Barriers to Reproductive Health Resources for Women in Southeast Asia

29.07.2023

Ilona Barrero

Southeast Asia as a region grapples strongly with gender discrimination, poverty, leading to early marriages for young girls, adolescent pregnancies, and high maternal mortality rates. This region has one of the highest occurrences of child brides, combined with inadequate sexual health services. Child marriage, unsafe abortions, gender-based violence, prevalence of HIV/AIDS and high maternal mortality remain a major concern for women’s health in the region. Enforcing and creating laws protecting women and girls’ health, providing educational opportunities, and identifying vulnerable points in women’s health services are crucial steps to empower women and girls in the region. Sexual and Reproductive Health and Rights (SRHR) are human rights, and encompass all of the health issues women in Southeast Asia face, and more. In coming up with policies to protect women from poor reproductive health outcomes, local governments must keep these principles in mind. Furthermore, what are the main healthcare obstacles for women in Southeast Asia, and how can they be addressed to improve sexual and reproductive health outcomes and combat issues such as maternal mortality, adolescent pregnancies, and child marriage?

Socio-Cultural Context

In this region of the world, promoting reproductive health and awareness among young women and girls is not only a question of gender equality, but of security. There is an immediate need to bridge health inequalities in the region, especially for internally displaced women who lose their homes due to natural disasters, violence or those trapped in cycles of poverty or abuse^[1]Tanyag, M. (2018). Sexual and reproductive health is a security issue for Southeast Asia. Australian Journal of International Affairs, 72(6), 495–499.https://doi.org/10.1080/10357718.2018.1534943.. Internally displaced women in the Philippines, of which there are approximately 102,000 as of 2022, state that the prevalence of unsafe sexual behavior is rooted in a lack of sexual education in the region^[2]Internal Displacement Monitoring Centre. (2022). Philippines. IDMC – Internal Displacement Monitoring Centre. … Continue reading. Lack of access to knowledge about safe sexual practices and contraceptives, which can be due to social stigma, is making women more vulnerable to related complications^[3]Internal Displacement Monitoring Centre. (2022). Philippines. IDMC – Internal Displacement Monitoring Centre. … Continue reading. Furthermore, an important contributing factor to these inequities is the prevalence of early marriages and child brides. These practices are common for many factors, mainly due to cultural acceptance, poverty, legal loopholes, economic practicality for the girls’ family in marrying her young^[4]Pui Yee, C. (2021, January 16). Eradicating Child Marriages in Southeast Asia: Protecting Children, Challenging Cultural Exceptionalism – Penang Institute. Penanginstitute.org. … Continue reading. 

However, these practices continue to arise specifically out of crisis situations and a broader system of structural violence permissive of women’s treatment as a financial object who should be sold off^[5]Pui Yee, C. (2021, January 16). Eradicating Child Marriages in Southeast Asia: Protecting Children, Challenging Cultural Exceptionalism – Penang Institute. Penanginstitute.org. … Continue reading. Southeast Asia hosts some of the most patriarchal societies in the world, with girls being regarded as a burden and boys regarded as a blessing^[6]Niaz, U., & Hassan, S. (2006). Culture and mental health of women in South-East Asia. World Psychiatry : Official Journal of the World Psychiatric Association (WPA), 5(2), 118–120. … Continue reading. The predominant attitude is that women are “born to be fed^[7]Niaz, U., & Hassan, S. (2006). Culture and mental health of women in South-East Asia. World Psychiatry : Official Journal of the World Psychiatric Association (WPA), 5(2), 118–120. … Continue reading.” and boys are “born to earn”. Placing girls in a situation of helplessness since they are born reinforces the idea that women need to rely on a man to achieve financial security, and the only value they provide is their ability to marry and reproduce. These attitudes result in around 12 million girls being married before the age of 18 in Southeast Asia^[8]Pui Yee, C. (2021, January 16). Eradicating Child Marriages in Southeast Asia: Protecting Children, Challenging Cultural Exceptionalism – Penang Institute. Penanginstitute.org. … Continue reading, and many other reproductive health problems which keep women inferior to men. 

