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Doctor | Academic | Global Advocate for Women’s Health

Hello, I’m Dr Hannah Nazri, a UK-based Malaysian Obstetrics & Gynaecology doctor, researcher, and global health advocate committed to advancing women’s healthcare through science, innovation, and policy. Alongside my clinical training, I hold a DPhil (PhD) from the University of Oxford. My work spans endometriosis research, FemTech innovation, and advocacy against FGM/C, driven by a mission to build equitable, compassionate healthcare systems worldwide. I am passionate about bringing scientific credibility to advocacy spaces, and advocacy urgency into scientific spaces.

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29 August 2025First published on the Royal Commonwealth Society website on 29th August 2025. Featured image of Kuala Lumpur at night by Wengang Zhai on Unsplash. On Malaysia’s 68th Independence Day, I reflect not just on Malaysia’s journey, but on my own, one shaped by Commonwealth ties, intergenerational service, and a city that raised me in contradictions. To be precise, this anniversary marks Malaya’s independence in 1957, when it became the tenth member of the Commonwealth. Malaysia as we know it emerged in 1963 through union with Sabah, Sarawak, and Singapore (though Singapore departed in 1965). This layered history matters. It reminds us that nationhood is not a moment, but a mosaic.  I was born and raised in Kuala Lumpur, bilingual from childhood – though truthfully, my first tongue was Manglish, that uniquely Malaysian blend of English and Malay, laced with Chinese and Tamil expressions. I later uprooted myself to England for medical school, and two decades on, now serving within the NHS, my heritage remains central. I speak with reverence, conscious of the privilege that shaped my journey and of what it means to honour Malaysia at 68. I remain a proud KL-ite, with no kampong to return to during festive seasons, for the city itself has always been my home. The Kuala Lumpur that raised me, where skyscrapers rise beside mismatched houses, and wildlife and greenery weave into the fabric of concrete, is ever sprawling, ever growing, a city of contrasts and constant becoming.  Yet Malaysia is more than Kuala Lumpur, just as the UK is not simply London. Beyond the metropolis lie countless stories, landscapes, and lives. Across all communities and socioeconomic classes, we share universal challenges: hunger, pain, exhaustion, injustice. That recognition fuels my health equity work in Malaysia, across Southeast Asia, and throughout the Commonwealth and globally. Even so, I feel a deep pride in being Malaysian. Since 1957, we have come a long way: resilient, diverse, and always striving toward progress. Our strength is reflected symbolically too, with Malaysia now ranked 11th in the Henley Passport Index (August 2025). But progress must also be measured in lived realities.  Post-independence was not without hardship. During the Malayan Emergency (1948–1960), our young nation relied on Commonwealth support against communist insurgency. My maternal grandfather was part of that history – serving with the British Royal Air Force in Singapore, then in Kinrara, Kuala Lumpur, before continuing with the Royal Malaysian Air Force into the 1970s. Though the Emergency ended in 1960, regional security remained a priority. In 1971, Malaysia became a founding member of the Five Power Defence Arrangements (FPDA) with the UK, Australia, New Zealand, and Singapore. Unlike the Emergency, the FPDA focused on regional cooperation after Britain’s “East of Suez” withdrawal. It remains one of the world’s oldest multilateral defence partnerships: a quiet testament to Malaysia’s enduring Commonwealth ties.  LONDON – 2nd Oct 2024. Dr Hannah Nazri in conversation with HM King Charles III at a Commonwealth reception, to celebrate the Commonwealth Diaspora, ahead of the Commonwealth Heads of Government Meeting in Samoa. Photo by Ian Jones ©Ian Jones  Living now in Royal Leamington Spa, I am reminded of that legacy by the town’s war memorial: a bronze soldier atop a granite plinth honouring those lost in conflicts including the Malayan Emergency. Malaysia’s struggles were never isolated – they were shared across the Commonwealth. My grandfather’s service, and mine, reflect a quiet continuity: of civic duty, of partnership, and of the evolving role of Malaysians in global public service.  Malaysia’s Commonwealth journey has flourished through sport. Since debuting at the 1966 Games in Kingston, Jamaica, Malaysia has competed consistently, and in 1998, Kuala Lumpur became the first Asian city to host. As a schoolgirl, I joined a pen-pal initiative tied to the Games. My correspondent, Lucy from Queensland, proudly wrote she was a girl – so I began my reply, “I am Hannah, a girl too.” In that childhood innocence lay the essence of the Commonwealth: connection across borders. Most memorably, I was a dancer in the Opening Ceremony, a moment of joy that stays with me still. Today, as an Associate Fellow of the Royal Commonwealth Society, I have judged the Queen’s Commonwealth Essay Competition and served as its Equality Lead for Europe (2020–2023).  Malaysia has hosted key Commonwealth moments, including the 1989 CHOGM in Langkawi, which produced the landmark Langkawi Declaration on the Environment, and the 2014 public service conferences. Today, Malaysia remains actively engaged – supporting trade and digital reform through the Commonwealth Connectivity Agenda and advancing sustainability through the Blue Charter’s Aquaculture Action Group.  Our Commonwealth story continues in action, through sustainability, connectivity, sport, and shared values of equity and progress. It is not a story of erasing colonial legacies, but of reconstituting them into partnerships grounded in equity, cooperation and shared purpose. As a member of the British Malaysian Society, I invite all – Malaysian or not – to discover our culture, our story, and our world-class food.  As a Malay woman, far from home but never far from heritage, I carry my Malaysian pride quietly but unwaveringly. In dedicating my life to public service across the UK and Malaysia, I honour the legacy of those who came before me. Happy 68th Independence Day – Saya Anak Malaysia. Now and always.  Related posts: International Women’s Day | Royal Commonwealth Society International Women’s Day: RCS Europe | Royal Commonwealth Society Not Too Young to Make a Difference | Royal Commonwealth Society International Women’s Day 2019: Four Inspirational Women in Science | Royal Commonwealth Society Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
25 June 2025Featured image by Nadezhda Moryak on Pexels. The term “Drexit”, describing the steady departure of doctors from the NHS, has become more than just a buzzword. Some go abroad for better working conditions; others leave clinical practice altogether. I understand why. I could have been one of them. Not too long ago, I let others define what success should look like for me, particularly through financial lenses. Coming from a family of lawyers and bankers, I have long been exposed to jokes about doctors’ modest pay and long hours. (However, when they face ’emergencies’, I smiled and joked in return, often countering mockingly, “What was it? A major obstetric haemorrhage?” as they fumbled through whatever their crisis was. But I digress). Those comments did linger. They planted doubt. For a while, I found myself questioning whether this career was worth it. I stayed, but not without detours; into research, policy, advocacy, and leadership roles in both start-ups and more established institutions. These forays did not pull me away from medicine; they pulled me deeper into it. Completing my DPhil at Oxford was a recalibration. I expected certainty at the end of it, but found discomfort instead. Imposter syndrome surfaced – not from incompetence, but from choosing a path that did not align with traditional expectations. Clinical medicine and academia often speak different languages. One demands immediacy, the other detachment. One is hierarchical and procedural; the other thrives on independence and critique. But rather than pick a side, I chose to hold both. In one of my earlier essays, I wrote that change often begins with small, sincere acts. Quiet advocacy can be more enduring than noise. In the same way, I have realised that the most meaningful impact happens not in choosing between roles, but in integrating them with intention. I spoke to my father (I am deeply grateful for his patience with what some might call my ‘insane’ life and career decisions) recently about my career so far; moving between hospitals, research presentations, policy conversations. I told him that people often assume I am doing too much. He smiled and said, “Your career is like a fruit tree that takes decades to bloom. But when it does, its impact is far-reaching.” That stayed with me. Not all careers are meant for fast returns. Some require deep roots and long seasons. But when they bear fruit, that nourishment goes far beyond the person who planted the seed. April and May were two such months; quietly full. In April, I contributed to a UNFPA Malaysia stakeholder meeting on FGM/C, and co-authored a publication on female genital cutting in Malay language with ARROW (Asian-Pacific Resource & Research Centre for Women) and Sisters in Islam. I also delivered lectures with Médecins Sans Frontières, Warwick, and SOAS, reflecting on how medicine intersects with culture and power. May brought me to Sydney, where I co-chaired a session at the World Congress on Endometriosis and presented my research on small extracellular vesicles – work that bridges molecular insight with the realities of women’s lived experiences. Shortly after, I spoke in Kuala Lumpur on holistic endometriosis care, in collaboration with colleagues from Monash and Oxford. I was also privileged to speak about my FGM/C work with the Obstetrical and Gynaecological Society of Malaysia, then represented the Asia Network on FGM/C to deliver our position of zero tolerance against FGM/C during a UNICEF-UNFPA Asia Pacific webinar on the medicalisation of FGM/C. Recently, I joined the RCOG World Congress in London, contributing to both panel discussions and a poster presentation on FGM/C. Alongside these commitments, I completed a textbook chapter on FGM-related trauma. Earlier in the year, in January, I also developed bilingual FGM/C patient information leaflets; practical, accessible tools designed to put knowledge directly into the hands of those who need it most. These efforts might appear disconnected, but they are rooted in the same question: how do we care better? How do we ensure our work is not only evidence-based, but culturally aware and ethically sound? For all of this, nothing keeps me grounded like the operating theatre. Being a surgeon is more than a job description. It is where my identity is continually tested and shaped. Clinical training has sharpened my decision-making, but also added depth to the way I approach research and advocacy. The recognition I receive in external arenas is validating, but Obstetrics and Gynaecology quickly reminds you not to get carried away. A pathological CTG. A maternal collapse. A shoulder dystocia. General chaos. Hierarchy. Demanding rota. These moments silence everything else. They demand presence, clarity, and humility. Having grown up with much of what I needed, I am grateful for a profession that strips away the comfort of abstraction. It keeps me connected to service, to perspective, and to purpose. Even when the work takes me far from theatre; into ministries, conferences, roundtables, and editorial deadlines – clinical medicine is what anchors me. It is what steadies me. It makes everything else more honest. I have long let go of expecting financial returns from public service medicine to match those of other professions. (That said, this does not mean I accept poor remuneration that fails to keep pace with over a decade of inflation. Fairness matters, even when money is not the primary motivator). That clarity has freed me. I have chosen to balance this by engaging in business and leadership roles elsewhere, allowing me to maintain clinical practice not for its financial rewards, but for its grounding purpose. In truth, I have joked that I have long wanted to make medicine my hobby – admittedly, a very expensive hobby, but one that keeps me rooted. When people ask me how it all fits together, I no longer feel the need to explain. I have come to believe that coherence doesn’t require uniformity. Perhaps the link between surgery, science, policy, and advocacy is care – not only in the clinical sense, but in how we listen, lead, and act with integrity. No two days in my week are ever the same. Even within Obstetrics and Gynaecology, my time is split between outpatient clinics, gynaecological theatre, the labour ward and dealing with emergencies in the emergency gynaecological unit and labour ward triage. This week alone is a good example of that rhythm. On Monday, I was in London for the RCOG World Congress 2025. By Tuesday, I was back in gynaecological theatre from early morning to afternoon, then carrying both the obstetrics and gynaecology registrar emergency bleeps, covering the department alongside colleagues for the twilight shift. Today, I am refining a paper on endometriosis. On Thursday, I will be in Oxford for an alumni networking event, and by the weekend, I will be back in hospital. Am I exhausted? Definitely. But am I satisfied? 110%. (Image by Nadezhda Moryak on Pexels). I hope my path offers an alternative narrative. That it is possible to stay in clinical medicine while building something broader. That we do not need to be everything, but we can choose to be intentional, consistent, and rooted. Most importantly, we must be patient: Medicine is not a sprint, it is a marathon. For now, this is my story. I may change my mind in the future. Because there is no single right way to walk medicine. Related posts: How to Make Change Top 10 Life and Career Hacks How to Feel Comfortable Disappointing Everyone Green Templeton College Alumni Graduation Speech July 2024 4 Things I Learnt from My Burnout My Reflections Post DPhil at the University of Oxford Great Expectations: Should Doctors Become “Everything”? | Boston Congress of Public Health Review Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
29 May 2025By Dr Hannah Nazri, Prof Samuel Kimani, and Saarrah Ray. First published on the Asia Network to End FGM/C blog 19th May 2025 here. Re-published on Equality Now on 18th August 2025 here. The medicalisation of Female Genital Mutilation/Cutting (FGM/C) is an alarming global trend. Performed by health professionals under the guise of safety, it reinforces a practice that is widely recognised as a violation of human rights. In reality, medicalisation neither eliminates harm nor erases the oppressive cultural roots of FGM/C. These and related issues were explored in the 4 April 2025 webinar “Understanding the Medicalisation of Female Genital Mutilation/Cutting (FGM/C): Impacts, Challenges, and Solutions”, hosted by the Asia Network to End FGM/C and Equality Now. Experts from Asia and Africa addressed the scope of the practice, the shifting responsibility to healthcare professionals, and the barriers to transformative change. A Global Practice, an Overlooked Asian Reality FGM/C continues in over 90 countries, affecting 230 million women and girls worldwide (UNICEF, 2024). While often associated with Africa, 80 million of these cases are from Asia. The practice is prevalent in Indonesia, Malaysia, Singapore, Sri Lanka, Brunei, Thailand, the Philippines, the Maldives, India, and Pakistan. In many Asian countries, Types I and IV, considered less severe, are dominant. However, this perception has contributed to the practice being overlooked in global discourse (ARROW, 2020). Despite progress at policy levels, including the SDG commitment to eliminate FGM/C by 2030, current efforts need to be 27 times faster to meet this goal (UNICEF, 2024)i. The practice persists largely due to misinformation, community resistance, and a lack of political will. Quiet advocacy: The role of healthcare professionals Healthcare professionals are increasingly implicated in the continuation of FGM/C. Dr. Hannah Nazri emphasises that advocacy isn’t limited to high-profile actions like lobbying or public campaigns—it can be quiet yet powerful. Routine patient interactions, education, workshops, and contributing to clinical guidelines are all meaningful forms of advocacy. Social media can amplify these efforts, but impactful advocacy doesn’t have to be loud to be effective. That said, many doctors are overwhelmed by the demands of day-to-day clinical work, leaving little time or energy for broader advocacy efforts. Heavy workloads, long shifts, and administrative pressures can make it difficult to engage beyond immediate patient care, even when clinicians care deeply about issues like FGM/C.  Advocacy within clinical settings also involves navigating complex social and ethical terrain. In societies where FGM/C is socially accepted or not criminalised, healthcare professionals may feel pressured to stay silent—or even comply. Dr. Nazri highlights that junior doctors in such contexts often struggle to challenge senior colleagues who support the practice, creating ethical dilemmas and limiting space for resistance.  