Rashidah Shuib

Cervical cancer screening attitudes and beliefs of Malaysian women who have never had a pap smear: a qualitative study.

Background: Attitudes toward cervical cancer and participation in early detection and screening services are well known to be profoundly affected by cultural beliefs and norms.Purpose: This study explored the attitudes and sociocultural beliefs on cervical cancer screening among Malaysian women.Method: In this qualitative study, in-depth interviews were conducted with 20 Malaysian women, ages 21 to 56 years, who have never had a Papanicolaou (Pap) smear.Results: Respondents generally showed a lack of knowledge about cervical cancer screening using Pap smear, and the need for early detection for cervical cancer. Many believed the Pap smear was a diagnostic test for cervical cancer, and since they had no symptoms, they did not go for Pap screening. Other main reasons for not doing the screening included lack of awareness of Pap smear indications and benefits, perceived low susceptibility to cervical cancer, and embarrassment. Other reasons for not being screened were related to fear of pain, misconceptions about cervical cancer, fatalistic attitude, and undervaluation of own health needs versus those of the family.Conclusion: Women need tobe educated about the benefits of cervical cancer screening. Health education, counseling, outreach programs, and community-based interventions are needed to improve the uptake of Pap smear in Malaysia.

The practice of female circumcision among Muslims in Kelantan, Malaysia

Abstract This paper describes the practice of female circumcision among Muslims in Kelantan, Malaysia. A convenience sample of 262 pregnant women admitted to the labour ward of the University Hospital were examined clinically and later interviewed using a questionnaire. Although all the women had undergone circumcision as infants, there was no clinical evidence of injury to the clitoris or the labia and no physical sign of excised tissue. In the interviews, the majority of women described the procedure as a nicking of the tip ofthe clitoris or prepuce with a pen-knife or similar, only drawing a drop of blood and causing briefpain. Almost all the women believed the practice was customary and a religious requirement and that womens sexual drives are reduced and mens sexual pleasure enhanced by it. All of them considered the practice desirable and could not see any harm in it. We decided to use the term ‘female circumcision’ as we believe ‘female genital mutilation’ would be a misnomer in the Malaysian context. We are concerned that if the issue is raised for religious and public discussion, any suggestions to stop the practice would not gain sympathy because of the implications and the meanings associated with ‘mutilation’.

An integrated health sector response to violence against women in Malaysia: lessons for supporting scale up

BackgroundMalaysia has been at the forefront of the development and scale up of One-Stop Crisis Centres (OSCC) - an integrated health sector model that provides comprehensive care to women and children experiencing physical, emotional and sexual abuse. This study explored the strengths and challenges faced during the scaling up of the OSCC model to two States in Malaysia in order to identify lessons for supporting successful scale-up.MethodsIn-depth interviews were conducted with health care providers, policy makers and key informants in 7 hospital facilities. This was complemented by a document analysis of hospital records and protocols. Data were coded and analysed using NVivo 7.ResultsThe implementation of the OSCC model differed between hospital settings, with practise being influenced by organisational systems and constraints. Health providers generally tried to offer care to abused women, but they are not fully supported within their facility due to lack of training, time constraints, limited allocated budget, or lack of referral system to external support services. Non-specialised hospitals in both States struggled with a scarcity of specialised staff and limited referral options for abused women. Despite these challenges, even in more resource-constrained settings staff who took the initiative found it was possible to adapt to provide some level of OSCC services, such as referring women to local NGOs or community support groups, or training nurses to offer basic counselling.ConclusionsThe national implementation of OSCC provides a potentially important source of support for women experiencing violence. Our findings confirm that pilot interventions for health sector responses to gender based violence can be scaled up only when there is a sound health infrastructure in place – in other words a supportive health system. Furthermore, the successful replication of the OSCC model in other similar settings requires that the model – and the system supporting it – needs to be flexible enough to allow adaptation of the service model to different types of facilities and levels of care, and to available resources and thus better support providers committed to delivering care to abused women.

