The Sustainable Development Goals or SDGs that underpin the 2030 Agenda for Sustainable Development have become a recurring catchphrase at various official launches and ceremonies in Malaysia, of late.

No wonder really, as we now stand at a true crossroads of our times. Less than 60 days away from the year 2020. A mere decade shy of meeting these much lauded SDGs or Global Goals, which serve as a universal benchmark for progress by governments, civil society and even the private sector via corporate social responsibility, in achieving their overarching vision of leaving no one behind.

Of the 17 goals, SDG 5 for GENDER EQUALITY is arguably the most imperative goal of all. With women and girls making up half the population globally, there can be no measurable change in any country’s living standards or sociocultural advancement unless women and girls are an integral, and integrated, part of the process.

Critically, as evidence has clearly shown over the years, significant progress in the arena of gender equality can only be achieved through ensuring women’s rights through comprehensive Sexual and Reproductive Health and Rights (SRHR) – a key premise of the landmark Programme of Action that stems from the 1994 International Conference on Population and Development (ICPD) in Cairo, the precursor to the SDGs.

I had the rare opportunity of speaking with Björn Andersson, Regional Director of the United Nations Population Fund (UNFPA) (Asia-Pacific), the custodian of the ICPD Programme of Action, on the groundbreaking work being done for SRHR in Malaysia and Asia-Pacific, together with the challenges that still lie ahead.

UNFPA’s core efforts focus on supporting the Malaysian government’s population and development policies through building stronger collaborations between civil society organisations, advocacy groups and academia to bridge systemic gaps and capitalise on the gains that have been made as well in the past 25 years under the ICPD umbrella.

Björn shared that UNFPA’s three transformative result commitments, or three zeros, are zero preventable maternal deaths, zero unmet family planning needs and zero gender-based violence, including female genital mutilation (FGM) and child marriage — each of which are clear matters of concern in the Malaysian context, including with regards to our teenage pregnancy and child marriage rates.

Malaysia’s primary health care system has made great strides in the last few decades, yet there’s still a lack of strategic implementation for SRHR, which ultimately hinders Malaysia’s full potential for economic development.

Access to SRHR and social services is key in ensuring women’s autonomy; choosing how many children to have, when to have those children is inextricably linked to women’s career progression, labour force participation and economic contributions. It is also key to their physical and social well-being. Being able to balance life and work allows women to fulfil their true potential.

Reflecting on UNFPA’s commitment to working with the Malaysian government, Björn highlighted the upcoming Nairobi Summit on ICPD25, the International Conference on Population & Development. Happening from 12th-14th November in Kenya, ICPD25 will be an important gauge of regional APAC governments’ commitment to the ICPD Programme of Action (POA) which is key to achieving the SDGs.

“Strong national commitment, including Malaysia’s, to advancing women’s access for SRHR and investments in women and girls education, needs to happen in tandem with a focus on the role of men and boys to improve gender equality and women’s rights,” said Björn.

He acknowledged the great opportunities for fulfilling SDG 5 in APAC can be best actualised through getting the full commitment of a new generation of parliamentarians, policy makers and activists at the Nairobi Summit. This would ensure continuity for SDG 5 focused policies and programmes across APAC, from the very grassroots through the highest levels of government, right up to 2030 and even beyond.

Locally, translating the ICPD POA into the lived reality of the average Malaysian means a focus on individual development across the life spectrum, starting from pregnancy and childbirth, through adolescence and into adulthood and ultimately to old age — all through strategic government across the life cycle, ensuring a strong foundation from the very first breath to the last.

Indeed, as Bjorn pointed out, it’s only by investing optimally across the years that countries can tackle the challenge of rapid population ageing, a demographic reality in the region. This is definitely part of Malaysia’s immediate population development concerns as well, with the overall birth rate of 1.8 babies – below the population replacement level of 2.1 – for the 2018 cohort of women of reproductive age (15-49 years), combined with a rapidly ageing population.

Björn noted that in recent years, there has been a rising tide of conservatism and pushback on the SRH rights and choices of women and vulnerable populations in particular.

And he recommended several strategies for tackling the stigma around full access for women and also men to SRHR and family planning.

The human rights and well-being perspective, together with refining the economic argument for Malaysia investing in women’s health as a barometer for the country’s development, is particularly compelling.

The Pakatan Harapan government has demonstrated keen insights through Budget 2020 allocations for women, while the Ministry of Women, Family & Community Development’s data-focused outreach on highlighting teenage pregnancies and the negative impact of child marriages has been normalising difficult conversations around SRHR in the last 18 months in particular.

