REDUCING TEENAGE PREGNANCY THROUGH OSTPC –

Sarawak Experience

Dr. Radziah Haji Mohamad

State Health Department

4th UNIMAS Public Health Seminar 2017,

25-26 October 2017

Teenage Pregnancy KKM 2014: • 16,528 pregnancy among 10-19 years.• 0.1% of total world pregnancies

Adolescent fertility rate (2014)- Malaysia;13.4 birth/1000 women age 15-19 yo- Sarawak; 22.6 birth/1000 women age 15-19 yo

Teenage Pregnancy WHO 2014: • 16 million teens age 15-19 years• 1 million teens age <15 years old

• give birth every year

Teenage Pregnancy Data Facts

The current situation

• Age of first sexual intercourse < 20

• Unmarried girls had unintended pregnancy 10-40%

• Children born yearly to young mothers 14 millions

Causes of teen pregnancy

• Customs and traditions

• Adolescent sexual behavior –alcohol and drugs

• Peer pressure

• Access to contraception

• Sexual abuse

• Poverty

• Low education ambition and goals

• Exposure to abuse. Violence and family strive at home

Life outcomes on a teen mother /child/ sibling

• Drop out of school

• No or low qualifications

• Unemployed or low-paid

• Live in poor housing conditions

• Suffer from depression which may result in suicide

• Child –live in poverty; grow up without father, become victim of neglect or abuse, do less well in school, involved in crime; risk of becoming teenage parents

• Younger siblings – accept sexual initiation early, play less importance on education and employment.

TEENAGE PREGNANCY FACTS

I am 16 yrs old, the eldest in family, I am a cheerleader in school, I love biology

I met my right man; he is so caring and he is more mature than me

Why me!!!!

I love my child, and I will take care of her

No good school had a mother in a classroom

You had shame a family name, you are good for nothing

I want to die

Continue to raise a child alone? What should I do?

NEGERI2011 2012 2013 2014 2015

Bil. % Bil. % Bil. % Bil. % Bil. %

Perlis 164 4.1 158 4 139 3.5 145 3.4 121 2.9

Kedah 688 2.2 708 2.3 666 2.0 764 2.3 574 1.7

Pulau Pinang 308 1.6 362 1.8 357 1.8 350 1.7 402 2.0

Perak 1,009 3.2 1,068 3.3 965 3.2 892 3.0 787 2.6

Selangor 1,765 2.2 1,614 1.9 1,640 1.8 1,486 1.6 1,461 0.7

N. Sembilan 310 1.9 308 1.8 255 1.5 255 1.5 325 1.8

Melaka 240 1.8 240 1.7 230 1.6 250 1.8 228 1.6

Johor 1,720 3.0 1,650 2.8 1,491 2.5 1,408 2.4 1,319 2.3

Pahang 1,085 4.1 1,061 4 1,015 3.7 1,032 3.7 940 3.5

Terengganu 479 2.0 508 2.3 436 1.9 460 1.9 438 1.8

Kelantan 546 2.1 615 2.4 792 3.0 739 3.0 775 3.0

Sarawak 3,707 9.5 4,131 9.7 4,075 9.9 3,396 8.4 2,910 7.5

Sabah 6,090 9.8 5,916 8.7 4,988 8.0 4,795 7.6 3,084 6.3

WP KL 370 2.2 359 2 380 2.0 412 1.9 350 1.6

WP PJ 2 0.0 10 0.2 8 0.2 4 0.1 7 0.2

WP Labuan 169 7.4 139 5.8 151 6.8 140 6.1 110 5.2

Malaysia 18,652 4.1 18,847 4.0 17,588 3.7 16,528 3.4 13,831 2.4

Number & Percentage of Teenage Pregnancy in Malaysia, 2011-2015

TEENAGE PREGANCY IN SARAWAK

CURRENT SITUATION

Malaysia

• Total teenage pregnancy

reported 12,492 (2016); 2.7%from total pregnancy

•33.0% decreased from total pregnancy reported in 2011 (18,652)

Sarawak

• The 2nd Highest number of teenage pregnancy after Sabah (2481 compared to 2564)

• Highest Percentage of teenage pregnancy , 2.4x compared to Malaysia (6.4 vs 2.7)

• 54.1% were unmarried; no of unmarried increasing

• 90-95% were not schooling at the time of booking; data fluctuates

• 56.7% were between the age of 10-17 yrs old. The age of pregnancy is getting younger.

