproductive health status of Health, Journal of Malaysian Society of Health, Sept 1997, 15:96
71
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
No Title 183 Adolescents' health: challenges of the 21st century
Organization/s ARROW
Source Individual/s -
Year -
ARROW 184 HIV/AIDS community (youths) mobilization programme on AIDS 185 Innovative approaches to ARROW population programme management: youth reproductive health ARROW 186 Empowerment of schoolchildren
-
1999
Jay S, Tahir S, Anderson 1995 C Chan Foong Mae
Published or Not Yes/ Type No Yes Malaysian Society of Health, Journal of Malaysian Society of Health, 96p Yes Ministry of Health Malaysia. 16p Yes ICOMP.109p
Theme Reproductive health status
Reproductive health status Intervention
No
187 “Sex education: Is there a ARROW need?”
Chan Foong Mae
No
188 Sexuality with youths with Disabilities
ARROW
Yes
189 Reproductive health of adolescents module
ARROW
Yes
190 Innovative approaches to ARROW population programme management 191 Youth sexual and reproductive health ARROW
Yes
Yes
192 Introducing young inspirers
ARROW
Yes
Paper presented at the National Conference on Adolescent Health Paper presented at the National Conference on Adolescent Health: Challenges for the 21st Century. FFPAM Youthlink. Occasional Issue No 7, June 1990: Pp 30-33 FFPAM News Issue. No 60, July1998: p15 ICOMP Youth Reproductive Health, Vol 2. 1995:63p IPPF-ESEAOR Report presented at the Regional Programme Advisory Panel Meeting organised by IPPF-ESEAOR, Kuala Lumpur, 14-16 Nov 1997, 134p Nandini, Johri Paper presented at the workshop on Innovative Approaches in Adolescent/ Youth Reproductive Health Programmes, organised by ICOMP, KL,'1-4 June 1996, 37p
Intervention
Intervention
Reproductive health status
Reproductive health status Intervention
Reproductive health status
Intervention
72
A Review of Literature and Projects 2005
No Title
Organization/s
Source Individual/s Jay S, Tahir S
Year
ARROW 193 Managing adolescent/ youth reproductive health programmes
194 Knowledge, beliefs, attitude and behavioural intention in relation to HIV/ AIDS among schooling adolescents in Penang 195 Sexual activities of Malaysian adolescents 196 Antenatal profile and obstetric outcome of adolescent pregnancy in a Malaysian semi-rural clinic 197 Sexual practices in Malaysia: Determinants of sexual intercourse among unmarried youths 198 Family environment and premarital pregnancy: A case study among adolescents 199 Family environment and gangsterism behaviour: A case study 200 The influence of and involvement in the Bohsia problem among students of a higher education institution: A study in UPM, Serdang. 201 Knowledge and attitude towards sexuality in urban and rural adolescents 202 Stress and parental involvement in sex education of adolescents with Down Syndrome 203 Drug addiction among female teenagers: A case study of Pusat Serenti, Serdang, Kedah 204 Relationship between parental religious teachings and practices and adolescent attitudes towards premarital sex 205 Knowledge and attitudes towards risk behaviour with regards to AIDS among young adults
Centre of Drug Research, University Sains Malaysia, Penang.