The strong stigma around sexual education in Southeast Asia also contributes to poor sexual health outcomes for women in the region. Comprehensive sexual education in the area is severely lacking, with factors like family avoidance, media restrictions, and legal loopholes preventing young people from learning about healthy sexual practices early on in life^[9]Wang, C. (2021). Analysis of How Sex Education in Asia is Expressed in the Media. 2021 International Conference on Public Art and Human Development.. Without access to information or resources to aid in their reproductive health, Southeast Asian women are forced to live in the dark and rely on the evasive answers given by the family members or even husband. 

Health Challenges Faced by Women in Southeast Asia

One of the main reproductive challenges that women in Southeast Asia face are the risks associated with maternal health and mortality. Improving maternal health is one of the United Nations’ Millennium Development Goals (MDGs) that has fallen regrettably behind schedule, a crisis highly visible in Southeast Asia. The United Nations Population Fund estimates that for every 100,000 live births, an estimated average of 220 women die in South Asia with 150 of those being in Southeast Asia, in comparison to 37 women in East Asia^[10]UNFPA: Asia and the Pacific. (2014, December 2). Maternal health. UNFPA Asiapacific. https://asiapacific.unfpa.org/en/maternal-health#. The Asian Development Bank provides an even higher estimate of maternal mortality, stating that the rate is 500 deaths per 100,000 live births^[11]Asian Development Bank. (2012, September 18). Gender Equality and Discrimination in Asia and the Pacific: 12 Things to Know. Asian Development … Continue reading. Women who give birth in South Asia, especially in rural areas, face dire environments, with little access to trained doctors or vital supplies in case of any birth complications. For example, the proportion of deliveries attended by skilled attendants is at a mere 18% in Bangladesh, 19% in Nepal, and 20% in Laos^[12]Asian Development Bank. (2012, September 18). Gender Equality and Discrimination in Asia and the Pacific: 12 Things to Know. Asian Development Bank. … Continue reading. The Organization for Economic Cooperation and Development (OECD) finds that the leading causes of maternal mortality around are severe bleeding childbirth, infections, and high blood pressure during pregnancy^[13]OECD iLibrary. (2020). Maternal Mortality. Www.oecd-Ilibrary.org.   https://www.oecd-ilibrary.org/sites/12a2742f-en/index.html?itemId=/content/component/12a2742f-en.. In Southeast Asia, these causes remain consistent, along with hemorrhage and obstructed labor^[14]Bhutta, Z. A., Gupta, I., de’Silva, H., Manandhar, D., Awasthi, S., Hossain, S. M. M., & Salam, M. A. (2004). Maternal and child health: is South Asia ready for change? BMJ, 328(7443), … Continue reading.

Most of these conditions, such as severe bleeding during childbirth or high blood pressure during pregnancy are common, and manageable under the right medical care. However, pregnant women in Southeast Asia are dying by the hundreds because of lack of access to basic medical care, like blood pressure monitoring and hemorrhage prevention. Aside from maternal mortality, rates of maternal malnutrition in the region are among the highest in the world^[15]Bhutta, Z. A., Gupta, I., de’Silva, H., Manandhar, D., Awasthi, S., Hossain, S. M. M., & Salam, M. A. (2004). Maternal and child health: is South Asia ready for change? BMJ, 328(7443), … Continue reading. Pregnant women experience overt malnutrition with low body mass indexes, and widespread micronutrient deficiencies^[16]Bhutta, Z. A., Gupta, I., de’Silva, H., Manandhar, D., Awasthi, S., Hossain, S. M. M., & Salam, M. A. (2004). Maternal and child health: is South Asia ready for change? BMJ, 328(7443), … Continue reading. Evidently malnutrition during pregnancy or not comes with its own risks, but can be especially dangerous when women have no resources to combat it. These conditions in Southeast and South Asia reflect the extremely poor state of basic health services and reproductive health education, especially for young women, and showcase the pressing need for an expanding healthcare infrastructure to protect and inform women on all the risks associated with pregnancy and childbirth. 