With regards to UNFPA’s three zeros and prevailing maternal mortality rates, Björn emphasised that Malaysia is still very much ahead, compared to many other APAC countries, despite having an official MMR (maternal mortality ratio) of 29 per 100,000 live births for 2017 – although this number could be higher if the data factored in women from refugee and nomadic populations who find it difficult to access SRH services, or who are not counted fully or consistently in demographic health surveys.

Ideally, Malaysia’s MMR should hover around 11. He felt this can be made possible particularly by linking maternal health and the non-communicable disease (NCD) epidemics of obesity, diabetes and high blood pressure — all of which dramatically increase the risk factor for safe deliveries and a woman’s ability to live a healthy life and take care of her children.

Continuing to improve access to maternal health, midwives, voluntary rights-based family planning and intensifying primary health care are the other key factors in addressing Malaysia’s MMR.

On the contentious question of Ministry of Health staff administering Orang Asli women with birth control injections in July this year, the ICPD POA is very clear that all family planning must be wholly voluntary and rights-based. At all times, “there can be no coercion on family planning, the decision has to come from the woman herself”, stressed Björn.

UNFPA’s second of the three zeros being the unmet need for family planning shifts the focus to Malaysia’s plainly alarming teenage pregnancy statistics. 18,000 annually, i.e; an average of 50 births daily, with one baby dumping every three days, all speaking volumes of the critical and unmet need for family planning.

Most troubling, around 4,000 teenage girls under the age of 18 were reported pregnant annually based on the Malaysian Health Ministry’s statistics. The real number may well be higher, as some cases may go unreported due to stigma and fear, or because of clandestine and potentially unsafe abortions.

In fact, the Malaysian Population and Family Survey 2015 by the National Population and Family Development Board (LPPKN) found that knowledge regarding sexuality and reproductive health is still very low among Malaysian teenagers. Additionally, “Based on the Ministry of Health’s National Health and Morbidity Survey 2017, only 10 per cent of sexually active teenagers have stated that they use contraceptives.”

The UNFPA’s recommendations and best practices for addressing Malaysia’s teenage pregnancy crisis are firmly in favour of collaboration between parents, society and education systems to ensure openness for increased access to SRHR information, which must be included in what is referred to as comprehensive sexuality education or life-skills education, depending on a country’s sociocultural context.

Björn also highlighted the need for pregnant girls to stay in school and have access to education, while noting that SRHR also must include boys and educate them about contraceptives and family planning from a life skills and basic human rights perspective, thus empowering all young people to manage their future through controlling their fertility.

UNFPA’s emphasis on education to effect behavioural changes also covers the issue of child marriage in Malaysia, which falls under the third of the three zeros, ending gender-based violence and other harmful practices.

The breakout case of a 41-year-old man marrying an 11-year-old girl in Kelantan in 2018 reignited pressures to ban child marriage. Using the current public interest as fuel, the UNFPA really encourages collaboration between countries in the region to share notes on tackling the root cause of such marriages, particularly poverty alleviation and lack of access to education and healthcare – as well as a woman’s or girl’s lack of agency in an environment of patriarchy and chauvinism.

“It’s completely unacceptable for a girl to marry before 18 due to implications on her education opportunities, early pregnancy and medical complications, together with harmful physical, psychosocial and mental well-being issues,” said Björn.

He noted that UNFPA actively advocates in favour of ending child marriages by recognising the importance of religious leaders, civil society organisations, and government working collaboratively for outreach at the community level.

Björn concludes that overcoming deeply entrenched patriarchal attitudes, either due to cultural or religious beliefs, must be done strategically, collaboratively and progressively to ensure young Malaysians, particularly young girls and women are not left behind to suffer lifelong consequences of unplanned pregnancies and a lack of SRHR. He emphasised the importance of continued partnerships with UNFPA to address emerging issues in the region in Malaysia.

In a nutshell, Malaysia’s progress in improving overall quality of life will mean little for accelerating towards developed nation status until and unless women and girls in Malaysia have full control over their sexual and reproductive health and rights, as they effectively remain second class citizens for now.

This not only marginalises women and girls but also Malaysia as a whole, as the focus of SDG 5 is ensuring quality of life, and if half the country’s population lacks full access to theirs, this definitely jeopardises overall growth. ICPD25 is an opportunity to reignite the movement for rights and choices for all – with women and girls at the centre.

Written by Tehmina Kaoosji