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Maternal Care of Undocumented Pregnant Women Under the Fees Act (Medical) for Foreigners 1951: Perspectives of Health and Non-Health Actors

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Maternal Care of Undocumented Pregnant Women Under the Fees Act (Medical) for Foreigners 1951: Perspectives of Health and Non-Health Actors Centre for Peace Studies Maternal Care of Undocumented Pregnant Women under The Fees Act (Medical) for Foreigners 1951: Perspectives of Health and Non-health Actors Pei Shan Loo Master’s thesis in Peace and Conflict Transformation May 2017 1 Maternal Care of Undocumented Pregnant Women under The Fees Act (Medical) for Foreigners 1951: Perspectives of Health and Non-health Actors By Pei Shan Loo A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of MASTER OF PHILOSOPHY in the Peace and Conflict Transformation Program Centre for Peace Studies The Arctic University of Norway May 2017 Supervisor Dr. philos. Professor emerita Randi Rønning Balsvik (Institute of History and Religious Studies) Abstract With the unprecedented international migration around the world, policies that restrict immigrants' health care access have become prevailing. In 2014, the amendment to The Fees Act (Medical) for Foreigners 1951 had further hindered the health care access of undocumented pregnant women. This qualitative study aimed to obtain perspectives of health and non-health actors regarding the implications of the amendment to the undocumented pregnant women. Ten semi-structured interviews were conducted in Kuala Lumpur, Malaysia. The findings show that Malaysians perceive as a threat when the competition for public health care access rises with the growing number of immigrants. The amendment was used to save the health care budget and to control the immigrant population. Scapegoating immigrants has nonetheless masked the weak governance and poor development of the health care system that has stretched the health care budget. The amendment is likely to show immediate cost saving. However, women are highly prone to various pregnancy complications without adequate maternal care, and may eventually result in increased hospital fees. The high medical cost will increase the difficulty in public health control as any outbreak of infectious disease can cost the government massive amounts of money. Also, provision of family planning services among the immigrants can directly improve maternal and child survival and extend women's work productivity from unwanted pregnancy. Stemming the undocumented immigrant pool not only can reduce job competition for Malaysia’s bottom 50%, the collected levy among the newly documented immigrants can in turn subsidies the health care services for immigrant group themselves. The presented findings are based on the perspectives from health and non-health actors in Malaysia. To conclude, this study shows a profound need for health and immigration policy reform. The effort is not just for the health of undocumented pregnant women, but most importantly for the economic and health benefit of Malaysians in general. Keywords: undocumented women; maternal health; health policy i Table of Contents Abstract ....................................................................................................................................... i Table of Contents ....................................................................................................................... ii List of Figures ............................................................................................................................ v List of Tables ............................................................................................................................. vi List of Acronyms ...................................................................................................................... vii Acknowledgement ................................................................................................................... viii Chapter 1: Introduction........................................................................................................... 1 Background ............................................................................................................................ 1 The Focus of This Dissertation .............................................................................................. 3 Research Objectives and Questions ....................................................................................... 3 Dissertation Outline ................................................................................................................ 4 Chapter 2: Literature Review ................................................................................................. 5 Introduction ............................................................................................................................ 5 Notes on Terminology ............................................................................................................ 5 Migration in Southeast Asia ................................................................................................... 7 Malaysia ................................................................................................................................. 8 Challenges ............................................................................................................................ 10 Gendered Dimensions of International Migration ............................................................... 11 Maternal Health Care ........................................................................................................... 12 Malaysia Health Care System and Health Care Access of Immigrants ............................... 14 Maternal Health Development in Malaysia ......................................................................... 15 Maternal Health of Undocumented Immigrant .................................................................... 15 The Turning Point, the Amendment on The Fees Act (Medical) for Foreigners 1951 ........ 17 Cost effectiveness of Maternal Care .................................................................................... 18 ii Conclusion ............................................................................................................................ 19 Chapter 3 Theoretical Framework ....................................................................................... 21 Introduction .......................................................................................................................... 21 Social Threat Theory ............................................................................................................ 21 Development of the concept and the Critics .................................................................... 23 Structural Violence ............................................................................................................... 26 The Debates ...................................................................................................................... 28 Conclusion ............................................................................................................................ 30 Chapter 4: Methodology ........................................................................................................ 31 Introduction .......................................................................................................................... 31 Research Design ................................................................................................................... 31 Data Collection Techniques ................................................................................................. 31 Document Review ................................................................................................................ 32 Selection of participants/sources .......................................................................................... 33 Data Analysis ....................................................................................................................... 35 Researcher Positionality ....................................................................................................... 36 Conclusion ............................................................................................................................ 43 Chapter 5: Interview Results ................................................................................................ 44 Introduction .......................................................................................................................... 44 General Perception on The Fees Act Amendment ............................................................... 44 Plausible Factors Contributing to the Amendment .............................................................. 45 Outcomes and Possible Impacts ........................................................................................... 48 Cost Effectiveness ................................................................................................................ 51 Current Response or Resources in Assisting the Undocumented ........................................ 52 Challenges Faced by Undocumented Pregnant Mothers ...................................................... 53 Alternatives Approaches ...................................................................................................... 55 Human Rights Perspective ................................................................................................... 58 iii Conclusion ...........................................................................................................................
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