They must be meaningfully supported in their professional environments to realise their potential as effective advocates. She also underscores the importance of cultural literacy. Marginalised communities experience structural exclusions that shape their access to care and health decisions. As Dr. Nazri notes, advocacy approaches must be context-specific—what works in one region may not apply elsewhere. For example, research in Malaysia shows many Muslim women who have undergone FGM/C report fulfilling sexual lives and reject dominant narratives linking the practice solely to sexual disempowerment (Isa et al., 1999). Rising Medicalisation: Urban and Institutional Trends The assumption that medicalisation is more common in rural areas is misleading. As societies begin to recognise the harms of traditional forms of FGM/C, medical professionals are increasingly taking over. In Malaysia, 20.5% of doctors admitted to performing Type IV FGM/C, typically involving pricking and needling, and some to performing Type I (Rashid et al., 2020). In Indonesia, healthcare workers conducted incision (26%) and excision (52%), often more invasive than traditional attendants who used scraping or symbolic cutting (Budiharsana, 2016; Hidayana, 2024 ). Dr Nazri also warned of early signs that FGM/C is becoming medicalised. These include incorporating the practice into delivery packages, shifts in community narratives that frame it as “safer,” and informal medical training outside regulated curricula. She argued that regulatory gaps enable the quiet normalisation of medicalised FGM/C and highlighted the need for legal and ethical clarity. Community-based strategies are essential to disrupting this trend. Dr Nazri advocated for engaging local influencers and religious leaders through culturally appropriate education, storytelling, and community health programmes. She noted that effective advocacy often happens when FGM/C is discussed as part of broader public health dialogues, not as a stand-alone issue. Investing in Change: Education, Ethics and Legal Gaps While some may argue that medicalisation reduces physical risks, Dr Nazri underscored that it gives the false impression of legitimacy. Ministries of Health and medical associations often remain silent, creating policy ambiguity and weakening enforcement. The conversation also touched on how students and early-career professionals can contribute to change. Dr Nazri advised students to collaborate with advocacy organisations, organise educational events, and engage with academic supervisors on FGM/C research. For long-term impact, curriculum reform is crucial, especially for midwifery and healthcare education. She proposed that norms change be embedded into training, supported by mentorship and real-world engagement with communities. Medicalised FGM/C is often passed down through informal channels, without any formal guidelines. Dr Nazri clarified that the lack of regulation has led to varied practices, and any effort to formalise procedures would risk legitimising them. The medicalisation of FGM/C exposes a critical fault line in global health advocacy. While healthcare professionals can be powerful allies in ending the practice, they also risk perpetuating it in the absence of clear guidance and cultural accountability. The April 2025 webinar made it clear: dismantling FGM/C requires a united effort across legal, medical, and community platforms. Every patient interaction, every educational initiative, and every policy reform must push toward one goal, eradicating FGM/C in all its forms. Speaker Profiles Professor Samuel KimaniAssociate Professor, Faculty of Health Sciences, University of Nairobi. With over 20 years of experience in global health, medical training, and research, Professor Kimani is a leading expert on FGM/C in Africa. Dr Hannah NazriNIHR Academic Clinical Fellow in Obstetrics & Gynaecology, University of Warwick. Director of Malaysian Doctors for Women & Children. Dr Nazri works internationally to end FGM/C through education, policy engagement, and healthcare leadership. Saarrah RayDPhil in Law candidate, University of Oxford. Saarrah’s thesis explores radical feminist legal arguments reconceptualising Female Genital Cosmetic Surgery as a form of violence against women and a variant of FGM/C. References:  Unicef (2024). Female Genital Mutilation: A global concern. https://data.unicef.org/resources/female-genital-mutilation-a-global-concern-2024/  Asian-Pacific Resource and Research Centre for Women (ARROW) and Orchid Project, 2020. “Asia Network to End Female Genital Mutilation/Cutting (FGM/C) Consultation Report,” 2020, https://bit.ly/3lz5O4w.   Isa, Ab. R., Shuib, R., & Othman, M. S. (1999). The practice of female circumcision among Muslims in Kelantan, Malaysia. Reproductive Health Matters, 7(13), 137–144. https://doi.org/10.1016/S0968-8080(99)90125-8  Rashid, A., Iguchi, Y., & Afiqah, S. N. (2020). Medicalization of female genital cutting in Malaysia: A mixed methods study. PLOS Medicine, 17(10).  Budiharsana, M. (2016). Female genital cutting common in Indonesia, offered as part of child delivery by birth clinics. The Conversation. https://theconversation.com/female-genital-cutting-common-in-indonesia-offered-as-part-of-child-delivery-by-birth-clinics-54379  Hidayana, I. M. (2024). The Medicalization of Female Genital Cutting (FGC) in Indonesia: A Complex Intersection of Tradition, Religion, and Human Rights. Current Sexual Health Reports, 16(4), 217–220. https://doi.org/10.1007/S11930-024-00393-2/FIGURES/1 Related posts: New: Khatan Perempuan: Selamat atau Tidak? New: Patient Information Leaflet on Female Genital Cutting Decolonising FGM/C Advocacy: Respecting Local Expertise | Boston Congress of Public Health Empowering Healthcare Professionals: Unveiling the Harms of Female Circumcision in Malaysia Sunat Perempuan Bukan Satu Keperluan | Ova Health Female Circumcision is Unnecessary: Girls Are Perfect as They Are Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
16 April 2025I had the privilege of contributing to our new publication on female circumcision (khatan perempuan, FGM/C) in Malaysia. This time, this publication delves into the social, cultural, and religious dimensions of the practice in Malaysia. It was developed in collaboration with Asian-Pacific Resource & Research Centre for Women (ARROW), the Asia Network to End FGM/C, and Sisters in Islam Malaysia – in Bahasa Melayu. Please have a read! Powered By EmbedPress Related posts: New: Patient Information Leaflet on Female Genital Cutting Decolonising FGM/C Advocacy: Respecting Local Expertise | Boston Congress of Public Health Empowering Healthcare Professionals: Unveiling the Harms of Female Circumcision in Malaysia Sunat Perempuan Bukan Satu Keperluan | Harvard Public Health Review Female Circumcision is Unnecessary: Girls Are Perfect as They Are Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
29 March 2025Featured image by Jorge Urosa on Pexels. I am often asked by medical students and doctors about my involvement in advocacy (I think in this case, most people mean advocacy in terms of lobbying and campaigning at governmental and international levels) – a question that has led me to reflect on my own journey. In truth, I found myself woven into the narrative before I even realised I had embarked upon it, much like falling in love – where does one truly begin? Trying to deconstruct my journey into practical insights for you is much like trying to deconstruct a well-crafted cocktail. On reflection, I believe that at the heart of every successful advocate, is the unwavering passion to make things work, and the desire to make change which had begun many years before their so-called overnight success. (Image: 2023 Women Deliver, Kigali, Rwanda) Laying the groundwork: I did not step into advocacy as a specialty registrar in obstetrics and gynaecology today. Rather, it has been my personality for not being able to turn a blind eye to what I feel is an injustice since young. Fuelled by personal experiences, I became determined to equalise educational opportunities for Malaysian youth in medical school, which led me to establish The Kalsom Movement. What started as a small student project grew into a youth education charity in Malaysia, where I honed my leadership and project management skills while learning how to advocate effectively to governing and grant-awarding bodies. At that time, many people thought I was wasting time and not focussing on my medical degree. I never set out to win accolades for voluntary work, however I found myself a finalist for the 2015 Queen’s Young Leaders Award, earning me the Associate Fellowship of the Royal Commonwealth Society. Above of all, there is a lot of love in every work that I do. However, recognition can open doors, offering valuable connections and opportunities to further advance your mission. Get involved in extracurricular activities: On that note, I would encourage medical students to look beyond their textbooks and academic achievements. While excelling in your studies is important, true growth comes from immersing yourself in societies, clubs, and causes that resonate with you – not just to fulfil a curriculum requirement, but to build skills that will shape your future career and life. Use these platforms to build leadership skills, network, and explore areas of interest that align with your passions. Jack Ma once advised his son: “You don’t need to be in the top three in your class; being in the middle is fine, as long as your grades aren’t too bad. Only this kind of person has enough free time to learn other skills.” I struggle with this concept myself, having been raised in a culture that glorifies perfect grades (my own 10As and 1B in my Malaysian GCSEs was not good enough). This is something I am still unlearning – both for myself and in the expectations I place on those around me. Looking back, I see that I started my journey 20 years ago, not today. But as the Chinese saying goes, “The best time to plant a tree was 20 years ago, the second best time is now.” So look around you – how can you make a difference in your community? Building your unique expertise: But of course, passion alone is not enough – expertise is essential. Undoubtedly, my academic qualifications and medical expertise lend both credibility and weight to the work I publish and the words I speak. Advocacy without knowledge is just noise; depth and substance give it lasting impact. Reflecting on my medical career now, I am often pressured to choose between my surgical, research, or advocacy career. To which, I would say, “While anyone can engage in advocacy, not everyone can perform surgery. And while every ObGyn doctor can operate, few excel in both research and advocacy.” So invest in what sets you apart. That said, I have my absolute respect for doctors who only pursue clinical work because they are able to put in their 110% into developing their surgical skills (unfortunately, my brain does not operate on solely doing one thing). Not everyone needs to do research or advocacy. Both purely ObGyns and clinical academics play a vital role in the system. Juggling three roles means constantly balancing expectations – pleasing some while inevitably disappointing others. The value of cultural capital: Over the years, I have taken on numerous voluntary leadership roles across various committees, and am often met with the question: why? While financial capital undoubtedly accelerates a cause, cultural capital is just as vital. Sometimes, this means working for free to build momentum, forge meaningful connections, and amplify your message. I did not enter the end FGM/C advocacy space expecting financial gain or leveraging prior connections – I simply saw a need and acted. I acknowledge that the ability to do so is a privilege, and everyone has their own limits – how much you are willing to give without financial return is a decision only you can make. My motivation, however, has always been shaped by something deeper – perhaps the legacy of my late great-granduncle, to whom I was very close, whose global philanthropic endeavours continue to inspire me. He showed me that true philanthropy thrives in quiet acts of kindness, without the need for fanfare. Sometimes, advocacy does not have to be loud. Yet, I grapple with my own privilege, juxtaposed against my own personal experience of hardship. I constantly fear becoming detached from the lived realities of those I wish to serve. It is a delicate balance – one that requires continuous reflection, humility, and, above all, a willingness to listen more than I speak. Your perceived disadvantage may be your greatest strength: This brings me to my final point: do not envy privilege. What you perceive as a lack of privilege could, in reality, be your greatest strength. Any gap in opportunity is an invitation to create something of your own – to carve out your path, define your success, and build something meaningful. Stop listening to negativity, and start focussing on what you can do now. If you have a great idea, start now. Even the smallest action can make a significant difference. Start small, whether it is hosting a discussion, sharing information on social media, or volunteering with an organisation. Small, consistent actions build momentum over time. My End FGM/C Advocacy To be honest, I had no idea where my end FGM/C advocacy would take me. Often, it is indecision that hinders progress, while taking even a single step can illuminate the path forward. If it is the wrong decision, it becomes a lesson – guiding you forward with greater wisdom. (Image: During the 2024 International Planned Parenthood Arab World Region Elimination of Female Genital Mutilation Centre of Excellence’s Experts Committee Member Annual Meeting, Nouakchott, Mauritania – holding an array of different forms of contraception.) I began my advocacy in ending FGM/C by focussing on medical education after reading a publication on its medicalisation by Professor Rashid. Though I had never met him, I reached out through ResearchGate, arranged a meeting, and sought his insights. Therefore, do not hesitate to reach out to experts in the field you are passionate about. Then, knowing that most doctors were not using LinkedIn at the time, I turned to my Instagram contacts and recruited my friends. Four years down the line, the Malaysian Doctors for Women & Children had produced four publications on FGM/C in Malaysia, spoken at high-level meetings and UN platforms, and influenced medical professional bodies to take a bold stance in ending FGM/C. Of course, the past four years have been anything but smooth sailing. Advocacy requires persistence and a willingness to learn – whether from mentors, peers, or personal experience. Like medicine, it demands lifelong learning, adaptation, and the ability to listen and adjust your approach. The path to creating change is often slow, requiring sustained effort. Set both short- and long-term goals, and regularly assess your progress to stay motivated. Perhaps it was the foundation I had laid years ago that gave me the confidence – and the conviction – to start my own non-profit and take full ownership of it. Of course, I am deeply grateful to my mentors and the Royal College of Obstetricians & Gynaecologists for their invaluable support along the way. So, what’s stopping you from starting today? Related posts: Top 10 Life and Career Hacks How to Feel Comfortable Disappointing Everyone The Heart of Success: Why Kindness Matters 4 Things I Learnt from My Burnout Green Templeton College Alumni Graduation Speech July 2024 Breathless and Living My Wildest Dreams Building Resilience: Top 3 Tips for Success Building Resilience: Dealing with Grief and Failure for So-Called Type A Personalities Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
20 February 2025Featured image by Gabrielle Henderson on Unsplash. I often get asked for career and life advice, so I am tagging this post for anyone who asks me next time. I believe these lessons are applicable to every step of the path you are on, both professionally and personally. Let me know if any of these help! Take pride in where you have come from and what you have accomplished, but do not cling to the glory of the past or let brand names define you. Your unique identity should never be overshadowed by external labels. Equally, do not let the weight of past mistakes hold you back. Accept them, learn from them, and keep moving forward. Comparing yourself senselessly with others is an act of violence towards yourself. There is no point in feeling envious of others’ success unless you are ready to take the same risks, face the setbacks and criticisms, and put in the work to reach the goals. However, it is truly impossible to compare two lives together. Trust yourself and your own journey. Do not keep up with others, keep up with yourself. Life is not fair. But that is not really a bad thing. The sooner you understand this, the more you will achieve. Be the hero of your own story, not the victim of life. Read more here. Recognising your privilege (or the lack of it) is important, but the concept itself is complex and multifaceted. There is no need to confine yourself to a single label if it does not fully reflect your experience. Being grateful does not mean one lacks ambition. It is OK to be content with life AND aspire for more. Both gratitude and ambition are vital to happiness in life. Ingratitude breeds resentment, and lack of ambition leads to a lacklustre life. Not every act of service needs to be transactional. To me, being kind is important (read more here). However, please define the act of service in relation to your life. You are not a free ride. Love is a verb. Do not give people the fluffiness of the buttercream frosting, and forgetting to bake the actual damn cake. But do not forget it is the frosting that lends the cake its allure. Be proud of your loved ones and significant others. You are not competing against them. We are one team, and we will conquer the world together. If you love or care about someone, give them real feedback. Honest truths do not need to be brutal. I once heard a great quote at a leadership workshop: ‘Combat is optional, conflict is essential.’ It is through constructive conflict and honest communication that we grow, both personally and professionally – assuming that two parties share the same goals. However, choose your battles wisely. Not everything needs to be addressed, and some things are better left unsaid. If you let the world dictate how you see others (i.e. judging someone based on stereotypes), you will miss out on discovering the most interesting people. Stay curious 🙂 Hope you have enjoyed reading this post, as much as I enjoyed writing it, as they are great reminders to myself. Related posts: How to Feel Comfortable Disappointing Everyone The Heart of Success: Why Kindness Matters 4 Things I Learnt from My Burnout Green Templeton College Alumni Graduation Speech July 2024 Breathless and Living My Wildest Dreams Building Resilience: Top 3 Tips for Success Building Resilience: Dealing with Grief and Failure for So-Called Type A Personalities Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