• 2016 data

Introducing the OSTPC

One Stop Teenage Pregnancy Committee (OSTPC)

OSTPC is a committee made up of representatives from various government and

non-governmental agencies that discuss and resolve specific issues face by

teenage mothers.

Rationale on Establishing the OSTPC

Due to the high incidence of teenage pregnancy in the

state and the complex issues faced by them, a

comprehensive approach involving various agencies was

established to address this issue.

Since the teenage mothers are in close contact with the

health department throughout their pregnancy, this

initiative was brought forward by the State Health

Department to the State Government for implementation.

OSTPC Objectives

General Objective:

To reduce the morbidity and mortality among pregnant teenagers

and newborns.

Specific Objectives:

1. To collaborate together with various agencies in efforts to prevent

teenage pregnancies.

2. To improve morale, self-esteem, and support particularly in the area

of education, skills training and spiritual support so that they can

return as productive members of the society.

3. To provide protection and accommodation to pregnant teens in need.

4. To prevent abortion and baby dumping.

5. To prevent occurrence of a second pregnancy in teenagers.

OST

PC S

TATE

ORGANISATION

• Chairman: YB Datuk Hajjah Fatimah Abdullah

• Director of Sarawak Health Department • Director of Sarawak Social Welfare Department

• Director of Sarawak Education Department

• Director of Sarawak Registration Department

• Director of Sarawak Islamic Development Department

• Director of Sarawak Police Department

• Director of Sarawak LPPKN

• Other Agency/NGO’s

STATE

• Chairman: Resident Officer • Divisional Health Officer

• Divisional Welfare Officer

• Divisional Education Officer

• Divisional Registration Officer

• Divisional LPPKN Officer

• Divisional PDRM Officer

• Other Agency/NGO’s

DIVISION

• Internal Committee of every agency regarding each issues related to teenage pregnancy before going to divisional secretariat INTERNAL

OST

PC S

TATE

S TAT E OS TPC

DI VI S I ON OS TPC

I NT E RNAL OS TPC

OST

PC S

TATE

FLOW CHART

Pregnant Teen <20 y.o

Visit doctor/Specialist Antenatal Registration

Problems Other Than

Health

Continue antenatal follow-ups

NOOSTPC Registration

Teenage Pregnancy Management Card Returned to Divisional OSTPC Secretariat

Case status reporting in Divisional OSTPC Secretariat

Case status reporting and Presentation to State OSTPC Secretariat

Teenage Pregnancy Case From Other Agency

State Education

Department

State Registration Department

Social Welfare

Department

JabatanAgama Islam

Sarawak/ Syariah Court

/MAIS

PDRM JWKS/NGO LPPKN

Referrals to respecting agencies (Teenage Pregnancy Mx Card)

NEW CASE REFERRED to OSTPC Secretariat

ISSUE/PROBLEMS

WELFARE DEPARTMENT

Financial Aid

Child/Baby/ Pregnant Teenage

Protection

Social Support

EDUCATION DEPARTMENT

Leave with reason

(Delivery)

Continuation of education

Deferment of education due to pregnancy/delive

ry

Sitting for exams

Change school

JWKS/NGOs

Counselling during

pregnancy

Counselling after pregnancy

Financial aid

Social support (Transportation, Morale support)

Survival skills

PDRM

Report of rape/statutory rape/Domestic

Abuse/Child abuse/Incest/s

exual abuse/Baby

dumping/etc. concerning

crime

LPPKN

Parenting skills for teenage

couples

Sexual Awareness

and Advocacy Programme

(with KKWKK)