Punithavathi A, Navaratnam V
1999
Published or Not Yes/ Type No Yes Population Manager (Vol4) Managing Adolescent/ Youth Reproductive Health Programmes, KL. Yes International medical research journal, 1999, 3(2):103-109 Yes Yes Medical journal Malaysia, Vol 50 No 1 Mar 1995 .Adolescent pregnancy
Theme Intervention
Reproductive health status, KAPB
Social Obst & Gynae Unit, Faculty of Medicine, UM -
1995 Kwa SK et al 1999
Reproductive health status Reproductive health status
-
Zulkifli SN, Low WY
2000
Yes
Reproductive Journal of adolescent health, health status 2000:27:276-280 Thesis Reproductive health status Reproductive health status Reproductive health status
Dept of Human Kamsinah Aida Development, Faculty of Kamarudin Human Ecology, UPM Dept of Family Dev, Faculty of Human Ecology, UPM Dept of Social Dev, Faculty of Human Ecology, UPM Norwati Shafie Zul Ezam Kamarul Ariffin
1998
No
1998 1998
No No
Thesis Thesis
Dept of Human Dev, Faculty of Human Ecology, UPM Dept of Family Dev, Faculty of Human Ecology, UPM Faculty of Human Ecology, UPM Dept of Family Dev, Faculty of Human Ecology, UPM Faculty of Human Ecology, UPM
Aini Khamsiah Abdullah Chan Wai Fong,
2000
No
Thesis
Reproductive health status, KAPB Reproductive health status Reproductive health status Reproductive health status
1998
No
Thesis
Suzana Abd Hamid
1999
No
Thesis
Fauzan Mustapha
1995
No
Thesis
Valamathi Subramaniam 1995
No
Thesis
Reproductive health status, KAPB
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Sexual and Reproductive Health of Adolescents and Youths in Malaysia
No Title 206 Selected family factors and prostitution: A comparison study between ex-prostitutes and non- prostitutes 207 The sources of knowledge and attitudes towards sex among adolescents 208 Knowledge, attitudes and practices regarding AIDS among UPM students 209 Komunikasi Kesihatan Dalam Menyedarkan Pelajar UPM Mengenai Bahaya AIDS : Perspektif Pegawai dan Pemimpin Pelajar 210 Tahap Pengetahuan, Sikap dan Tingkahlaku yang Berkaitan Dengan Penyakit AIDS di kalangan Pelajar UPM 211 Knowledge, attitudea and behaviour towards HIV/AIDS among secondary school students 212 Knowledge, attitudes and practices towards healthy lifestyle among Chinese adolescents at Seri Kembangan Secondary School, Selangor. 213 The comparison study of selected personality and family factors among teenagers of employed and unemployed mothers 214 The relationship of drug addicts' selected personality factors with the level of drug abuse 215 Level of knowledge and sources of sex education among adolescents 216 The rape report: An overview of rape in Malaysia 217 Policies in health 218 The National Policy on Women
Organization/s
Source Individual/s
Year 1995
Dept of Family Rosmahwati Ishak Development Faculty of Human Ecology, UPM Dept of Family Mohamad Thuairi Development Faculty of Mohamed Tayeb, Human Ecology, UPM Dept of Family Mastura Harun Development Faculty of Human Ecology, UPM Faculty of Human Ismail Hussin Ecology, UPM
Published or Not Yes/ Type No No Thesis
Theme Reproductive health status
1994
No
Thesis
Reproductive health status, KAPB Reproductive health status, KAPB Intervention
1993 1993
No No
Thesis Thesis
Dept of Nutrition and Community Health, Faculty of Human Ecology, UPM Dept of Nutrition and Community Health, Faculty of Human Ecology, UPM Dept of Nutrition and Community Health, Faculty of Human Ecology, UPM
Mok Fang Shang
1993
No
Thesis
Reproductive health status, KAPB Reproductive health status KAPB Reproductive health status, KAPB
Gan Hock Cheng
1993
No
Thesis
Chai Tze Kong
1997
No
Thesis
Dept of Human Che Radziah Yaakub Development, Faculty of Human Ecology, UPM
1992
No
Thesis
Reproductive health status
Dept of Human Halimahton Kamarudin 1992 Development Faculty of Human Ecology, UPM Faculty of Agriculture Ministry of Health Zahila Mohamed Yan LS et al AWAM & SIRD 2002 1991 2002 1999 1995
No
Thesis
Reproductive health status Reproductive health status, KAPB Reproductive health status Policies Policy
No No No Yes
Thesis Thesis Draft Report Text
Ministry of Health Women's Affairs Division (HAWA), Ministry of National Unity and Social Development, Malaysia (MNUSD) Women Affairs 219 Plan of Action for the Advancement of Women Department, MNUSD Ministry Youth And 220 National Youth Sports Malaysia Development Policy Department of Social 221 The National Plan of Welfare Malaysia Action for Children 2001-2020
-
1997 1997 2002
Yes Yes Yes
Report Text Report
Policy Policy Policy
74
A Review of Literature and Projects 2005
No Title 222 Malaysian Mental Health Service- The Framework for Service Delivery Policy For Implementation 223 Executive Summary Education Development Plan 2001-2010 224 Pembangunan Pendidikan 2001-2010 225 Dasar Pendidikan Kebangsaan 226 Annual Report Family Health Development Division 227 Annual Report 2002 FFPAM 228 Family Soul of the nation 229 Laws of Malaysia, Act 611, Child Act 2001 230 Laws of Malaysia, Act 1152, Education (Amendment) Act 2002 231 Laws of Malaysia, Penal Code (Act 574) 232 Malaysian Family Law 233 Laws of Malaysia, Food Act 1983, (Control of Tobacco Product Regulations 1993) 234 Adolescent health and development: The key to the future
Organization/s Ministry of Health
Source Individual/s -
Year 2002
Published or Not Yes/ Type No No Report
Theme Policy
Ministry of Education, Malaysia Ministry of Education, Malaysia Ministry of Education, Malaysia Ministry of Health
-
2001 2001 1999 2001
Yes Yes Yes Yes
Report Report Text Report
Policy Policy Policy Reproductive health status, Services and interventions Services and interventions Services and interventions Law Law Law Law Law
FFPAM NPFDB Legal Research Board, Malaysia Legal Research Board, Malaysia Legal Research Board, Malaysia -
-
2002 2001 2001 2002 May 2000 May 1994
Yes Yes Yes Yes Yes Yes Yes
Report Report Text Text Text Text Text
World Health Organization, Geneva
-
Jan 1995
Yes
Text
World Health 235 The health of young people: A challenge and a Organization, Geneva promise