However, there are many ways to curb the maternal mortality rate in this region. A study published by the National Library of Medicine found that expanding medical coverage for hypertensive disease in pregnancy and safe access to abortions could drastically reduce deaths associated with pregnancy and birth^[17]Acuin, C. S., Khor, G. L., Liabsuetrakul, T., Achadi, E. L., Htay, T. T., Firestone, R., & Bhutta, Z. A. (2011). Maternal, neonatal, and child health in southeast Asia: towards greater regional … Continue reading. The only country in Southeast Asia that allows abortions upon request is Nepal, with a 12 week gestation maximum. Bangladesh and Timor Leste only allow them if the woman’s life is critically endangered. The rest are somewhere in between: abortios are legal under certain circumstances, like pregnancies stemming from rape or incest, fetal impairment, and to preserve women’s mental and physical health^[18]World Health Organization: Regional Office for Southeast Asia. (2021). Policies, programme and services for comprehensive abortion care in South-East Asia Region.. Furthermore, since unsafe abortions account for up to 11% of maternal mortality rates, liberalizing abortion laws and removing barriers to accessing abortions such as requiring a medical panel to approve the procedure can do a great deal in preventing deaths and complications from this procedure^[19]World Health Organization: Regional Office for Southeast Asia. (2021). Policies, programme and services for comprehensive abortion care in South-East Asia Region.. Moreover, the previous study also finds that a steady policy focus from governments on maternal and child health programs in countries like Thailand and Malaysia have been effective in protecting women from maternal mortality. This proves the real and tangible progress that can be done if national governments invest in sexual health policy expansion. 

Sexual health education and protection in Southeast Asia is also of concern. A study published by the Australian Journal of International Affairs found that in the Philippines, women and girls residing and seeking refuge in internal displacement camps face dangerous situations in regards to their sexual health^[20]Tanyag, M. (2018). Sexual and reproductive health is a security issue for Southeast Asia. Australian Journal of International Affairs, 72(6), 495–499. … Continue reading. As stated by one of the women interviewed. The women in these camps have no access to reproductive health services. This same study reveals that the persistent lack of emergency aid to respond to the repeated realities of sexual assault and daily sexual practices leads to heightened maternal mortality and unplanned pregnancies in these camps^[21]Tanyag, M. (2018). Sexual and reproductive health is a security issue for Southeast Asia. Australian Journal of International Affairs, 72(6), 495–499. … Continue reading. With the lack of availability of reproductive health services in these camps, such as abortion services and contraceptive distribution, women and girls are forced to go forward with pregnancies which often happen as a result of rape^[22]Tanyag, M. (2018). Sexual and reproductive health is a security issue for Southeast Asia. Australian Journal of International Affairs, 72(6), 495–499. … Continue reading.

Without access to these crucial services and the cultural stigma women face when talking about sexual health, highly vulnerable women such as those in these refugee camps in the Philippines lose their personal agency in their reproductive decisions. This situation poses a crisis to women’s health not only in the Philippines, but in broader South Asia as well. There is an urgent need for funding of sexual health clinics in refugee camps and elsewhere, and even though cultural barriers to these exist, governments should welcome non-governmental medical organizations to at least provide emergency aid, medical checkups, and contraception to women who wish to access these.

In broader South Asia, women in India are disproportionately at risk of contracting HIV/AIDS. 40% of people with these conditions in India are women^[23]Women’s and Girls’ Health in South Asia: Challenges for Global Policy. (2003). Asia Society. https://asiasociety.org/womens-and-girls-health-south-asia-challenges-global-policy., most of them underage girls and young women. Although coverage for HIV testing and treatment has improved among pregnant women, these rates remain low in all countries except Thailand, which has been effective in removing mother-to-child transmission of HIV and syphilis^[24]Pendse, R., Gupta, S., Yu, D., & Sarkar, S. (2016). HIV/AIDS in the South-East Asia region: progress and challenges. Journal of Virus Eradication, 2 (Suppl 4), … Continue reading.  Additionally, the young population in Southeast Asia is considerable, comprising about a third of the region’s population. Aside from young women being particularly vulnerable to gender-based violence and child marriage, adolescents in general are poorly informed about protection from unwanted pregnancies, STDs, and STIs^[25]Pachauri, S. (2011). Sexual and reproductive health services: Priorities for South and East Asia. Indian Journal of Community Medicine, 36(2), 83. https://doi.org/10.4103/0970-0218.84116.. Since adolescents are a large portion of the population in South Asia, the lack of education on STDs and STIs makes them more likely to contract these illnesses without knowing how to prevent them and how to treat them. 