Counselling aid for Teenage pregnancy

REGISTRATION DEPARTMENT

Registration of birth

Identification for pregnant

teen and partner

Certification of Adoption

Processing of Nationality

request

JAIS/SYARIAH COURT

Pre-Marital course

Registration

Marriage with non-muslim

partner

Underage marriage request

Pregnancy due to Co-habitation

cases

Polygamy involving Teen

pregnancy

RESIDENT/DISTRICT OFFICE/ MAJLIS ADAT ISTIADAT

Registration of Customary Marriage

Adoption of child

PROBLEM BASED MANAGEMENT

OST

PC

TEENAGE PREGNANCY MANAGEMENT CARD

OST

PC

TEENAGE PREGNANCY MANAGEMENT CARD

OST

PCKEY PERFORMANCE INDEX

KPI: 10 % DECREASE OF TEENAGE PREGNANCY FROM THE PREVIOUS YEAR

NO INDICATOR STANDARD NUMERATOR DENOMINATOR

1 Percentage of High Risk Clients to be pregnant within 2 years after current pregnancy

20% Number of High Risk Client (OSTPC Registry) with recurrent pregnant within 2 years

Total High Risk Client registered under OSTPC Registry

2 Percentage of referred Teenage Pregnancy given help by Education Office

100% Number of teenage pregnancy mothers aided

Total teenage pregnancy mother referred to District Education Office

3 Percentage of referred Teenage Pregnancy given help to obtain marriage certificate (If both parents and teenager consented)

100% Number of teenage pregnancy mothers with obtain marriage certificate by Adat

Total teenage pregnancy mother with issues regarding Adat Marriage Certificate

4 Percentage of teenage pregnancy with “statutory rape” brought to court

80% Number of “statutory rape” teenage pregnancy case brought to court

Total teenage pregnancy mother with issues regarding “statutory rape” referred to PDRM

5 Total Case of Teenage Pregnancy referred given social aid

N/A Number of teenage pregnancy case given social aid

Total teenage pregnancy mother with social issues referred to social welfare dept

6 Total Case of Teenage Pregnancy referred given child protection

N/A Number of teenage pregnancy case given child protection

Total teenage pregnancy mother with protection issues referred to social welfare dept

2017 ACHIEVEMENT’S

SARAWAK’S OSTPC MANAGEMENT OF TEENAGE PREGNANCY BOOK

GRAND LAUNCHING 10 AUGUST 2017

OSTPC MEETING ACCORDING TO DIVISION

DIVISION MEETINGS NUMBER CHAIRMAN

2016 2017

Kuching 12 3 DHO

Samarahan 3 3 Residen(6)

Serian 1 2 Residen (3)

Sri Aman 2 2 DHO

Betong 1 1 DHO

Sarikei 2 1 Residen

Sibu 0 1 Residen

Mukah 2 2 Timbalan Residen(4)

Kapit 1 0 Residen(1)

Bintulu 2 3 Residen (2), DHO (3)

Miri 11 7 DHO (14)

Limbang 2 Nil

NEGERI 2 2 YB Datuk Hajjah Fatimah Abdullah

279 Cases discussed at

Divisional OSTPC meetings

2015 - 2016

EDUCATION ISSUES; 21 CASE

WELFARE ISSUES; 141 CASE

REGISTRASTION ISSUES; 24 CASE

RELIGION ISSUES; 22 CASE

LAW ISSUES; 32 CASE

234 Cases discussed at Internal

OSTPC meetings 2017 (Jan-Jun)

79 Cases were discussed at

Divisional OSTPC meetings 2017

(Jan-Jun)

ACHI EVEMENTS

JAN JUN 2017

OST

PC S

TATE

TEENAGE PREGNANCY 2011 -2016

Sumber : SPKK, Jabatan Kesihatan Negeri Sarawak, 2016

3698 3866 4078 3401 2909 2481

18652 18847 1758816528

1383112492

9.5 9.1 9.98.4 7.5

6.4

0

5

10

15

20

2011 2012 2013 2014 2015 2016

0

5000

10000

15000

20000

25000

Sarawak Malaysia %

Reduction of Teenage Pregnancy 2011-2016.-Sarawak 33.0%: Decreased by 27.1% (2014-2016)

compared to 8.1% (2011 -2014)

RE DUC I NG T E E N PRE GNANCY AND B I RT H I S ONE OF T HE MOS T E F F E C T I VE WAYS T O RE DUC I NG CHI L D POVE RT Y I N T HE COUNT RY

- J O R D A N B R OWN

THANK YOU