9 February 2025I had the honour of being invited to the observance of the International Day of Zero Tolerance for FGM on 6th February 2025, an event organised by Barnardo’s National FGM Centre and hosted by the Home Office in London. My speech is as follows. Today, on the International Day of Zero Tolerance for Female Genital Mutilation (FGM), we are reminded that this is not just a distant issue – it exists in many forms across the world, including in Malaysia. As a healthcare professional, I am deeply disturbed by what is locally referred to as “female circumcision,” which is, in reality, a form of Female Genital Cutting (FGC) or Mutilation (FGM). For years, I had a vague memory of a female relative undergoing this practice – until my medical studies and research forced me to confront the truth. In Malaysia, Type IV FGC is most common, involving needling or pricking the external clitoris to extract a drop of blood, usually in newborns. Because of this, many women are unaware they have undergone it unless they ask their parents. While proponents argue there are no major health complications – which is true, we lack studies on its psychosexual impact, and we cannot dismiss the broader implications of violating bodily autonomy.  A colleague from an FGM/C clinic in London once shared the case of a Southeast Asian woman suffering from sexual dysfunction and chronic pain. Despite visiting multiple clinics, she was repeatedly told she had not undergone FGM/C – yet her suffering persisted. Was it undiagnosed endometriosis? A consequence of FGC? A psychological response to a trauma she never even knew she had experienced? We do not have the answers, and the reality is that many women may live with unexplained chronic pelvic pain and sexual dysfunction. More concerning is the growing medicalisation of FGC. A study by Professor Rashid in 2020 found that 20.5% of doctors in Malaysia admitted at performing FGC and agreed for the practice to be continued with a substantial number of doctors performing Type I FGM – partial or total removal of the external clitoris – something previously unheard of when the practice was limited to traditional midwives. This medical endorsement dangerously legitimises an already harmful practice.  Supporters often justify Malaysian FGC by drawing distinctions between it and more severe forms practised elsewhere. But let me be clear: acknowledging these differences is not a justification for its continuation. There is no cultural superiority in any form of gender-based violence. No matter how “mild”, it remains a violation of bodily autonomy.  However, it is also crucial to recognise that not all Malaysian Muslim women identify as survivors of FGM/C, and many may even find the term offensive. This raises difficult questions: Are Malaysian women oppressed? Can others decide that for us? Do the oppressed always recognise their oppression? FGC in Malaysia is rooted in misconceptions – religious, cultural, and social. But to say that Malaysian women are oppressed solely because of it would be an oversimplification. Oppression is complex and exists everywhere. Even in countries that condemn FGM, women’s bodies are still controlled – whether through laws restricting reproductive rights or societal expectations of purity and modesty. The recent overturning of Roe v Wade in the US is proof that reproductive control is not exclusive to any one culture. This is why today matters. The International Day of Zero Tolerance for FGM is not just about eliminating one form of harm – it is about ensuring that all women, everywhere, have the right to bodily autonomy, dignity, and choice. Let us not remain silent. Let us challenge harmful traditions, advocate for research, and ensure that no girl or woman has to experience FGM – no matter the form, no matter the justification.  Thank you. Related posts: New: Patient Information Leaflet on Female Genital Cutting Decolonising FGM/C Advocacy: Respecting Local Expertise | Boston Congress of Public Health Empowering Healthcare Professionals: Unveiling the Harms of Female Circumcision in Malaysia Sunat Perempuan Bukan Satu Keperluan | Ova Health Female Circumcision is Unnecessary: Girls Are Perfect as They Are Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
14 January 2025I am very proud of this work. At Malaysian Doctors for Women & Children, we firmly believe that vulval and clitoral anatomy should not be considered specialised knowledge. With this conviction, we set out to create a resource that educates parents and the public about anatomy while articulating our stance against female genital cutting in Malaysia.Although the project faced delays due to funding challenges (we are a very small group of doctors who contribute our time and money), it eventually came to life through months of dedicated planning, focus group discussions, writing, editing, and careful revisions based on feedback from external reviewers. The result is a leaflet that embodies our commitment to compassion and cultural inclusivity, presenting our message in a way that resonates deeply with the communities we serve. Thank you Monsters Among Us (MAU) (Firzana Redzuan) and Asian-Pacific Resource & Research Centre for Women (ARROW).A special shoutout to Appolonia Tesera, our graphics illustrator, for the collaborative synergy in bringing this vision to life.This leaflet is more than a resource—it’s a step towards fostering awareness, dismantling harmful practices, and advocating for informed conversations. English version: Malay version: Printable copies for personal use can be found here. Related posts: Decolonising FGM/C Advocacy: Respecting Local Expertise | Boston Congress of Public Health Empowering Healthcare Professionals: Unveiling the Harms of Female Circumcision in Malaysia Sunat Perempuan Bukan Satu Keperluan | Ova Health Female Circumcision is Unnecessary: Girls Are Perfect as They Are Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
3 November 2024Featured image by charlesdeluvio on Unsplash. This cute pug is disappointed that you are not disappointing enough people. This year, I set clear goals for myself, and I am proud to say I achieved nearly all of them, both professionally and personally. This was not without its challenges – constant criticism for being “too young,” “too inexperienced,” “too junior,” or simply “just female,” alongside every other obstacle life tossed my way. I know I have likely disappointed many along the way – supervisors, colleagues, lovers, friends, acquaintances, and even some family – as I focussed on ticking off my own boxes. But I have learnt that a crucial part of success is being comfortable disappointing everyone except yourself. And this has definitely not come easy for me. So, how do you learn to feel comfortable disappointing everyone? Shut your ears to those naysayers and listen to me: You can never make everyone happy. I tried, year after year, to make everyone around me happy, at the expense of my own mental and physical health. But the truth is, chasing everyone else’s approval only leads to burnout. Instead of pouring energy into pleasing others, focus on what makes you happy. Find purpose in fulfilling your own goals, not everyone else’s expectations. Learn to appreciate the “gleamers” of your day rather than wishing for an everyday filled with fireworks, pomp and circumstance. Discover the little things that make you happy. Be cut-throat in eliminating people or things that no longer serve you. It is OK. Sometimes friendships have ran its course, the romance has fizzled out, life happens and we are all at different phases of life. Find out what is your 80/20. Understand what you want from life, and set your own key performance indicators. This means taking the time to know what is required of you professionally and figuring out how that aligns with your personal goals. If you do not take control of your own ambitions, your work will start to consume everything, leaving little space for the rest of your life. In this process, you also come to better understand your inner circle – family and close friends – and realise it is their happiness that truly matters, rather than trying to please everyone else. Even so, prioritise your own happiness first. Be comfortable with being seen as “stupid”. When you choose to follow your own path, people may misunderstand or think poorly of you, and that is OK. Often, it is simply because they cannot see the bigger picture you are working towards. For instance, when I decided not to pass my internal mock A-level exams many years ago, almost everyone – except the teachers I had explained my plans to – thought I was being reckless or lazy. I walked out of that exam hall after only writing my name because I wanted to give my focus on my AS-levels which were happening around the same times. It seemed “stupid” to others, but to me, it was strategic. I know my strengths, so I applied it accordingly. Similarly, I do not mind not having all the answers at hand during a handover because I know will learn them in time. You’d be surprised how many times people have implied I am somehow “stupid” or compared me unfavourably to other doctors in clinical settings. I have even been told, repeatedly and to my face, that I should not speak about endometriosis because I am “only” an expert on my DPhil thesis – not an authority on the entire field (I never claimed I was). There have also been times when I have been called “stupid” outright in emails, and I have let it go, taking it on the chin for the team. But you know what? Fixating over my “reputation” is not worth my energy. I am here to focus on the things that matter, not to waste time worrying about judgements that do not serve me. It is important to understand my limits and lack of knowledge so I can learn. Therefore, whether I am truly lacking in certain areas or being outright insulted by someone, I may burn with embarassment in that few minutes, but in 10 years time, these minor events will be a distant memory and I will be a lot wiser. Be selective with the feedback you receive and from whom you seek advice. Not everyone who offers you feedback or advice has your best interest. Sometimes, they simply want to put you down, make themselves look better, or have other ulterior motives. Often, their criticism stems from their own insecurities or a chip on their shoulder. Consider this: Would someone who has never pursued the path you aspire to follow really be the best advisor for your journey? While it is not an absolute rule as there can still be valuable insights to glean from their perspective, it is essential to remain mindful of the tone and context of their advice. Constructive feedback is essential for growth, and good advice typically begins with a genuine desire to understand your decision-making process rather than simply criticising or judging. They often extend their assistance to help you grow, offering support and resources to guide you in your development. This willingness to help reflects their genuine investment in your success. Realise the unique value you bring to the world. There is no one else who can contribute exactly as you can, in the way you do. Do not get pulled into playing by everyone else’s rules or seeking validation in their games. Approach life like it is yours to create, because it is. Those who measure their worth by the expectations of others often find themselves the unhappiest. You have to decide the value you bring to others; otherwise, society will make it up for you in the most unfair manner (because life is not fair). I have had people tell me that my “brand” should portray this and that on my social media, but excuse me, this is not a brand; this is a person; this is my life. I will contribute to the world on my terms. I am, afterall, a clinical academic, not a clinician and an academic, and everything else that I do, is just by and by. The tug of war between clinical and academic work is real and not for the faint-hearted. It is extremely difficult trying to balance learning surgical skills, producing scientific publications, and having a reasonable online presence for advocacy work. Do not engage in gossip – it is a waste of time. Focus on your own goals and let your actions speak for themselves. In the end, success is the best response. However, remember to work hard not just to prove a point, but because these goals are meaningful to you and reflect your aspirations. Be patient. Be kind to yourself. I will say this over and over again. Clinical mastery is hard. Balancing that with academic work is hard. You will make mistakes and may find yourself on the receiving end of insinuations about your intelligence. You must never let these sentiments to your head. If others are unkind to you, be kinder to yourself. Unfortunately, both areas are extremely hierarchical and come with their own sets of rules to navigate. While it is important to play by these established rules, do not hesitate to create your own as well. Forge a path that reflects your values and aspirations, allowing you to thrive in both realms. In conclusion, this year has taught me that while I may have disappointed many – I have remained true to myself and my goals. The pursuit of others’ approval often leads to burnout, so it is essential to focus on what truly brings you joy and fulfilment. Embrace your unique contributions, be discerning about feedback, and do not shy away from being perceived as “stupid” for making choices that align with your values. Life is too short to be constrained by others’ judgements; instead, engage with your journey as the author of your own narrative. Ultimately, success is about pursuing your passions and aspirations, so be patient and kind to yourself, and remember that standing firm in who you are is the key to a meaningful life. Related posts: The Heart of Success: Why Kindness Matters 4 Things I Learnt from My Burnout Green Templeton College Alumni Graduation Speech July 2024 Breathless and Living My Wildest Dreams Building Resilience: Top 3 Tips for Success Building Resilience: Dealing with Grief and Failure for So-Called Type A Personalities Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