There is a great need for expanded access to information and sexual health services. Social taboos around adolescent and female sexuality have impeded educational programs around these topics, and they remain a strong necessity^[26]Pachauri, S. (2011). Sexual and reproductive health services: Priorities for South and East Asia. Indian Journal of Community Medicine, 36(2), 83. https://doi.org/10.4103/0970-0218.84116.. Furthermore, the Guttmacher Institute reports that the lack of high-quality sexual and reproductive health care puts women in Southeast Asia at risk of poor emotional and physical health outcomes, with 2.4 million women having unsafe abortions and 10 million not receiving proper care for illnesses like chlamydia, gonorrhea, syphilis, and trichomoniasis yearly^[27]Guttmacher Institute. (2020, October 15). Investing in Sexual and Reproductive Health in Southeast Asia. Guttmacher Institute. … Continue reading. As mentioned previously, funding clinics with testing equipment for these illnesses can be extremely helpful in preventing their proliferation.

Finally, the issue and systematic presence of child marriage and child brides is one of the highest obstacles to reproductive health for the women of Southeast Asia. According to UNICEF, South Asia has the highest rates of child marriage in the world. Almost 45% of all women aged 20-24 report being married before 18^[28]Al Jazeera. (2023, April 20). South Asia has world’s highest number of child brides, says UN. … Continue reading. Moreover, approximately ⅕ girls are married before they turn 15^[29]UNICEF. (2023). Child marriage. https://www.unicef.org/rosa/what-we-do/child-protection/child-marriage.. There is strong pressure on girls in South Asia to marry young and have children early. A recent study by UNICEF included findings that many parents in Bangladesh, India, and Nepal regarded child marriage as the best option for daughters who “had limited options to study during COVID lockdowns^[30]Al Jazeera. (2023, April 20). South Asia has world’s highest number of child brides, says UN. www.aljazeera.com. … Continue reading.”. Evidently, girls’ economic situations and educational opportunities worsened during the economic depression caused by the COVID-19 lockdowns, as many families saw no other options for their daughters other than marriage. Medical doctor and researcher Nawal M. Nour finds that there are three main drivers for child marriage: “poverty, the need to reinforce social ties, and the belief that it offers protection^[31]Nour, N. M. (2009). Child marriage: a silent health and human rights issue. Reviews in Obstetrics & Gynecology, 2.1, 51–56.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2672998/..” 

Child marriage is much more predominant in areas with high levels of poverty, and parents favor this practice since it is supposed to ensure their daughters’ financial security and reduces the perceived economic burden that daughters place on their families. Nevertheless, child marriage has an array of highly negative consequences for young girls, such as cervical cancer, sexual assault, pregnancy complications, depression, isolation, and lack of agency and independence, among others. Child marriage is not only a formal violation of human and children’s rights, but it is also a practice overwhelmingly targeting young girls. It lowers women’s participation in the workforce, ends their childhood, exposes them to rape and dangerous pregnancies, and lowers their quality of life^[32]Tanyag, M. (2018). Sexual and reproductive health is a security issue for Southeast Asia. Australian Journal of International Affairs, 72(6), 495–499. https://doi.org/10.1080/10357718.2018.1534943..

