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Garis Panduan Pengendalian Masalah Kesihatan Seksual Dan Reproduktif Remaja Di Klinik Kesihatan

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Garis Panduan Pengendalian Masalah Kesihatan Seksual Dan Reproduktif Remaja Di Klinik Kesihatan GARIS PANDUAN PENGENDALIAN MASALAH KESIHATAN SEKSUAL DAN REPRODUKTIF REMAJA DI KLINIK KESIHATAN Kementerian Kesihatan Malaysia BAHAGIAN PEMBANGUNAN KESIHATAN KELUARGA KEMENTERIAN KESIHATAN MALAYSIA 2012 KANDUNGAN MUKA PERKARA SURAT Kata-Kata Aluan i Prakata iii Daftar Kata v Pendahuluan 1 UNIT 1 : Pengendalian Kehamilan dan Pengguguran 7 UNIT 2 : Pengendalian Jangkitan Kelamin dan HIV/ AIDS 35 UNIT 3 : Pengendalian Keganasan Seksual 47 (Rogol, Cabul, Liwat dan Sumbang Mahram) UNIT 4 : Pengendalian Perkhidmatan Kontraseptif 57 SOALAN LAZIM 67 Lampiran Lampiran 1: Undang-Undang 83 1.1 Surat dari Pejabat Undang-Undang, KKM 85 1.2 Akta Umur Dewasa 1971 93 1.3 Guardianship of Infants (Act 1961) 96 1.4 Kanun Keseksaan (Akta 574) 103 1.5 Akta Kanak-Kanak 2001 112 1.6 Akta Pencegahan dan Pengawalan Penyakit 1988 (Akta 342) 146 Lampiran 2: Etika Perubatan 151 2.1 Code of Professional Conduct 153 2.2 Code of Medical Ethics 164 2.3 Confidentiality 169 Lampiran 3: Perspektif Agama 183 3.1 Fatwa (Keputusan Muzakarah Kali Ke-90) 185 3.2 Majlis Perundingan Agama Buddha, Hindu, Kristian, Sikhism 198 dan Taoism (MCCBCHST). 3.3 Religion, Contraception & Abortion Factsheet by FPA, 2004 212 Lampiran 4: Peranan Pelindung (JKM) 217 Lampiran 5: Contoh Borang Persetujuan Ibu bapa 221 Lampiran 6: Borang 9 (Akta Kanak-kanak 2001) 223 Lampiran 7: Panduan Telefon Agensi Sokongan 225 7.1 Hotline & Jabatan Kebajikan Masyarakat Negeri 226 7.2 NGO Yang Memberi Perlindungan 231 Senarai Rujukan 235 Glosari 237 Penghargaan 244 Garis Panduan Pengendalian Masalah Kesihatan Seksual dan Reproduktif Remaja di Klinik Kesihatan Kata-Kata Aluan Saya ingin merakamkan ucapan terima kasih kerana diberi peluang memberi sepatah dua kata sempena penerbitan Buku Garis Panduan Pengendalian Masalah Kesihatan Seksual dan Reproduktif Remaja Di Klinik Kesihatan. Masalah kesihatan seksual dan reproduktif yang melanda generasi muda kini amat membimbangkan. Tinjauan Kesihatan dan Morbiditi Kebangsaan oleh Kementerian Kesihatan Malaysia menunjukkan prevalen aktiviti seksual dalam kalangan remaja meningkat daripada 1.8 peratus (1996) kepada 8.3 peratus (2012). Kajian di peringkat kebangsaan oleh Lembaga Penduduk dan Pembangunan Keluarga Negara pula menunjukkan peratus remaja yang terlibat dalam aktiviti seksual telah meningkat dari 0.9 peratus (1994) kepada 2.2 peratus (2004) dan 6.5% (2010). Manakala kajian-kajian yang dijalankan oleh pihak universiti dan agensi lain dalam kalangan remaja berisiko tinggi adalah sekitar 54 – 99 peratus. Data KKM pula menunjukkan kes baru ibu hamil dalam kalangan remaja 10 – 19 tahun dari Januari hingga Disember 2011 adalah sebanyak 18,652, di mana sebanyak 4,222 (23%) daripadanya tidak berkahwin. Lain-lain masalah sosial dan reproduktif dalam kalangan remaja adalah seks di luar nikah, pembuangan bayi, sumbang mahram, penyakit jangkitan kelamin dan HIV. Antara faktor yang menjurus ke arah masalah seksual reproduktif remaja adalah kurangnya pengetahuan dan kemahiran mengenai kesihatan seksual