29 October 2024Also re-published in Ova Health – The Galen Centre on 1st November 2024 here. The tragic case of Jia Xin Teo and Baby Teo1 in the United Kingdom casts a heartbreaking light on Malaysia, bringing attention to the alarming prevalence of infanticide cases across Malaysia. Since 2018 to February 2024, there have been 509 recorded instances of attempted or completed infanticide2, often referred to as “baby dumping” (I thoroughly detest this term) in Malaysia – a term that describes the devastating act of abandoning newborns, often in unsafe places, leading to their subsequent demise. Unfortunately, infanticide is not a new phenomenon in Malaysia. While baby hatches were established by the government as a means for mothers to anonymously leave their infants, these facilities are not widely accessible and have not proven to be an effective solution. At the same time, while conversations on financial literacy continue to echo through Malaysia, the pressing need for health literacy – especially comprehensive sexual and reproductive health education – remains neglected. A brief introduction to reproductive biology in secondary school is insufficient preparation. Many Malaysians, myself included, barely recall learning about contraception beyond its existence. Since I left school, further efforts to strengthen sexual and reproductive health education have undoubtedly been made through the National Reproductive and Social Health Education Policy, but improvements could come sooner. Comprehensive sexual health education should go beyond covering about contraception and sexually transmitted diseases (STDs), but to also medical risks of teenage pregnancy, young parenting, the concepts of bodily autonomy, dangers of sexting and pornography, the foundations of a healthy relationship, as well as a thorough understanding of where to seek help. Equally important, in my view, are topics often omitted, such as clitoral anatomy, menstrual health, fertility, and menopause. Research shows that abstinence-only education is ineffective3 in lowering teen pregnancy, another issue closely related to infanticide in Malaysia. In fact, A 2009 UNESCO review of 87 studies4 found that none of these comprehensive sex education programme prompted earlier sexual activity; in fact, one-third of the programs reduced the frequency of sexual activity, and over a third led to a decrease in the number of sexual partners. We must also offer comprehensive sexuality education to teens, young adults, and adults who missed this vital instruction earlier. This should be emphasised and reinforced through tertiary education, at governmental health centres, and various Ministry of Health information portals. Stigma, however, poses a significant barrier in Malaysia. A simple act like buying a pack of condoms at a local pharmacy or seeking a gynaecologist for further contraceptive options or a cervical smear test if unmarried often invites unwarranted questions or judgemental stares. Friends have shared similar experiences, where healthcare professionals place undue focus on marital status. Additionally, many healthcare professionals seem unaware of the legal standing of abortion in Malaysia, with 59.2% viewed abortion as taking one’s life5. Abortion, in fact, has been legal in Malaysia since 19896 for up to 22 weeks’ gestation (for Muslims up to 20 weeks’ gestation with varying caveats as stipulated by the National Fatwa Council)7 for cases in which continuation of pregnancy would jeopardise a woman’s mental and/or physical health, with no limits in cases for severe fetal abnormalities and in maternal life-saving situations. Despite legal access, the option remains hard to navigate, and social stigma endures. Clearly, the lesser of all evils, is to provide accessible contraception and abortion services – rather than the dire of option of infanticide, which has somewhat become a national phenomenon. Teo’s Malaysian upbringing, her recent move to the United Kingdom, her desperate measures to conceal her pregnancy from everyone, then to face a complicated labour own her own and the subsequent infanticide, painfully underscores our nation’s critical shortfall in sexual and reproductive health education and the deep-rooted cultural and religious stigma surrounding women’s bodily autonomy. While I sympathise to an extent with Teo due to these constraints, I struggle to excuse her poor decisions, especially considering the availability of resources online and the reduced stigma for single, pregnant women in the United Kingdom. This may partly explain the lack of public empathy for her in the United Kingdom, as she is 22 years old, and therefore, seen as an adult fully capable of making decisions – murdering a newborn is beyond forgivable. May Baby Teo rest in peace. As a Malaysian obstetrician and gynaecologist in the United Kingdom, this tragic case hits close. I am deeply saddened and profoundly ashamed that, despite the stark reality of these cases no meaningful progress has been made to address the issue of infanticide in Malaysia. This tragic case is, undeniably, a reflection of our collective failure. NB: The time limit for abortion in Malaysia has been further clarified. I had previously stated 24 weeks’ gestation in error, which is the limit in the United Kingdom; however, the correct limit in Malaysia is 22 weeks. References: Student convicted of killing newborn baby | The Crown Prosecution Service. Cps.gov.uk. Published October 24, 2024. Accessed October 30, 2024. https://www.cps.gov.uk/west-midlands/news/student-convicted-killing-newborn-baby Nancy Shukri: 509 baby dumping cases reported from 2018 to February. Malay Mail. Published March 25, 2024. https://www.malaymail.com/news/malaysia/2024/03/25/nancy-shukri-509-baby-dumping-cases-reported-from-2018-to-february/125435 Stanger-Hall KF, Hall DW. Abstinence-Only Education and Teen Pregnancy Rates: Why We Need Comprehensive Sex Education in the U.S. PLoS One. 2011;6(10):e24658. https://doi.org/10.1371/journal.pone.0024658.  UNESCO. Online Programme and Meeting Document International Technical Guidance on Sexuality Education: An Evidence-Informed Approach for Schools, Teachers and Health Educators.; 2009. https://unesdoc.unesco.org/ark:/48223/pf0000183281.  Low WY, Tong WT, Gunasegaran V, eds. Issues of Safe Abortions in Malaysia: Reproductive Rights and Choice. UNFPA Malaysia; 2013. LAWS of MALAYSIA REPRINT Act 574 PENAL CODE.; 2006. https://ccid.rmp.gov.my/Laws/Act_574_Panel_Code_Malaysia.pdf GUIDELINES on TERMINATION of PREGNANCY (TOP) for HOSPITALS in the MINISTRY of HEALTH KETUA KETUA NEGARA KESIHATAN MALAYSIA DIRECTOR GENERAL of HEALTH MALAYSIA.; 2012. https://www.moh.gov.my/moh/images/gallery/Garispanduan/Guideline%20On%20TOP%20for%20Hospitals%20in%20MOH.pdf Related posts: The Future is Female: #IWD2024 – Gender Pain Gap Empowering Healthcare Professionals: Unveiling the Harms of Female Circumcision in Malaysia ‘We’re not hysterical’ – A call for action on the gender pain gap in Malaysia | The Star Malaysia Female Circumcision is Unnecessary: Girls Are Perfect as They Are Malaysia: FGM/C, Period Spot Checks, and Sexual Harassment | Harvard Public Health Review Countering Everyday Extremism Against Women: The Other Pandemic Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
11 October 2024Featured image by Tim Marshall on Unsplash. When asked how I have reached this point in my life, I often attribute my journey to a blend of luck, a desire to make a positive impact, calculated risk-taking, and a profound sense of self-belief. However, upon reflection, I realised that the most essential element in any success story is kindness – both in giving and in being receptive to it. No man is an island, and what we contribute to the world often returns to us in unexpected ways. By volunteering your time, sharing your knowledge, mentoring younger students, or working on projects that benefit others, you not only experience the profound fulfillment that comes from helping others, but you also unlock unforeseen opportunities. Kindness should never be transactional; when you give freely, expecting nothing in return, the universe has a way of rewarding you in remarkable and surprising ways. It saddens me when I see others respond to calls for help with questions about what they stand to gain. Writing this is challenging for me, as I too often feel overwhelmed by the many requests I receive online. It is crucial to set boundaries; we are not obliged to respond to every message or email. However, when a sincere and thoughtful request is made, it deserves to be met with kindness, not with dismissive or belittling remarks. It does not matter who that person is; he or she can be the King or Queen of a country, your junior colleague, or someone you do not know. Kindness should not be transactional Perhaps I have yet to convince you that kindness should not be transactional, so allow me to express it differently. In our consumer-driven society, we frequently fixate on personal gain and seek to minimise losses. While many prioritise accumulating financial capital, I have opted to invest in cultural capital as well. At times, when others were tightening their belts, I devoted my resources to pursuits that some might deem impractical. Life is not merely defined by financial success, but by the meaningful connections we cultivate and the enrichment we bring to others – and ourselves – through learning and diverse experiences. Sometimes, what may initially seem like a wasteful investment (be it time, money, or effort) can ultimately prove to be the most rewarding financial decision. But, remember, at the heart of successful connections is kindness, not the act of engaging with someone simply to gain something in return. No opportunity in life comes without a cost. The enriching experiences I have been fortunate to enjoy arise from years of volunteering and dedicating myself to causes I hold dear, which have inadvertently shaped my CV and helped build the career I aspire to. That said, I do not support unpaid internships (with a caveat). Furthermore, I do not harbour grand ambitions of saving the world, as some might believe. I simply wish to contribute in my own small way, offering what I can. And in doing so, I live my life with no regrets. In practising kindness, it is essential to remember to be kind to yourself first, ensuring that you do not stretch beyond your limits in your efforts to serve others. Remember, that you too deserve kindness. Sometimes, in the midst of a demanding work shift, particularly in fields like medicine, the best one can offer may simply be civility – and that is perfectly acceptable, so long that one avoids being unkind. Conclusion In conclusion, kindness remains a fundamental pillar of a meaningful and successful life, transcending mere transactions or expectations of reciprocity. By investing in cultural capital and dedicating ourselves to causes we care about, we not only enrich our own lives but also contribute to the greater good. Kindness fosters genuine connections, which are essential for personal and professional growth, often opening doors to unforeseen opportunities. While it is vital to establish boundaries and advocate for fair compensation within the voluntary sector, we must also embrace our capacity to make a difference, however small. I would like to express my heartfelt gratitude to those who have shown me kindness as I climbed the ladder of my career. Their support and generosity have made a significant impact on my journey. Ultimately, by practising self-compassion and extending kindness to others, we can create a ripple effect that enhances our communities, nurtures our relationships, and enriches our shared humanity. In doing so, we pave the way for a more fulfilling and successful life, grounded in the values that truly matter. Related posts: 4 Things I Learnt from My Burnout Breathless and Living My Wildest Dreams Building Resilience: Top 3 Tips for Success Building Resilience: Dealing with Grief and Failure for So-Called Type A Personalities Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
9 September 2024First published in the Boston Congress of Public Health Review on 8th September 2024. Featured image by Ishan @seefromthesky on Unsplash. I have given considerable thought to the importance of writing this article. While I wholeheartedly support the participation of individuals from cultures where FGM/C (female genital mutilation/cutting) is not practiced in advocacy efforts, I have become increasingly uncomfortable with certain stereotypical responses in this space. Transcending discussions on harm and culture, especially for those unfamiliar with FGM/C practices in Malaysia, is undeniably challenging. Nevertheless, everyone, regardless of background, has a right and responsibility to condemn violence against women and children and advocate for positive change. I fully agree that this is not a form of Western soft colonisation, contrary to what some Malaysians want to believe; international pressure can be crucial in ending harmful practices like FGM/C. I often reflect on my experiences in this advocacy space to my various “strange” encounters in the UK. One notable instance occurred several years ago at the High Commission of Malaysia, where I organised an event for The Kalsom Movement’s Commonwealth Cultural Programme. The event featured non-Malaysian British university students, who had spent four weeks volunteering and travelling in Malaysia for free, presenting their experiences1. I recall the emcee’s long-winded introduction and pleasantries to the VIPs, and I sheepishly apologised to the parents of one of the British students, saying, “Sorry for this!”, to which they responded, “Not at all, you learnt it from us (the British).” I was stunned by their remark and regretted not having the quick wit to reply, “Funny you say that, given my family tree goes back to the 10th century. Bet you don’t even know who your great-grandparents are.” I gritted my teeth, bit my tongue to stop myself from saying that, because I knew it was an inappropriate thing to say at such events. Instead, what I did was walk away feeling rather cross and stuffing myself with Malaysian food. Now, you get the idea of where I am coming from, and my opinion of international FGM/C advocacy. Regrettably, I have encountered numerous “well-meaning people”, who should know better than to promote the “we know best” rhetoric they have been espousing. I respect those who have taken the time to study the issue, connect with local activists, and understand the movement to end FGM/C in Malaysia, and who then collaborate with us to eliminate this practice. However, I am cautious about superficial comments born out of ignorance about FGM/C practices in Malaysia. It is not entirely my responsibility to educate others; there are ample resources available for those who seek to understand. There are respectful ways to ask questions and I am more than happy to answer questions. Approaching the subject respectfully is essential, yet many prefer to provoke, believing it will garner more attention on social media. Some may argue that this raises awareness, but as a Malaysian, I can attest that it does not contribute to ending FGM/C in Malaysia. (Image by Mike Baumeister from Unsplash) Increasingly, I have witnessed the dehumanisation of Malaysian Muslim women, reducing them to the status of their supposedly cut clitorises. One such instance involved a comment on a LinkedIn post I had reshared from another author not too long ago, celebrating successful Malaysian Muslim women.  Although the commenter praised their achievements, they added, “But what about FGM? Is there the will and movement to stop this?” This remark transformed the compliment into a back-handed one. Despite numerous posts I shared on LinkedIn about FGM/C that garnered little response, this particular post drew unexpected attention. But why? The original author who saw the comment was not impressed at all; I don’t think I need to repeat what she said! (Because you folks cannot handle it when it is reversed to you).Viewing Malaysian Muslim women merely as sexually oppressed individuals with cut clitorises is a reductionist perspective that disregards our humanity and individuality. Cultural and religious practices are complex and must be approached with sensitivity and respect, not sensationalism. Harmful practices against women are not exclusive to so-called “uncivilised” cultures; they can arise from any culture. Having lived in both the UK and Malaysia, I do not believe one culture is superior to the other. There are many aspects of Malaysian culture that I am proud of, and areas where I believe Malaysia could learn from the UK. Similarly, there are many aspects of the UK that I admire, and areas where I think Malaysia surpasses the UK. I recall seeing a patient who had undergone FGM/C as a young girl, attending an antenatal appointment. She was in tears, fearing being seen as a woman from a “barbaric” culture and lamented how others had treated her like a “poor little thing,” as if she lacked the intellect to make her own decisions. She despised being treated that way, and I despised it for her. She wanted to be treated like any other woman, and not make FGM/C the sole focus of her antenatal care. When treating survivors of any gender-based violence, it is essential not to infantilise them, which could lead to secondary psychological trauma. In Malaysia, not all Muslim women identify as survivors of FGM/C, and many would find this term offensive if applied to them. Which brings us to the question – are we, Malaysian Muslim women, oppressed? Is it right for other people to tell us that we are oppressed? Is it true that the oppressed do not realise that they are being oppressed?” I do not want to go into detail why FGM/C is practised in Malaysia (you can read all about it here). The reasons for this practice range from a lack of understanding about religious requirements to wanting to control a woman’s sexual libido. The idea behind the practice is oppressive. But Malaysian women are probably not oppressed solely because of this practice. It is overly simplistic to say that Malaysian Muslim women are sexually oppressed. Moreover, societies worldwide, and not just the Malaysian society often perceive women through the medical gaze2 , reducing them to mere vessels for reproduction (eg. The overturning of Roe v Wade, which overturned the constitutional right for women access to safe abortion in the USA). This underscores the importance of understanding the forces that shape societal views of oppression and developing a nuanced analysis of oppression that does not regard women of colour outside the Western world as “easy victims.” When I highlight the differences between the FGM/C practices in Malaysia and those in Africa, I am not downplaying its impact on Malaysian women, nor am I implying cultural superiority over others. There is no cultural superiority in any form of gender-based violence, no matter how minimal it is. The differences include a lack of long-term physical complications, though immediate complications can occur due to an infant’s clitoral anatomy, and there is a scarcity of studies on psychosexual dysfunction following the Malaysian practice. My intention of writing this article is to emphasise the importance of educating oneself on the specific nuances of the practice before proposing solutions. It is likely that local perspectives have already been considered in addressing this issue. Having said that, by no means we are not open to ideas to end this practice. Please remember that Malaysian women are not empty vessels walking around to be filled in with “education” from the West. Rather, we are open to collaborative efforts that respect our agency and expertise in finding solutions to end FGM/C in Malaysia. References The Kalsom Movement is a youth-education charity that encourages Malaysian university students, mainly in British universities, to take up the leadership in supporting and encouraging secondary school Malaysian students in Malaysia to aspire to pursue higher education. The Commonwealth Cultural Programme is one of The Kalsom Movement’s programme). Their trip was fully-funded by The Kalsom Movement and the aim is to enable these students to broaden their horizons by immersing in volunteer work with The Kalsom Movement and culture in Malaysia. Iguchi Y, Rashid A, Afiqah SN. Female genital cutting and the “medical gaze” in Southeast Asia. In: Nakamura, K., Miyachi, K., Miyawaki, Y., Toda, M. (eds) Female Genital Mutilation/Cutting. Springer, Singapore. 2023. https://doi.org/10.1007/978-981-19-6723-8_9 Related posts: A Medical Practitioner’s Toolkit to Ending FGM/C Female Circumcision is Unnecessary: Girls Are Perfect as They Are Jessica Pin on Clitoral Anatomy, Labiaplasties, and Smart Patients | Harvard Public Health Review Malaysian Doctors for Women & Children Asia Network to End FGM/C Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