Empowerment through Education and Access

Although the obstacles to proper access to reproductive health in Southeast Asia are complex and systematic, there are several steps that governments and civil society organizations can take to improve access to these services and improve women’s healthcare and safety. First and foremost, comprehensive sexual education programs in school help educate young people about reproductive health, STI and STD prevention, consent, and safe sex practices. Furthermore, governments should work on providing equitable access to contraceptives for young women who wish to prevent pregnancies. For example, the U.N regularly hosts dialogues between the World Health Organizations and civil society organizations dedicated to promoting reproductive health, such as the IPPF (International Planned Parenthood Foundation^[33]World Health Organization. (2023). Siding with science and SRHR: Civil Society Organizations (CSO) Dialogue on SRHR with Dr Tedros. Www.who.int. … Continue reading.). In these dialogues, they discuss how to better uphold SRHR principles and apply them to the daily realities faced by women everywhere. The World Health Organization reports that there is a positive relationship in South Asian countries between the funding of sexual health programmes and STI declines^[34]World Health Organization- Regional Office for South East Asia. (n.d.). Moving ahead on elimination of Sexually Transmitted Infections (STIs) in WHO South-East Asia Region – progress and … Continue reading. These programs include services as simple as condom distribution, and more complex services^[35]World Health Organization- Regional Office for South East Asia. (n.d.). Moving ahead on elimination of Sexually Transmitted Infections (STIs) in WHO South-East Asia Region – progress and … Continue reading like maintaining good clinical services. Nevertheless, these findings reinforce the importance of governmental investment in sexual health clinics, and even allowing simple contraceptives like condoms to be distributed locally.

It is also of utmost importance to address maternal health and childbirth health risks. By expanding healthcare services, especially in rural areas, women who are in gestation or giving birth can prevent common health complications and enjoy safe pregnancies and deliveries. Southeast Asia also happens to be a region that commonly grapples with natural disasters, such as floods. Since 60% of maternal deaths around the world happen in fragile contexts, it is important for governments to research and create proper medical emergency responses for pregnant women in these situations^[36]UNFPA: Asia and the Pacific. (2014, December 2). Maternal health. UNFPA Asiapacific. https://asiapacific.unfpa.org/en/maternal-health.. Funding local clinics that offer prenatal care and safe delivery services can be the difference that saves millions of women’s lives. These clinics can also provide essential reproductive health services such as contraception distribution, illness screenings, and counseling. 

However, it is also of key for local governments to enforce and strengthen child protection laws. Implementing and enforcing laws that set the minimum age for marriage at 18 and impose strict penalties for parents and community leaders involved in child marriages. However, in Southeast Asia, local customs hold more weight than international laws prohibiting child marriage, and many nations have already set the legal age for marriage at 18 years old. Since customs and religious laws bear a heavy influence on how prevalent child marriage is, it is extremely complex and arduous work to undo hundreds of years of this practice^[37]Pui Yee, C. (2021, January 16). Eradicating Child Marriages in Southeast Asia: Protecting Children, Challenging Cultural Exceptionalism – Penang Institute. Penanginstitute.org. … Continue reading. While there is not much to do when laws are in place, organizations like UNICEF work to help women who married young escape poor health situations and even work with local organizations to get teenage girls life-skills training, comprehensive sexuality education, and school attendance support^[38]UNICEF. (2023). Child marriage. https://www.unicef.org/rosa/what-we-do/child-protection/child-marriage.. Nevertheless, there are steps that can be taken to provide girls with financial opportunities to escape child marriage. 

This goes hand in hand with the need for educational opportunities for girls to be able to remain in school and access higher education. Education is the main way for women and girls to escape cycles of poverty and reduce their chances of being married off against their will. Financial incentives could also be helpful in the forms of scholarships to families who keep their daughters in school and delay their marriages. Developing rural areas to create educational opportunities which then translate into job opportunities is one of the most surefire ways to prevent child marriage without delving into a cultural dispute about customs and practices. If governments at the national level build more schools in rural areas, girls are more likely to finish school and access higher education and social mobility^[39]UNICEF. (2023). Child marriage. https://www.unicef.org/rosa/what-we-do/child-protection/child-marriage..

To quote this article : Ilona Barrero. (2023). Barriers to Reproductive Health Resources for Women in Southeast Asia. Gender in Geopolitics Institute. igg-geo.org/?p=14457&lang=en

The statements in this article are the sole responsibility of the author.