“I feel it is not enough…” Health providers’ perspectives on services for victims of intimate partner violence in Malaysia

BackgroundThis study explores the views and attitudes of health providers in Malaysia towards intimate partner violence (IPV) and abused women and considers whether and how their views affect the provision or quality of services. The impact of provider attitudes on the provision of services for women experiencing violence is particularly important to understand since there is a need to ensure that these women are not re-victimised by the health sector, but are treated sensitively.MethodsIn-depth interviews were conducted with 54 health care providers responsible for providing services to survivors of IPV and working in health care facilities in two Northern States in Malaysia. A thematic framework analysis method was employed to analyse the emerging themes. Interviews were coded and managed by using NVIVO (N7), a qualitative software package.ResultsWe found that when providers follow the traditional role of treating and solving IPV as “medical problem”, they tend to focus on the physical aspect of the injury, minimise the underlying cause of the problem and ignore emotional care for patients. Providers frequently felt under-trained and poorly supported in their role to help women beyond merely treating their physical injuries. What emerged from the findings is that time shortages may well impact on the ability of medical officers to identify cases of abuse, with some saying that time limitations made it more difficult to detect the real problem behind the injury. However, data from the interviews seem to suggest that time constraints may or may not end up resulting in limited care, depending on the individual interest of medical professionals on violence issues.ConclusionsPromoting empathetic health care provision is challenging. More awareness training and sensitisation could help, especially if courses focus on women’s needs and strengths and how health providers can validate these and contribute to a longer term process of change for victims of violence. Clear guidance on how to record history of abuse, ask questions sensitively and validate experiences is also important together with training on good communication skills such as listening and being empathetic.

Correlates between risk perceptions of cervical cancer and screening practice

OBJECTIVES To identify the correlates between risk perceptions and cervical cancer screening among urban Malaysian women. METHOD A cross-sectional household survey was conducted among 231 women in Petaling Jaya city in 2007. The association of risk perceptions of cervical cancer and screening practice was analyzed using Poisson regression. RESULTS 56% of the respondents ever had a Pap smear test. Knowledge of signs and symptoms (aPR=1.11, 95% CI=1.03-1.19), age (aPR=1.02, 95% CI=1.01-1.03), number of pregnancies (aPR=1.06, 95% CI=1.01-1.11), marital status, education level and religion were found to be significant correlates of Pap smear screening. Respondents who were never married were less likely to have had a Pap smear. Those who had no education or primary education were less likely to have had a Pap smear compared to those with degree qualification. The prevalence of screening was significantly higher among Christians and others (aPR=1.35; 95% CI=1.01-1.81) and Buddhists (aPR=1.38; 95% CI=1.03-1.84), compared to Muslims. CONCLUSION Eliminating anecdotal beliefs as risks via targeted knowledge on established risk factors and culturally sensitive screening processes are strategic for increasing and sustaining uptake of Pap smear screening versus current opportunistic screening practices.

Circuitous Pathways: Marriage as a Route toward (Il)Legality for Indonesian Migrant Workers in Malaysia

This paper addresses the disjuncture between an immigration regime that seeks to prevent unskilled migrant workers from marrying citizens, and the reality that many are actually able to carve a marital pathway toward legality of residence. Beginning from the premise that the state constructs (il)legality through laws and policies, we draw from 38 interviews conducted among Indonesian migrant workers and their citizen spouses in Malaysia to highlight the agency of migrants and local citizens in reconfiguring and reshaping this construction. Locating our discussion within the migration literature that challenges the construction of legality and illegality as rigidly separate and non-overlapping zones, we trace the circuitous marital pathways that our interviewees forge toward (il)legality as they navigate through blurred categories of legal and illegal, wife and worker. State institutionalization of marriage has produced its own ambiguities, and a marriage can be religiously valid even if not officially registered. Societal ambiguities arise from the tensions between what is valid according to religion and custom and what is prohibited according to state policy. These ambiguities allow for the institutionalization of a marital pathway, though complicated and circuitous, from temporary legality and illegality toward (il)legality of residence, though not necessarily toward full membership in the nation.

Work and Lifestyle Factors Associated with Morbidity of Electronic Women Workers in Selangor, Malaysia

The objective of this study was to identify sociodemographic, work, living arrangement and lifestyle factors associated with morbidity of electronics women workers in selected factories in Selangor, Malaysia. The research design was a cross-sectional questionnaire-based survey. Most of the 401 respondents were young single Malay women. Morbidity was high as 85.5% of the women reported experiencing at least one chronic health problem, and 25.7% said that an illness or injury prevented them from carrying out normal activities within the last two weeks. Major acute illness symptoms were the common cold, backache, and diarrhoea while chronic health problems such as persistent headache, eye problems, menstrual problems, and persistent backache were also reported. After logistic regression, chronic health problems was significantly associated with room sharing; while illness that prevented normal activities within the last two weeks was significantly associated with overtime work and exercise. Further research is recommended to understand the complex inter-relationship between morbidity and working and living conditions. Asia Pac JPublic Health 2002; 14(2): 75-84.