10 August 2024On the 13th of July 2024, I had the distinct honour of delivering an alumni speech to the graduating DPhil and medical students at Green Templeton College (GTC), University of Oxford. Unlike other Oxford colleges, GTC upholds the unique tradition of hosting an “informal” graduation luncheon, where graduands receive their degree certificates from the College Principal, following the formal ceremony at the Sheldonian Theatre. During the formal graduation ceremony at the Sheldonian, graduands are introduced as a group according to their respective colleges by their Professors or College Deans to the Vice Chancellor, Bedels, Proctors, and Registar, before being accepted into the alumni community (but if you are a graduating DPhil student, you get to be presented individually). However, no individual presentations of degree certificates occur. Therefore GTC ensures that their graduands are personally acknowledged and celebrated at the graduation luncheon. Graduating DPhil students also have the opportunity to talk briefly about their research at the graduation luncheon. But I digress. As I stood before the new graduates, I was reminded of my own graduation luncheon in 2016, when my sister, Liyana, was present. At the time, I believed this tradition was common across all Oxford colleges. It was wonderful to be back to my old college. I present my speech below. __ Featured image by Clark Tibbs on Unsplash. Ladies and Gentlemen, esteemed faculty, proud parents, and most importantly, the incredible graduates, Good afternoon, and thank you for the honour of being part of this significant milestone in your lives. I still remember my experiences at GTC, even though it was 10 years ago. GTC is unique as a postgraduate college, seamlessly combining the best of the medical and business worlds. In 2015, after completing my medical foundation training, I applied to Oxford for my MSc in Clinical Embryology. I remember meeting incredibly clever and passionate people, often feeling like an imposter myself. But it wasn’t all work—I fondly recall the many practice sessions at the Observatory as a soprano in the college choir, which was a lot of fun and a great way to de-stress. Following my MSc, I spent more years in Oxford doing a DPhil. Today, I am a trainee Obstetrician and Gynaecologist and an Academic Clinical Fellow at the University of Warwick, continuing my endometriosis research. I have travelled all over the world talking about my research. I am also a women’s rights activist, advocating for the end of female genital mutilation in Southeast Asia, and I had the honour of speaking at the 68th United Nations Commission on the Status of Women about my advocacy work. Recently, I was invited to this year’s Garden Party at Buckingham Palace. And it all started with one catalyst: Being accepted to Oxford. Being accepted to GTC. Being shown what was possible for myself and what I could offer to the world. This was my experience of GTC. I hope all of you had the most positive, life-changing experiences too. Today, we celebrate your hard work, perseverance, and achievements. This moment marks the start of a journey that will define your lives. As you step out into the world, I want to share with you three things: Firstly, life is not fair, and I don’t mean it in a negative way. There is so much inequality and disparity in this world and it is OK to get angry and frustrated. Getting angry and frustrated makes you want to take action, but really, a logical and strategic mindset will make you go further. Be the hero of your own story and not a victim of life’s injustices. Secondly, remember rules are not set in stone. By that I am not suggesting you break the law or act recklessly. Rather, remember that rules, guidelines, regulations are written by man and we are not infallible – sometimes we get it right, sometimes we get it wrong. This is why representation matters. Just imagine if Martin Luther King Jr., Ruby Bridges, or Elizabeth Garrett Anderson had simply accepted the status quo. We won’t be anywhere. Progress relies on challenging outdated paradigms and dogmas. Sticking to the status quo does a disservice to both yourself and society. Thirdly, be kind. Be kind to yourself. In a divided world, your compassion can bridge gaps and build connections. Lift others up, listen, and act with integrity and respect. Above all, remember to be kind to yourself! You cannot be everything to everyone and nothing to yourself. As you leave GTC, know that you carry the hopes and dreams of those who came before you and those who will come after you. The world is waiting for your contributions. Go forth with confidence, courage, and a sense of purpose. Embrace the unknown and trust in your ability to navigate it. Finally, as a proud alumna of GTC, I can personally attest to the strength and support of our alumni community. The connections I made here have been invaluable in both my professional and personal life. This community is a source of inspiration, collaboration, and lifelong friendships. You are now part of this remarkable network. Lean on it, contribute to it, and let it help guide you through the exciting journey ahead. Congratulations, Class of 2024. May your journey be filled with success, joy, and endless possibilities. The world is yours for the taking. Go out and make it better. Thank you. Related posts: 4 Things I Learnt from My Burnout My Reflections Post DPhil at the University of Oxford Building Resilience: Top 3 Tips for Success Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
23 June 2024Featured image by David Gavi on Unsplash. Yesterday, I had attended a workshop on building a sustainable medical career by Professor Tim Hoff as part of the Management in Medicine programme at Green Templeton College. It was lovely to come back to Green Templeton College, as I did my MSc Clinical Embryology some years ago at this college. This workshop focuses on fostering a sustainable career ethos, exploring what individuals can achieve despite challenging work environments while considering intrinsic and extrinsic motivations, individual personality types (Myers-Briggs) and defensive routines. Predictably, the topic of burnout came into the picture. When I had undergone my own burnout experience, it was extremely isolating and difficult to reconcile with as a perfectionist. You always have this gnawing feeling that you were a failure for experiencing burnout, though a quick Google search will pull out numerous literature on doctors experiencing burnout globally. Burnout, as defined by the World Health Organization (WHO), is a syndrome resulting from chronic workplace stress that has not been successfully managed. It is characterised by three primary dimensions: feelings of energy depletion or exhaustion, increased mental distance from one’s job or feelings of negativism and cynicism related to one’s job, and a reduced sense of professional efficacy. This condition is recognised as an “occupational phenomenon” in the WHO’s International Classification of Diseases (ICD-11). Individuals suffering from burnout often feel overwhelmed, emotionally depleted, and incapable of meeting constant demands. This state can manifest in various ways, including chronic fatigue, insomnia, frequent headaches, and a weakened immune system. Emotionally, it can lead to feelings of helplessness, detachment, loss of motivation, and a pervasive sense of cynicism. Behaviourally, burnout can result in diminished performance and productivity, withdrawal from responsibilities, and a tendency to isolate oneself from others. Not surprisingly, while also acknowledging the limitations of the Myers-Briggs personality, following the “Great Burnout”, I am now an ENTJ-A, an extrovert of the highest form who wants to charge through life with logical precision and no time for emotive reasoning (Ah well, having “unconstrained rationalism” always comes back to me! By the way, you can take your test here). It is understandable that the challenging circumstances of the past decade have shaped my personality differently, leading me to prefer introversion over the extroversion I exhibited in the past year following my burnout. It is quite striking when even my family agrees with the ENTJ-A personality, as a bunch of people who knew me before, during, and after my burnout/ depression. But I digress. During my DPhil (or a PhD) at the University of Oxford, I faced numerous potential career paths, often feeling the pull to pursue them all, including leaving medicine and going for management consultancy jobs! However, after years pursuing a DPhil, I realised my deep-seated desire to reconcile with my identity as a medical doctor. At that time, I did not know whether this feeling I had inside of wanting to pursue specialty training was to do with the deep imprinting during medical school that I must continue to become a medical doctor, and so the next logical step was to try it out. Financial pressures and various challenges necessitated immediate entry into the job market upon completing my DPhil, without respite. I accepted the first available specialty trainee position, which required relocating to the North, while also writing my DPhil thesis. Balancing thesis writing with shift work led to burnout. Then, taking up my dream role as an NIHR Academic Clinical Fellow involved moving to a new location and starting a new job without any support network, which culminated in further burnout. Additionally, I had struggled to envision a future beyond this Fellowship due to the pull of wanting to do everything. I have always been the girl who wants to do everything and everything…leading to burnout. Whenever you find yourself at the end of the tether: You need to remember to take care of yourself firstly before others. I do not remember where I have read this; but this beautifully surmises my point: “You cannot be everything to everyone, and nothing to yourself”. I do not think this is in conflict with the Hippocratic Oath. As medical professionals, we have a legal and moral duty towards our patients and therefore it is paramount that we prioritise our own physical and mental health to deliver the best care possible. Therefore you need to find that 5-30 minutes in your busy shift for food and comfort breaks. Being autistic with women’s health as my special interest and a highly driven individual means that I could very easily work into late hours in the night in the past without any meal breaks or doing anything else, and I had done that for decades of my life to my own detriment. It is vital to have non-negotiable elements in your weekly routine to nourish and rejuvenate your soul. Think carefully about what or who should be in your mental health toolkit. During my burnout and its aftermath, I realised how important it is to take every step to prevent this from ever occurring again, which also culminated to my official diagnosis of autism and a thorough reflection of understanding what this means to me. This requires substantial effort and a receptive mindset to absorb the wisdom gained from those with neurodiversity and to embrace personal growth. You need to cut out “bare minimum people”. I first heard this term yesterday while catching up with some friends at College (how refreshing it is to meet like-minded people!). I have realised that throughout the years that I have been doing myself a disservice by entertaining “bare minimum people”. Of course, many things I did were done out of kindness and I did not expect returns but I am not Prophet Muhammad, Jesus, Buddha – I am just human with desires, needs and feelings of my own. No one should feel like they have been taken advantage of, even if it was unintentional. I have found greater happiness by freeing myself from the mental stress of caring for others who do not deserve an ounce of my time and energy. All of us deserve people who genuinely care about us, who choose their words thoughtfully, demonstrate patience, and clearly not playing mind games. Medicine is a hard job. It is not just the long hours, but the physical and emotional toll that comes with it. No doctor should have to endure the added stress of dealing with individuals who offer only the bare minimum outside of work – you get paid zero to “mother” or “doctor” these people. And yet, as an individual, I am not even asking for the moon and the stars. My terms are simple: show appreciation for me, my job, my interests, and do not make me feel small. While I am not fond of labels, it is refreshing to read that ENTJ-A personalities do not prefer friendships that happen out of circumstance or routine habits. For me, meaningful friendships involve engaging discussions about personal development, a shared passion for learning, and mutual efforts towards self-improvement. It can be challenging to keep up with such individuals as they are always engaged in important pursuits. Nonetheless, life is too short to focus on the wrong people. Based on my experiences, I would rather spend quality time alone than in the company of those who do not align with my values. Do not be disheartened, you will find your “maximum effort people” where you will feel safe to be yourself. You need to remember that every single step you take culminates to a consequential outcome and you are very much responsible for this outcome. I know, I know…we have been sold a lie, the NHS is crumbling as we speak, and doctors are underpaid. This is not the point of this post. I want you think about what you can do now to ensure that you do not have any regrets later in life. Life is not always fair; some contend with chronic illness, others with financial hardships, and we must play the hand we are dealt. If you are in your mid-thirties, you are nearing middle age, considering the global average lifespan of 72.6 years and even higher in more developed nations with better healthcare. What is your legacy? Will it be your career accomplishments, your children, or something else? These are crucial questions to ponder as you navigate life and make career choices. Every decision, no matter how small, carries weight and can significantly impact your future. Therefore, I am deliberate in my choices today, paying attention to even the simplest aspects such as my diet, sleep habits, leisure activities, how I present myself to others, and the company I keep. Otherwise, you will go through life feeling FOMO (fear of missing out). You might perceive me as someone who overthinks or is overly selective. This is not the case – I am highly attuned to my desires and my timeline that I hardly overthink about these fundamentals and am thankful that I effortlessly attract the right things and the right people. This requires a deep dive into what motivates you, where you want to see yourself in the short- and long-term, and your timeline. You need to remember that you are doing a hard and important job. Doing a DPhil is extremely hard. Clinical mastery is extremely difficult. This is especially so with surgical jobs like Obstetrics & Gynaecology. You will not get it right the first time and that is OK. To be successful at anything monumentally difficult takes time and considerable effort. Try many, many, many times before giving up. During my burnout, I questioned my own abilities. I am sure my clinical tutors and supervisors also questioned my abilities. As an ENTJ-A with zero patience for lack of efficiency in other people, I certainly was brutal towards myself because I could not see the logical reasoning behind my burnout and saw my burnout as my own failings without consideration of other factors. I had almost beaten myself to a pulp. Because I did that to myself, I let other “bare minimum people” did the same to me. The last person who needs to doubt yourself is you. To my credit, I never give up that easily and persevered and today I am glad that I did not leave specialty training. It took me a year and a half to get into the groove and feeling happy since I started my Fellowship. I learnt that everyone has their own timeline in specialty training, and you should not indiscriminately compare yourself to others. You are unique and if you are going against the grain like I am, you should expect to encounter more obstacles than the average doctor. You are incomparable. It is almost funny that I still keep asking myself whether or not I still want to do medicine and revisiting my reasons for doing medicine as you probably read in my previous articles. It is not because I have second thoughts. It is crucial to regularly revisit your decisions, conducting a life audit annually to ensure you are on the right path, not only in terms of your career but in life as a whole. Luckily, so far, each time I perform a life audit, I have always said “yes” to doing medicine. In fact, once I made the commitment to Obstetrics & Gynaecology, revisiting this decision again only helps me actively find ways to make my entire experience better. I am aware of how easily it is to be “drawn and quartered” by the different aspects of my medical career and life; be it clinical work, research, advocacy, and relationships. It is very easy to feel FOMO by the array of opportunities presented to you and you will want to say “yes” to everything. I have mitigated feeling FOMO through meticulous career planning across different life stages. In other words, I can do everything but not at the same time and that is OK because I still get to do them all, just at different phases in my life. My burnout compelled me to reflect deeply on my intrinsic values and career timeline, resulting in me to continue to reduce my clinical hours to 80% of full time even after my burnout. I know this a privilege not many in my position could afford. What works for me may not necessarily work for you, so whatever choices you make, whether it involves entering the private sector or leaving medicine altogether, feel confident that you have carefully considered your decisions. I hope you find my tips useful. I am always rooting for you. Related posts: My Reflections Post DPhil at the University of Oxford Building Resilience: Top 3 Tips for Success In the Pursuit of a Great Education and Career | Phenotype, Issue 32 Hilary Term 2019 Building Resilience: Dealing with Grief and Failure for So-Called Type A Personalities Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