-
1993
Yes
Text
236 Laws and policies affecting adolescent health 237 UNICEF's priorities for children 2002 2005.
World Health Organization, Geneva UNICEF
JPaxman JM, Zuckerman RJ Leete R
1987 2002 1996
Yes Yes Yes
Text
Adolescent sexual and reproductive health status, Laws/ policies, Recommendations Adolescent sexual and reproductive health status, Laws/ policies, Recommendations Laws and Policies
238 Malaysia's demographic transition: Rapid development, culture and politics. 239 Youth, sexuality and public policy in Asia: A research perspective NPFDB 240 Marriage trends among Peninsular Malaysia women.
Text (2nd Edn, Policies UNICEF, New York, 2002) Demography Text (Oxford University Press) Report Report Policy Demography
Xenos P Khalifah, Mohd Tom
1990 1992
Yes Yes
75
Sexual and Reproductive Health of Adolescents and Youths in Malaysia
No Title 241 Trends in marriage and divorce in Peninsular Malaysia 242 Vital statistics Peninsular Malaysia, (For the years 1970,1975, 1980, 1985, 1990, 1994, 1995, 1996, 1997, 1998, 1999, 2000) 243 Monthly statistical bulletin Malaysia, March 2001: Nov 2002, March 2003 244 Social statistics bulletin Malaysia, (For the years 1996, 1999, 2000, 2001, 2002) 245 General report of the Population Census Vol 2, 1991, 2000 246 Education and social characteristics of the population 2000 247 Population distribution and basic demographic characteristics, 2000 248 Yearbook of statistics Malaysia, 2002 249 World development report 1993 250 Dawn of a new millennium: Future of public health issues in Malaysia. In: Issues and challenges of public health in the 21st century 251 Pengetahuan dan Sikap Remaja Terhadap HIV/AIDS: Kajian Kes di KK, Sabah (Knowledge and attitudes on HIV/AIDS: Case study at health clinics in Sabah) 252 HIV-associated risk behaviour among male drug abusers in Malaysia
Organization/s
Source Individual/s Jones G
Year 1980 19702000
Published or Not Yes/ Type No Yes Text Yes Text
Theme Demography Demography
Department of Statistics Malaysia
Department of Statistics Malaysia Department of Statistics Malaysia Department of Statistics Malaysia Department of Statistics Malaysia Department of Statistics Malaysia Department of Statistics Malaysia World Bank Low WY, et al
20012003 19962002 1991, 2000 2000 2000 2002 1993 1996
Yes
Report
Demography
Yes
Report
Demography
Yes Yes Yes Yes Yes Yes
Report Report Report Report Report Text
Demography Demography Demography Demography Demography profile Reproductive health status, Issues and challenges Reproductive health status, KAPB
-
Adi Fahrudin
2002
No
Paper presented
Juita G, Osman A
1995
Yes
UPM 253 Faktor-faktor Yang Berkaitan Dengan Tahap Pengetahuan dan Sikap Mengenai HIV/AIDS : Suatu Kajian di Kalangan Remaja Cina di Sekolah Menengah Kebangsaan Chung Ling Butterworth, Pulau Pinang (Factors related to knowledge and attitude on HIV/AIDS: A study among Chinese adolescents at Chung Ling Secondary School, Butterworth, Penang)
Koo P.F.