dan reproduktif, pengaruh rakan sebaya, konflik kekeluargaan, kurangnya pendidikan agama serta pengaruh teknologi komunikasi, internet dan globalisasi. Syabas kepada Bahagian Pembangunan Kesihatan Keluarga dan bahagian-bahagian lain di peringkat kementerian serta semua agensi kerajaan dan bukan kerajaan yang terlibat secara langsung dan tidak langsung dalam penyediaan garis panduan komprehensif ini, yang mengambil kira aspek-aspek perundangan, etika perubatan, agama, hak dan sosiobudaya dalam pengendalian masalah kesihatan seksual dan reproduktif remaja. Semoga garis panduan ini dapat menjadi rujukan kepada semua anggota kesihatan khususnya di peringkat penjagaan kesihatan primer dalam menyediakan perkhidmatan yang berkualiti, komprehensif dan bersepadu kepada golongan remaja di Malaysia. Sekian, terima kasih. DATUK DR. LOKMAN HAKIM BIN SULAIMAN Timbalan Ketua Pengarah Kesihatan (Kesihatan Awam) Kementerian Kesihatan Malaysia m u k a | i Garis Panduan Pengendalian Masalah Kesihatan Seksual dan Reproduktif Remaja di Klinik Kesihatan Prakata Program Kesihatan Remaja dimulakan pada tahun 1996 di bawah perkembangan skop Program Pembangunan Kesihatan Keluarga. Ia diwujudkan bagi merancang program dan perkhidmatan untuk golongan remaja berdasarkan matlamat yang ditetapkan dalam Dasar Kesihatan Remaja Negara. Kementerian Kesihatan telah menyediakan beberapa modul, garis panduan dan borang saringan untuk membantu anggota kesihatan menyediakan perkhidmatan kepada golongan remaja di peringkat kesihatan primer. Dengan penggunaan borang saringan kesihatan remaja yang semakin meluas, didapati terdapat peningkatan kes-kes berkaitan kesihatan seksual dan reproduktif remaja dikesan. Didapati anggota kesihatan menghadapi dilema dalam mengendali masalah kesihatan seksual dan reproduktif remaja kerana ianya sulit dan remaja di bawah 18 tahun dianggap kanak-kanak yang mana mempunyai implikasi perundangan, etika, hak, agama dan sosiobudaya. Memahami cabaran yang dihadapi oleh anggota kesihatan, Bahagian Pembangunan Kesihatan Keluarga telah mengambil inisiatif untuk menyediakan “Garis Panduan Pengendalian Masalah Kesihatan Seksual dan Reproduktif Remaja Di Klinik Kesihatan” yang mengambil kira aspek perundangan, etika, hak, agama dan sosiobudaya. Garis panduan ini merangkumi empat skop iaitu pengendalian kehamilan dan pengguguran, pengendalian jangkitan kelamin, termasuk jangkitan HIV / AIDS, pengendalian keganasan seksual dan pengendalian perkhidmatan kontraseptif. Ia juga mengandungi carta alir, peranan dan tanggungjawab anggota kesihatan, dokumen dan akta-akta berkaitan. Diharap garis panduan ini dapat membantu anggota kesihatan membuat keputusan yang bijaksana dan memberi perkhidmatan optimum kepada remaja dengan masalah seksual dan reproduktif. Akhir kata, saya mengucapkan terima kasih serta syabas kepada para anggota KKM dan semua agensi yang terlibat secara langsung dan tidak langsung dalam menghasilkan garis panduan ini. Sekian, terima kasih. TO’ PUAN DR. SAFURAH BINTI HAJI JAAFAR Pengarah Bahagian Pembangunan Kesihatan Keluarga Kementerian Kesihatan Malaysia m u k a | iii Garis Panduan Pengendalian Masalah Kesihatan Seksual dan Reproduktif Remaja di Klinik Kesihatan DAFTAR KATA AIDS – Acquired Immunodeficiency Syndrome BSSK/R – Borang Saringan Status Kesihatan Remaja CEDAW – Convention on the Elimination of All Forms of Discrimination Against Women CRC – Convention on the Rights of the Child FMS – Family Medicine Specialist GPKSR – Garis Panduan Pengendalian Masalah Kesihatan Seksual dan Reproduktif Remaja di Klinik Kesihatan HEADSS – Acronym “Home, Education Employment, Activities, Drugs, Sexuality, Suicide HIV – Human Immunodeficiency Virus ICPD – International Conference on Population and Development ICT – Information Communication Technology IPTA – Institut Pengajian Tinggi Awam IPTS – Institut Pengajian Tinggi Swasta JAKIM – Jabatan Kemajuan Islam Malaysia JK – Jururawat Kesihatan JKM – Jabatan Kebajikan Masyarakat JM – Jururawat Masyarakat JPL – Jabatan Pesakit Luar LPPKN – Lembaga Penduduk dan Pembangunan Keluarga Negara m u k a | v Garis Panduan Pengendalian Masalah Kesihatan Seksual dan Reproduktif Remaja di Klinik Kesihatan KD – Klinik Desa KPM – Kementerian Pelajaran Malaysia KK – Klinik Kesihatan KKM – Kementerian Kesihatan Malaysia M&HO – Medical and Health Officer MCCBCHST – Malaysian Consultative Council for Buddhism, Christianity, Hinduism, Sikhism and Taoism MO – Medical Officer MOE – Ministry of Education MOHE – Ministry of Higher Education NGO – Non-Government Organization O&G – Obstetrik dan Ginekologi OKU – Orang Kurang Upaya PDRM – Polis DiRaja Malaysia PLKN – Program Latihan Khidmat Negara PPK – Pembantu Perawatan Kesihatan PPP – Penolong Pegawai Perubatan PT – Pembantu Tabdir SRH – Sexual and Reproductive Health VCC – Verbal Confidentiality Contract m u k a | vi Garis Panduan Pengendalian Masalah Kesihatan Seksual dan Reproduktif Remaja di Klinik Kesihatan PENDAHULUAN 1. LATAR BELAKANG Kesihatan reproduktif ditakrifkan sebagai “keadaan sihat dari segi fizikal, mental dan sosial dan bukan hanya bebas dari penyakit dalam semua perkara yang berkaitan dengan sistem reproduktif, fungsi dan prosesnya. Ia merangkumi keupayaan untuk menjalin kehidupan seksual yang memuaskan dan selamat serta bebas membuat pilihan yang bertanggungjawab”. Kesihatan seksual pula adalah komponen penting dalam kesihatan reproduktif. Ia merupakan keupayaan lelaki dan wanita melakukan aktiviti seks dengan bertanggungjawab dan selamat. Malaysia telah menerimapakai persetujuan hasil Persidangan Kependudukan dan Pembangunan Antarabangsa, Kaherah 1994 (International Conference on Population and Development, Cairo 1994) yang menekankan perlunya: “Protect and promote the rights of adolescents to the enjoyment of the highest attainable standard of health, provide appropriate, specific, user-friendly and accessible services to address their reproductive and sexual health needs, including reproductive health education, information, counseling and health promotion strategies”. Peringkat remaja ditafsirkan oleh Pertubuhan Kesihatan Sedunia sebagai peringkat umur 10 – 19 tahun. Ia merupakan masa peralihan dari alam kanak-kanak ke alam dewasa yang penuh dengan cabaran fizikal, mental dan sosial. Dalam menghadapi cabaran-cabaran ini, proses pengubahsuaian dan pembelajaran akan menglibatkan pengambilan risiko oleh golongan remaja, yang boleh menentukan samada hasilnya bersifat membina ataupun membinasa. 1.1 RASIONAL Semakin ramai remaja yang terlibat dengan aktiviti seks datang ke klinik dengan
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