23 April 2024My personal thoughts a year after graduating from my DPhil (Doctor of Philosophy) at the University of Oxford. — Photo of the Radcliffe Camera from the top of the University Church taken by myself towards the end of my DPhil at the University of Oxford in 2021. In navigating the intricate realms of pursuing specialisation in Obstetrics & Gynaecology while nurturing academic aspirations, one inevitably encounters the persistent spectre of imposter syndrome. If I were to be harsh, I would say that I am rather disappointed in myself. The arduous balancing act between clinical mastery and scholarly pursuits demands a steadfast resolve. Indeed, the dichotomy between the expectations of clinicians and scientists, each demanding their own measure of dedication, can be formidable. But perhaps, we are viewing my role wrongly. Positioned at the nexus of clinical practice and scientific inquiry, one embodies a synthesis of both realms. Herein lies the essence of my role – one that comprehends the patient’s journey intimately while possessing the acumen to delve into the depths of biological research. A year after my DPhil graduation, I do not feel any wiser than before. Instead of basking in newfound sagacity, an unsettling notion of diminishing acumen pervades my consciousness, shrouding me in a veil of perceived inadequacy. In plain words, I feel that I have become stupider having gone through the DPhil process: the acquisition of knowledge has seemingly been overshadowed by the sobering realities of academic politics, the relentless pressure of the “publish or perish” ethos, and the formidable obstacle of inadequate funding especially in women’s health. All of which are not unique to Oxford, but permeate throughout all realms of academia. So, why did I do a DPhil? Is a DPhil required to be me? What am I trying to be? A medical doctor-scientist-activist? The notion of pursuing a DPhil never crossed my mind in the wildest of reveries. It emerged gradually, fuelled by the burgeoning passion unearthed during my MSc research endeavours and the enriching collaborations with peers. While I never perceived myself as inherently scholarly, perhaps that self-assessment belied a deeper truth. Though my academic journey was punctuated by periods of perceived inertia, juxtaposed against peers with unwavering career aspirations, I found myself grappling with a profound sense of self-discovery and belonging. Unlike colleagues whose vocational paths seemed predestined, my own trajectory was marked by uncertainty and a relentless quest for identity amidst the sea of expectations. I had first-time passes in medical school, but I was not exactly the top-of-the-year student material. I was struggling emotionally too – trying to fit in everywhere I went but never fit in. I did not know what I wanted to specialise in unlike my neurosurgical colleagues who knew from day 1 of medical school that they wanted to become neurosurgeons. I got to where I am now not because I am smart, but because I am just extremely tenacious. Through my journey of exploration, experimentation, and engaging with individuals across diverse vocations, a profound insight has crystallised: Passion is not stumbled upon; it is meticulously cultivated. Share on X The culmination of my present achievements is rooted in a decade-long odyssey, marked by a humble commencement undertaking the most mundane tasks and respecting others for their contributions. I developed an interest in endometriosis and operating in the same manner. However, embarking on an *Academic Clinical Fellowship (ACF) post DPhil has unveiled a unique set of challenges. While possessing the research autonomy in this role, I find myself navigating a funding landscape that often overlooks my hybrid profile. *An Academic Clinical Fellowship is a post funded by the National Institute of Health & Research (NIHR), UK which stipulates 75% clinical work and 25% academic work and is designed to give medical doctors research experience. It is not typically awarded to PhD holders, but stiff competition at top UK universities meant that those who applied very often have an MSc or a PhD. At my DPhil graduation at the University of Oxford, 25th February 2023 The conventional grant criteria, tailored for either doctoral candidates or seasoned clinicians, pose a conundrum for someone like myself, a postdoctoral researcher and a junior specialty trainee doctor. The typical avenues for funding for clinical academics in the UK favour those in pursuit of doctoral candidacy or those already established in clinical practice, leaving me betwixt and between. To surmount this impasse, innovative strategies become imperative. I am cognisant that securing substantial funding hinges on an ample portfolio of publications. Yet, to augment this portfolio, an abundance of data is requisite, which, paradoxically, demands substantial funding. This cyclic dependency presents a formidable conundrum, akin to a catch-22 scenario. Additionally, the acquisition of clinical proficiency in a surgical specialty such as Obstetrics & Gynaecology necessitates a significant investment of time, often at the expense of academic pursuits. Embarking on biological research in a wet lab also demands considerable time investment, particularly when pursuing new hypotheses. I feel that an ACF arrangement would be better suited for non-surgical medical specialties such as psychiatry, or that I should forget about pursuing biological research. I have been told many times by people around me that I cannot do everything, and I am already doing the best I could. But what if I can do everything? But what if I can do even better? Some time during my DPhil, coupled with a strong sense of justice, I revisited the practice of FGM/C (female genital mutilation/ cutting) in Malaysia and that gave birth to the Malaysian Doctors for Women & Children (MDWC). I vividly remember contacting Prof Rashid Khan on ResearchGate upon reading his work on the medicalisation of FGM/C in Malaysia. Leveraging platforms like ResearchGate and Instagram, I rallied fellow Malaysian doctors, envisioning a collective effort to address overlooked yet impactful issues affecting Malaysian women. Though beset by initial challenges and the departure of some due to ideological differences, our nascent team persevered. Beginning with naught but a shared passion and no institutional support, we embarked on our mission. Through sheer enthusiasm and a collaborative ethos, we managed to secure modest funding and garnered international recognition, albeit still in the nascent stages. Details remain confidential for now, but our journey stands as a testament to the power of collective dedication and shared vision. As MDWC flourished, our scope expanded to encompass critical areas such as the gender pain gap, menstrual health, and endometriosis. When I attended the World Congress on Endometriosis last year, I realised the need for more high-quality research from the Global South. But I digress. Motivated by a dedication to measurable impact, I remain resolute in my pursuit of advancing endometriosis research within my capacity as a clinical academic, undeterred by constraints of time or funding. If this means becoming an activist or an advocate of some sort to wet everyone’s appetite for more funding towards my area of research interest in underserved communities, such as the Southeast Asian population, so be it! Embarking on my DPhil journey unveiled a profound realisation of my intrinsic value – a culmination of acquired knowledge and cultural capital. Beyond the confines of my clinical role, I embrace the boundless possibilities afforded by my enriched experience and skill set. Therefore, if my current role or job no longer satisfies my aims of making a tangible impact in my areas of interests, I may look into different and unconventional ways of solving that problem. Possessing a DPhil should not tether one solely to academia, just as a medical degree should not restrict one solely to clinical practice. Wicked medical problems require an ensemble of experts from different backgrounds and qualifications, not just those belonging to the medical profession. It is imperative for doctors and clinical academics to transcend conventional networks, fostering genuine connections beyond the confines of tradition. However, not every interaction should be viewed through the lens of networking. Sincere engagement with others proves invaluable in life’s journey. Related posts: Embracing My Neurodiverse Journey: Navigating Interactions, Challenging Stereotypes, and Cultivating Connections | HPHR Journal, Boston Congress of Public Health Breathless and Living My Wildest Dreams Building Resilience: Top 3 Tips for Success In the Pursuit of a Great Education and Career | Phenotype, Issue 32 HT 2019 Building Resilience: Dealing with Grief and Failure for So-Called Type A Personalities Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
29 March 2024First published in the Boston Congress of Public Health Review on 29th March 2024. I recently attended a panel discussion that highlighted the profound influence of socio-economic factors, race, and ethnicity on health outcomes as this is a topic I deeply care about. The session underscored the significance of continuity, sustainability, and relationships in healthcare. A notable 25% mortality reduction was observed for patients with a named regular GP for 15 years1. The sustainability discourse focused on planetary health, illustrating the macro-level impact of climate change, especially food scarcity, on health. The session also focused on relationships and asking doctors and healthcare professionals to understand factors behind patients’ behaviour towards illness. A sustainable NHS (National Health Service UK) is dependent on preventative medicine2,3. All points which I completely agree with. However, a sustainable NHS is also dependent on its workforce4. It is understandable that within an audience predominantly comprised of doctors, there exists a sense of cynicism regarding the escalating expectations placed upon them to embody an idealised archetype of perfection – an expectation to seamlessly integrate the multifaceted intricacies of core health determinants, delivering personalised medical care within the confines of an increasingly strained NHS. One doctor among many articulated this sentiment with poignant inquiry: “Am I to assume the roles of priest, confidant, and counsellor in addition to my medical duties? What further burdens must I bear?” Share on X Society already expects doctors to behave to the highest moral standards, and any minor mistakes are not taken lightly. It sometimes feels like doctors are increasingly being asked to make up for the failings of the State and individual patient responsibility. It is essential to recognise that doctors are not a separate entity from society, and they too could be affected by core health determinants, climate change impacts, and at times, are thrust into untenable circumstances such as conflict zones. While the privilege associated with the medical profession is undeniable, it is equally crucial to recognise the sobering reality that doctors are not immune to illness or injury and may find themselves in the role of the patient. Furthermore, junior doctors in the UK increasingly grapple with the reality of soaring living costs, often forced to make sacrifices in basic necessities like food and warmth5. In what manner are we expected to deliver optimal care to our patients amidst these lamentable circumstances? I shudder to think about those less privileged that I am. Neglecting the fundamental needs of the healthcare workforce could risk restricting medicine to only the most privileged of our society, resulting in a workforce that struggles to relate to an increasingly diverse UK population. Expecting healthcare professionals to address these complex issues without adequately addressing their wellbeing, especially considering the prevalent issue of burnout6 due to unmanageable workload raises crucial considerations for safe, sustainable, and empathetic healthcare practices7.  Recognising and supporting the financial, mental, and emotional needs of healthcare workers is essential for fostering a resilient workforce that can effectively navigate the challenges posed by issues like climate change and health disparities. (Image by Mulyadi on Unsplash). Amidst discussions and focus groups, a seemingly straightforward solution emerges: to re-establish a sense of security for the entire population, by addressing the most fundamental needs in Maslow’s hierarchy, can serve as a fundamental step towards a more resilient and sustainable healthcare system. Clinical training ought to transcend mere service provision and the perfunctory act of ticking boxes. If individuals are to acquire specific skills, it is imperative that such training be proactively provided, rather than burdening doctors with the responsibility outside of their designated working hours. Another proposed solution to one of the questions raised during the discussion was advocacy training for doctors. While I have embraced advocacy in certain areas, it is crucial to recognise that expecting doctors to assume the role of activists universally may not be realistic. Historical examples, like Elizabeth Garrett Anderson, illustrate doctors as activists, and in my past, fuelled by idealism and naïvety, had encouraged all doctors to be activists. But not all doctors should become activists. Being an activist in addition to being a doctor does not imply superiority; rather, it highlights the diversity of approaches within the medical community. Furthermore, advocacy need not be characterised by constant social media visibility or vocal presence. I want to reassure patients that there are numerous doctors who are quietly attentive, internalising what they learn, and incorporating it into their practice, fostering a commitment to positive change in a more nuanced and impactful manner. But let’s not blame the failings of the State on the healthcare workforce. References Sandvik H, Hetlevik Ø, Blinkenberg J, Hunskaar S. Continuity in general practice as a predictor of mortality, acute hospitalization, and use of out-of-hours services: registry-based observational study in Norway. British Journal of General Practice. 2022;72(715). doi:10.3399/BJGP.2021.0340 Sood H. NHS England » Disease prevention is vital to a sustainable NHS – Dr Harpreet Sood. Accessed February 24, 2024. https://www.england.nhs.uk/blog/harpreet-sood-2/ Department of Health & Social Care U. Prevention Is Better than Cure Our Vision to Help You Live Well for Longer.; 2018. Anderson M, O’Neill C, Macleod Clark J, et al. Securing a sustainable and fit-for-purpose UK health and care workforce. Lancet. 2021;397(10288):1992. doi:10.1016/S0140-6736(21)00231-2 Waters A. Junior doctors are cutting back on food and heating amid cost of living crisis, BMA poll finds. BMJ. 2022;379:o3038. doi:10.1136/BMJ.O3038 Imo UO. Burnout and psychiatric morbidity among doctors in the UK: a systematic literature review of prevalence and associated factors. BJPsych Bull. 2017;41(4):197. doi:10.1192/PB.BP.116.054247 General Medical Council UK. The State of Medical Education and Practice in the UK.; 2023. Related posts: Embracing My Neurodiverse Journey: Navigating Interactions, Challenging Stereotypes, and Cultivating Connections | HPHR Journal, Boston Congress of Public Health Inspirational Asian Women in Medicine: A Non-Exhaustive List Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