2000
No
Medical journal of Malaysia, 1995, vol 50, no 4 pg 320-325 Final year dissertation
Reproductive health status, KAPB Reproductive health status, KAPB
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A Review of Literature and Projects 2005
No Title 254 Pengetahuan, Sikap dan Amalan Terhadap Kesihatan Seksual dan Reproduktif di Kalangan Pelajar Cina Yang Tinggal di Luar Kampus (KAP on Sexual and Reproductive Health among Chinese Students Staying Out of Campus) 255 Report of the Meeting (19-20 Nov 2000) on the Integration of Preventive Services in Adolescents Health 256 Knowledge, attitudes and practice on HIV/AIDS adolescents in a new village, Penang 257 Knowledge, attitudes and beliefs related to HIV/AIDS among adolescents in Malaysia 258 Pengaruh dan kesan bacaan lucah dalam kes jenayah seksual di kalangan remaja (Influence and effect of pornographic materials on adolescents involved in sexual crimes) 259 Belia Malaysia dan seks siber : Isu, masalah dan cabaran penyelesaian (Malaysia youth and cyber sex: Issues, problems and challenges) 260 Peranan bukan kerajaan (NGO) dalam menangani masalah gangguan seksual (Role of NGO in dealing with sexual harassment problems)
Organization/s UPM
Source Individual/s Low CM
Year 2003
Published or Not Yes/ Type No No Final year dissertation
Theme Reproductive health status, KAPB
Department of Family Health Development, Ministry of Health, Malaysia UPM
2000
No
Report
Intervention
2000
No
Final year dissertation Medical journal of Malaysia, 2002, vol 57, no 1 pg 3-23 Prosiding Persidangan Kebangsaan Kerja Sosial 2002, ms 293-303
Reproductive health status Reproductive health status Reproductive health status
-
Zulkifli SN
2002
Yes
Universiti Sains Malaysia Mohd Shukri Hanapi
2002
Yes
Universiti Utara Malaysia Rohana Yusof, Syamsul Anuar B. Ismail.
2002
Yes
Prosiding Reproductive Persidangan health status Kebangsaan Kerja Sosial 2002, ms 330-339 Prosiding Intervention Persidangan Kebangsaan Kerja Sosial 2002, ms 351-368
Universiti Utara Malaysia Hajah Sabitha Marican
2002
Yes
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Sexual and Reproductive Health of Adolescents and Youths in Malaysia
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A Review of Literature and Projects 2005
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Siti NZ, Low WY. Sexual health education for youths – A Malaysian experience. Asia-Pacific journal of public health, 2000; 12(Supp): S58-S66. Maimunah SZ. Sexual and reproductive health education in schools – Family health education and Islamic education: The curriculum, implementation and challenges. Kuala Lumpur, Ministry of Education, 2003. Umi Kalsom AM. Tahap Pengetahuan, Sikap dan amalan Kesihatan Reproduktif di Kalangan Wanita Belum Berkahwin:Satu Kajian Ke atas Jururawat Pergigian Pelatih. 2001 (Final Year Dissertation U.P.M.). Westley. 2002. World Bank. World development report 1993. New York, Oxford University Press, 1993. Wah Yun Low et al. Dawn of a new millennium: future of public health issues in Malaysia. In: Khairuddin Y, et al (eds.) Issues and challenges of public health in the 21st century. Kuala Lumpur: University of Malaya Press, 1996. World Health Organization. Adolescent health and development. The key to the future. Geneva, World Health Organization, 1996. World Health Organization and Ministry of Health, Malaysia. Consensus report on STI, HIV and AIDS epidemimiology Malaysia. Kuala Lumpur, Ministry of Health, 2001. Xenos P. Youth, sexuality and public policy in Asia: a research perspective. In: Quah SR. (ed.). The family as an asset: an international paper on marriage, parenthood and social policy. Singapore, Times Academic Press, 1990. Zulkifli SN. Knowledge, attitudes and beliefs related to HIV/AIDS among adolescents in Malaysia. Medical journal of Malaysia, 2002, Vol. 57 No. 1:3-23. Zulkifli SN, Low WY. Sexual health education for youths – a Malaysian experience. Asia-Pacific journal of public health, 2000, 12: S58-S66. Zulkifli SN, Low WY. Sexual practices in Malaysia: determinants of sexual intercourse among unmarried youths. Journal of adolescent health, 2000, 27:276-280. Zulkifli SN, Low WY, Yusof K. Sexual activities of Malaysian adolescents. Medical journal of Malaysia, 1995, Vol 50 No 1 March 1995:4-10.
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