11 March 2024I had an interesting conversation with Melisa Melina Idris on the gender pain gap, endometriosis, women’s health research, and female genital mutilation. Thank you for your kind invitation. It is important to talk about these issues in wider spaces and platforms. Health is wealth. And women deserve the best healthcare! Watch “The Future is Female” International Women’s Day (#IWD2024) special on Astro AWANI Malaysia this Sunday, 10th March 2024 at 2200 MYT. Related posts: Empowering Healthcare Professionals: Unveiling the Harms of Female Circumcision in Malaysia ‘We’re not hysterical’ – A call for action on the gender pain gap in Malaysia | The Star Malaysia Sunat Perempuan Bukan Satu Keperluan | Ova Health Female Circumcision is Unnecessary: Girls Are Perfect as They Are A Medical Practitioner’s Toolkit to Ending FGM/C Bagaimana Hubris dan Ketidaksaksamaan Gender Memberi Kesan Negatif Terhadap Pengalaman Pesakit | Code Blue How Hubris and Misogyny Affect Patient Care | Harvard Public Health Review Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
17 December 2023I am proud to have contributed to this publication with my colleagues from Malaysian Doctors for Women & Children, Asian-Pacific Resource & Research Centre for Women (ARROW), and Asia Network to End FGM/C. It has been a year-long project, with sleepless nights so I am delighted to finally see the results of my work. This leaflet has been cited in ARROW / Orchid Project’s “Country Profile: FGC in Malaysia” (March 2024) and covered by Ova Health “Leaflet: Many Doctors Who Perform Female Genital Cutting In Malaysia Lack Knowledge Of Clitoral Anatomy” on 20th March 2024. Powered By EmbedPress Related posts: Reflections of the 2023 Women Deliver and What it Means for Eliminating FGM/C in Asia – Dr Hannah Nazri Sunat Perempuan Bukan Satu Keperluan | Ova Health Female Circumcision is Unnecessary: Girls Are Perfect as They Are A Medical Practitioner’s Toolkit to Ending FGM/C Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
19 October 2023First published in The Star Malaysia on 17th October 2023. In light of the recent International Day of the Girl Child on Oct 11, 2023, the International Islamic University Malaysia, the Endometriosis Association of Malaysia, Malaysian Doctors for Women & Children, Peduli Merah, and Projek Gadis Mekar collaboratively hosted an online forum to raise awareness about “Period Poverty, the gender pain gap, and endometriosis”. The gender pain gap relating to menstrual health and issues of endometriosis are cultural aspects of period poverty that are often overlooked. In recent years, Malaysia has placed significant attention on various aspects of gender equality. Girls are making strides in education, and women are taking on more managerial roles. However, beneath the surface of these visible achievements lies an issue that is often overshadowed: the gender pain gap. This silent and pervasive problem deserves our attention. The gender pain gap refers to the differences in how men and women experience and manage pain, as well as the disparities in access to adequate pain management and healthcare services. It is an issue that goes beyond the visible, headline-grabbing inequalities, delving deep into the lives of Malaysian women who silently endure pain without proper acknowledgement or care. Here are some of the facts that highlight the reality of the gender pain gap: > Up to 25% of women are less likely than men to receive pain relief and wait longer for pain relief when presenting with abdominal pain at an emergency department. > Women are 50% more likely to be misdiagnosed when having a heart attack due to the lack of awareness of atypical presentations of heart attack experienced by women and gender bias. > Normalisation or trivialisation of women’s pain was the reason for Malaysian girls with dysmenorrhoea to not seek professional help. The lack of awareness among Malaysians regarding endometriosis is mainly attributed to its commonly mistaken perception as normal menstrual discomfort. Consequently, this misconception hinders Malaysian women from accessing comprehensive information and assistance pertaining to their reproductive and menstrual well-being. One reason for this bias is the persistence of gender stereotypes that cast women as “emotional” and “hysterical”. These stereotypes influence medical practitioners, sometimes unconsciously, to downplay the pain reported by female patients. The consequences of such biases are immense. Women with chronic conditions such as endometriosis, fibromyalgia, and migraines often struggle to find understanding and effective treatment. Additionally, the gender pain gap extends into cultural norms and expectations. Women, particularly in more conservative or traditional settings, may be reluctant to openly discuss their pain, fearing the stigma associated with perceived weakness. This cultural silence can lead to women delaying seeking medical help until their conditions have progressed to critical stages, making treatment more challenging and costly. In endometriosis, the delay in seeking treatment could immensely affect patients’ quality of life. The reasons for the long waiting times for women (six-12 years) to be diagnosed with endometriosis are multifactorial, but the gender pain gap plays a significant role. Although the evidence is limited, failure to diagnose and treat endometriosis on time may promote progression of the disease and a longer time between first clinical consultation and referral or diagnosis. Findings indicated that one in 10 women suffer from endometriosis, which equates to 190 million women worldwide. In Malaysia, approximately 350,000 women have endometriosis. This implies a global emergency in addressing the unmet needs of women with endometriosis. Typically, the stigma associated with endometriosis and its effects on patients’ psychosocial well-being serve as obstacles that contribute to the delay in diagnosing the condition, explicitly referring to the prolonged period between the emergence of symptoms and the subsequent diagnosis or treatment. A 2020 study on Malaysian members of the Endometriosis Association of Malaysia Facebook page revealed that these patients encountered persistent challenges in effectively communicating and conveying the nature of their suffering to others. The results also suggested that women with endometriosis were not receiving sufficient information from healthcare providers, leading them to rely on online interactions with fellow patients for solutions. These statistics and findings are alarming, and they highlight the need for action to address the gender pain gap in Malaysia. More studies need to be done to understand the impact of the gender pain gap on Malaysian women. Here we highlight some steps that can be taken to close the gap: Increase awareness: Initiatives should be undertaken to raise awareness about the gender pain gap among healthcare providers, the public, and women themselves. Healthcare professionals in particular need to be aware of the gender pain gap and the biases that contribute to it. This can be achieved through training and education programmes that focus on gender sensitivity and cultural competence. Conduct research: More research is needed to understand the biological and psychosocial bases of pain differences between men and women. This research can help inform the development of effective treatments and interventions. Address systemic gaps in healthcare: There are systemic gaps in healthcare that contribute to the gender pain gap, such as the lack of representation of women in clinical trials. Addressing these gaps can help ensure that women receive the same level of care as men. Empower women: Women need to be empowered to speak up about their pain and to advocate for themselves in healthcare settings. This can be achieved through education and awareness campaigns that encourage women to take an active role in their healthcare. Establish support networks: Encourage and support the creation of support networks and safe spaces where women can openly discuss their experiences, fostering a culture of understanding and empathy. The main objective of the Endometriosis Association of Malaysia is to establish a conducive and impartial atmosphere that promotes the physical and emotional well-being of patients while facilitating open and effective communication regarding the management of their endometriosis-related concerns. Policy changes: Advocate for policies that promote gender equality in healthcare and employment, ensuring that all individuals receive the same quality of care, regardless of their gender. Closing the gender pain gap in Malaysia will require a concerted effort from healthcare professionals, policymakers, and the public. It is time to recognise that women’s pain is real and to take action to ensure that they receive the care and treatment they deserve. Let us work together to close the gender pain gap and create a more equitable society for all. This is a future we hope for our girls. DR FATIMAH AL-ATTAS Coordinator, Unit for Social Issues and Development Advocacy and Research, International Islamic University Malaysia ANNSLEY DASHAWNA STEPHEN Member of the Youth Parliament Malaysia (Penang) 2023/2024 Session Founding President, Pertubuhan Projek Gadis Mekar Malaysia SURITA MOGAN Founding president, Endometriosis Association of Malaysia DR HANNAH NAZRI National Institute for Health and Care Research, Academic Clinical Fellow in Obstetrics & Gynaecology, University of Warwick, Britain Specialty Trainee Doctor in Obstetrics & Gynaecology, National Health Service, Britain Founding director, Malaysian Doctors for Women & Children PEDULI MERAH Addressing period poverty in Malaysia Related posts: Suara Empuan: Sanggup Mengandung Elak Datang Bulan, Apa Kata Doktor | Peduli Merah Suara Empuan: Terpaksa Berlapar Kerana Miskin Haid, Apa Kata Doktor | Peduli Merah Bagaimana Hubris dan Ketidaksaksamaan Gender Memberi Kesan Negatif Terhadap Pengalaman Pesakit | Code Blue Malaysia: FGM/C, Period Spot Checks, and Sexual Harassment | Harvard Public Health Review How Hubris and Misogyny Affect Patient Care | Harvard Public Health Review Countering Everyday Extremism Against Women: The Other Pandemic Like what you read? 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24 August 2023First published in the Boston Congress of Public Health Review (previously Harvard Public Health Review) on 23rd August 2023. Featured image by Peter Burdon on Unsplash. I never thought much about how interacted with others other than to follow the golden adage of treating others how you wish to be treated. However, traversing my formative years – childhood, adolescence, and university – unveiled a tapestry of challenges in my interpersonal engagements. One poignant memory was an exercise during an English language class when I was 16. We were told to write our name on a piece of paper and to pass it around for the whole class to give constructive feedback. My blank sheet of paper was soon filled with unkind comments and one that stood out was “To have a friend, be a friend.” It was a blow to my confidence to know that there was something wrong with me despite my excellent record in school but not quite grasp the nature of the “error”. I did not understand how I could offend anyone without meaning to, leading to my own special brand of college misadventures with a side of bullying. For as long as I could remember, I often felt misunderstood and not belonged to any particular social groups. I am the lone wolf. Females with “high-functioning autism” are often misdiagnosed with anxiety due to how well female autistic adults camouflage their idiosyncrasies (Tubío-Fungueiriño et. al, 2020). So we go for as long as possible like square pegs trying to fit into round holes – and being told countless times that we are not doing life right. Being diagnosed with autism as an adult was the light bulb moment for me – it all suddenly made sense. Life with “high-functioning autism” means differently to different people. In my case, it primarily entails grasping contextual nuances and delivering fitting responses, not to mention the sensory overload which I thought was normal. Regrettably, a stereotype persists about autistic doctors lacking empathy or the ability to empathise. I wholeheartedly disagree; we are far from impolite individuals or psychopaths. Similar to neurotypicals, a spectrum of dispositions exists, spanning those who are indifferent to others and those who genuinely care. For an autistic person who values common decency, navigating the intricacies of facial expressions and body language can be a solitary endeavour, marked by the frustration of missing subtle cues. Often, I have departed from situations believing I have exhibited appropriate behaviour, only to later realise my inadvertent offences. Realising these inadvertent offences much later, can lead to a full-blown panic attack. To mitigate this, I have made it a near-constant habit to apologise at the conclusion of each shift, just in case. In the initial stages of my clinical career following my PhD, I grappled with anxiety at the mere thought of work or replying work emails. However, I have often wondered if a substantial part of my behaviour stems from the social conditioning of women, neurotypical or not, into becoming people-pleasers. Regrettably, excelling in the art of displeasing people seems to be my forte. The UK Equality Act (Moore et al., 2020) stipulates that appropriate adjustments should be made by employers for autistic individuals. Academia and lab work have been touted to be perfect spaces for autistic doctors but with the appropriate support, autistic doctors can also excel in clinical work. As a specialty trainee doctor, I am grateful to receive the support I need at work. Having senior doctors taking me under their wings and making sure I get the clinical experiences I need, has been transformative. Autistic doctors are often passionate and driven people who would not mind the long years of perfecting the art of clinical medicine. My interest in women’s health meant that I am not only passionate about clinical medicine, but also in research and anything to do with improving the quality of life of women and marginalised communities. Above all, I hate inequality and injustice. I cannot stand just watching things happen. I must do something. My personal take on life is to perform my best in all aspects of life which bodes well for my career. Interacting with patients is different to having to do small talk. There is a purpose to patient interactions versus the open-ending conversations that most of the time, leads to nowhere. I am more comfortable giving a speech to a large crowd than in a networking event where I have to actively go around and introduce myself. But a lot of people do not feel comfortable during networking events, not just autistic people. On a light-hearted and chuckle-inducing tangent, I’ve acquired a comical life lesson: putting on my A-game in romantic relationships is like wearing a “kick me” sign on my heart. Turns out, my previous overzealous efforts were as endearing as a puppy wearing a superhero cape – cute, but slightly overwhelming from the outset which sadly made me a weirdo. Thankfully, these days I have learnt to go a notch lower on operatic grand gestures. However, I also no longer expect to be understood by most people in this respect. Now when it comes to family and relationships, I believe in being genuine and kind. Because let’s be real, the “genuine and kind” combo isn’t just a solid relationship strategy, it’s a recipe for life’s best connections – with or without decoding the mysteries of romantic weirdness. As I continue to evolve, both personally and professionally, I embrace the wisdom that emerges from acknowledging my unique strengths and limitations. My trajectory as a doctor and advocate for positive change has been one of transformation, and I carry forward the conviction that genuine kindness and dedication are the bridges that foster connections. My story highlights that, beyond labels and preconceptions, lies a remarkable potential to contribute meaningfully to the world – a potential that’s present in every individual, whether neurotypical or neurodiverse. Related posts: Breathless and Living My Wildest Dreams Building Resilience: Top 3 Tips for Success Building Resilience: Dealing with Grief and Failure for So-Called Type A Personalities Like what you read? Subscribe to my blog. References ​​Tubío-Fungueiriño M., Cruz S., Sampaio A., Carracedo A., Fernández-Prieto M. Social camouflaging in females with autism spectrum disorder: A systematic review. J. Autism Dev. Disord. 2020 doi: 10.1007/s10803-020-04695-x. ​Moore, S., Kinnear, M., & Freeman, L. (2020). Autistic doctors: overlooked assets to medicine. The Lancet Psychiatry, 7(4), 306–307. https://doi.org/10.1016/S2215-0366(20)30087-0 About the Author: Hannah Nazri Follow me [...] Read more...
11 August 2023This article is first published on the blog of the Malaysian Doctors for Women & Children. On the 15th July 2023, I touched down at Kigali International Airport, Rwanda for the 2023 Women Deliver (WD2023) conference which was held in Kigali from 17th to 20th July 2023. As the Director of the Malaysian Doctors for Women & Children and an active member of the Asia Network to End FGM/C (female genital mutilation/ cutting), I am grateful to Asia Pacific Resource & Research Centre for Women (ARROW) for their sponsorship and the organisation of a successful WD2023 FGM/C pre-conference. The WD2023 is the largest multisectoral gathering of governmental bodies, international organisations, the private sector, civil society organisations, youth-led, and LGBTQIA+ organisations, and advocates to represent, promote and strengthen efforts and drive solutions for girls, women, and underrepresented populations. I was one of the lead discussants along with Christina Pallitto from the WHO and Domtila Chesang I-Rep Foundation (I am Responsible Foundation), Kenya on “Emerging Trends: Medicalization, Cross-border FGM/C, FGM/C Economics” at the WD2023 FGM/C pre-conference organised by ARROW and their international partner organisations.  Christina Pallitto gave an overview of FGM/C and the role of the World Health Organization in eliminating this practice. In particular, Christina shared WHO strategies for governments to eliminate FGM/C.   However, these strategies could not work in countries where FGM/C is not illegal. I shared perspectives on the Malaysian and Southeast Asian practice of the type 4 FGM/C subtype of needling or pricking the external clitoris in infants and how increasing rates of medicalisation of FGM/C cause more harm, not harm reduction. There is no explicit law banning FGM/C in Malaysia. In a 2020 study, 20.5% of Malay Muslim doctors admitted to cutting the clitoris which represents type 1 FGM/C with greater risks and complications. Although the Malaysian practice (type 4 FGM/C subtype of needling/ pricking the external clitoris) does not cause long-term obstetrics harm, we fail to recognise that sexual pleasure is an important outcome which can be a main contributor to the breakdown in marriage and family life (and is difficult to measure especially when FGM/C is done in infants). In Southeast Asian society, speaking of sex is still taboo.   We must recognise that strategies to eliminate FGM/C in Africa may not be applicable to Southeast Asian practice. In Malaysia, FGM/C is not a requirement for marriage or to become a Muslim, although adult women who were not born Muslims have undergone FGM/C for these reasons. In contrast, Domtilla Chesang explained how climate change can increase the rates of FGM/C in Kenya. The effects of climate change cause crop failure which means a significant reduction in household income. Families are then forced to marry off their daughters earlier to have fewer mouths to feed and to earn their dowries, and for these daughters to be marriageable, they need to undergo FGM/C. Due to being married, these girls are taken out of school and therefore will never complete their secondary education and enter college or university. The cycle repeats when these girls give birth to girls. From left to right, at the Frontline Ending FGM mixer. Frontline Ending FGM is a movement of activists and grassroots organisations from 14 African countries. The aim of the movement is to allocate more funds directly to local organisations: Oumou Touray – Mali (Activist), Ifrah Ahmed – Somalia (Ifrah Foundation | A Girl From Mogadishu), Sadia Hussein – Kenya (Brighter Society Initiative), Dr Natalia Kanem – Panama (Executive Director of UNFPA), Domtila Chesang – Kenya (I-Rep Foundation), Dr Hannah Nazri (Director of the Malaysian Doctors for Women & Children), Antonia Waskowiak – Germany (Zinduka eV). In the Malaysian practice, it is not economic reasons that drive parents to perform FGM/C to their infant daughters. Rather, Malaysian parents truly believe that FGM/C is harmless and that it is essential for the spiritual enhancement of their daughters though we cannot deny the reasons behind the practice are rooted in misogyny. Myths such as uncircumcised women being wilder than those who are not are unfounded. If parents want their daughters to self-regulate their sexual drives, then education is a better method. A much better strategy is to educate both men and women at a very young age to respect each other’s bodily autonomy through comprehensive sexuality education in schools. A barrier to eliminating FGM/C in many countries including Malaysia is the belief that FGM/C elimination is a Western agenda and a way to curb cultural practices, which is of course, not true. I echoed the thoughts of Sivananthi Thanenthiran, Executive Director of ARROW at the UNFPA’s WD2023 pre-conference on “Fostering Partnerships to Realise Bodily Autonomy”, “Sexual and reproductive health rights is seen as a white colonial agenda. Civil society organisations rely on small pockets of funding but are getting pushback from the government. Our governments need to take responsibility, provide funding and support by taking leadership from young feminists, not just engaging.” Therefore, it is essential for governments to lean into the leadership of youth advocates and to provide the appropriate support to avoid reliance on international funding. There is recognition during the FGM/C pre-conference that more funding to local grassroots organisations is needed. On eliminating the funding gap, Domtila Chesang emphasised the importance of removing unnecessary barriers such as requiring non-profits to have built capacity before applying for funding. “This is similar to asking for 5 years of work experience from a fresh graduate,” she opined. Dr Leyla Hussein Gikandi OBE, founder of The Dahlia Project and first Black woman rector of the University of St Andrews, said that lack of funding hampers the progress of ending FGM/C as we are not reframing FGM/C correctly. “FGM/C cannot be reframed as just a cultural practice, if you’re pinning a girl down, spreading her legs and introducing a shaper object to their genitalia – that’s sexual assault.” While I agree with Dr Leyla Hussein Gikandi’s statement, I cannot see reframing FGM/C in this way is in any way helpful to eliminating FGM/C in Malaysia and Southeast Asia. I concur with Saza Faradilla of End FGC Singapore’s statement during a session at WD2023, I have zero tolerance for FGM/C but criminalisation is not a route that we should pursue at present in Malaysia and Singapore. Education is key in Malaysia and Singapore. We need to remember that any strategies for eliminating FGM/C should be unique to the culture. We cannot have international organisations telling local advocates what works and what doesn’t in terms of advocating the elimination of FGM/C in their communities and we cannot impose standards that are impossible to achieve in a low-resource setting for an organisation to qualify for funding – doing so is infantilising and reeks of White saviourism. We have to trust highly educated professionals who have a greater understanding of their own equally superior cultures and therefore know what strategies work and do not work in the elimination of FGM/C in their own cultures. The girls run to you, they don’t run to the funders. If we cannot provide the solutions, what is the point of providing anti-FGM education? Trust us to do the work that we are already doing. – Domtila Chesang, I-Rep Foundation The global end FGM/C movement’s discussions at WD2023 culminated in the announcement of the Kigali Declaration by Nabeela Iqbal, founder of the Sisterhood Initiative in Sri Lanka, who represented the Asia Network to End FGM/C, making an urgent appeal to fund more grassroots organisations working to end FGM/C. The Kigali Declaration can be read here.  The Asia Network to End FGM/C at the WD2023 FGM/C Pre-Conference. From left to right: Nabeela Iqbal – Sri Lanka (Sisterhood Initiative), Aarefa Johari – India (Sahiyo), Ika Augustin – Indonesia (Yayasan Kalynamitra), Sharmeen Hakim – India (We Speak Out), Adibah – Malaysia (Sisters in Islam), Saza Faradilla – Singapore (End FGC Singapore), Dr Hannah Nazri (Malaysian Doctors for Women & Children), Elizabeth Angsioco – Philippines (Activist), Keshia Mahmood – Malaysia (ARROW). I believe the pre-conference is a step in the right direction to eliminate FGM/C in Asia. I am grateful to put names to the many faces I see online during the Asia Network to End FGM/C virtual meetings in real life and to meet other activists of FGM/C elimination from other organisations from different parts of the world. They are wonderful and passionate people and many of them are survivors of FGM/C. It is a difficult space for survivors of FGM/C to be in, but they are in this space because ending FGM/C is crucial. However, like many of them, I am tired of conversations. I am tired of listening to “more funding to grassroots”, “collaborations” and “spaces.” We are now post-WD2023. Enough with the talking, let’s see some action.  To that end, the Malaysian Doctors for Women & Children welcome any enquiries for collaboration to end FGM/C. The importance of getting healthcare professionals behind the anti-FGM/C movement cannot be overstated. Presently, there are not enough healthcare professionals involved in collaborating with civil society organisations to support eliminating this practice. The Malaysian Doctors for Women & Children are ready to provide evidence-based research and work with civil society organisations across Asia to end FGM/C. Related posts: Sunat Perempuan Bukan Satu Keperluan | Ova Health Female Circumcision is Unnecessary: Girls Are Perfect as They Are A Medical Practitioner’s Toolkit to Ending FGM/C Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
12 May 2023First published in the Boston Congress of Public Health Review (previously known as Harvard Public Health Review) on 12th May 2023. An article detailing on Hannah’s experience as a UN Women UK delegate to the United Nations 67th Commission on the Status of Women (CSW67). The United Nations 67th Commission on the Status of Women (CSW67) was held from 6th to 17th March 2023. It is the only gathering convening intergovernmental and non-governmental/ non-profit organisations that discuss the current status of women globally as well as sharing best practices on advancing gender equality and women empowerment. CSW serves three core functions to promote women’s rights worldwide, to create a space for women to tell their stories and to create a blueprint to shape global laws and policies. I was privileged to be selected as the UN Women UK delegate to CSW67. UN Women was founded in 2010 with the triple mandate of working with governments, societies, and supporting grassroots communities to further advance gender equality and women empowerment. As a UN Women UK delegate, I attended plenary sessions as well as parallel or side events organised by non-governmental/non-profit organisations. This year’s CSW67 priority theme was “Innovation and technological change, and education in the digital age for achieving gender equality and the empowerment of all women and girls.” We are still 300 years from achieving gender equality. Unfortunately, women at fourteen times more likely to die in a natural disaster. 435 million women and girls earn less than $1.90 per day worldwide by 2021 including the 47 million directly impoverished by the COVID-19 pandemic. 15 million girls will never learn to read or write. The advent of technology has the potential to mitigate some of these issues faced by women and girls however it was also acknowledged that there are significant barriers faced by women and girls to experience the full benefits of technology so much so that technology itself could enlarge the gender inequality gap. Women and girls worldwide are less likely to use digital tools in their personal lives, education or in business. As our daily lives become digitalised, women and girls will be left behind if nothing was done to ensure that they too could capitalise on the available technology. The COVID-19 pandemic highlighted already existing gaps between men and women. Education in poorer communities worldwide is deprioritised for girls and this was even more so during the pandemic when girls could not participate in online learning due to the care burden. Today, the absolute gender gap between men and women’s access to technology has increased by 20 million since 2019. Excluding women and girls from digital spaces had cost low- and middle-income countries up to $1 trillion off their GDP. During a plenary session of CSW67, I was reassured by the initiatives and progress made by many countries. Panama had transformed their national digital strategy for rural and indigenous women and introduced a business platform for women with changes to public policy regarding education especially in the early years. Panama was proud to announce that it was chosen as the headquarters of the World Robotics Olympiad 2023. Namibia emphasised that its constitution outlaws discrimination on the basis of sex, and its global alliance to protect children from sexual abuse and exploitation. Timor Leste provides gender-based violence training to journalists, organises programmes for rural women in ICT by educating these women on technology through mobile phones and digital marketing through social media and has scholarships for STEM. Importantly, Burundi reiterates that we cannot turn a blind eye to the fact that technology can be a source of hostility and abuse to women and children. Online spaces can be dangerous for women and girls – they may experience hate speech, gendered misinformation, misinformation, and be prone to grooming sites and be victims of deepfakes and scammers. Therefore, in empowering women in digital spaces, we must also empower women to recognise the pitfalls of technology, abusers of technology and the right course of action should one face abuse. My interest in reproductive health saw me attending the parallel event on Going Digital: Improving Sexual and Reproductive Health Rights and Services for Women and Youth. I agree that sexual reproductive health rights should include a discussion about artificial reproductive technology (ART) to help couples decide if and when to have children. Social attitudes toward ART vary across Asia, and social stigma has decreased. More than 5000 IVF clinics across Asia, with China having approximately 1000 clinics, so there is an unequal distribution and access. There is a multitude of barriers to accessing ART, especially for LGBTQI, low-income, low-education groups. Many are unaware of tools in reproductive technology and there is a lack of access and rights with obsolete laws. For example, in Thailand, only heterosexuals can access surrogacy. ART is largely unregulated as laws focus on clinical applications rather than the ethics of using human genetic materials. This made me reflect on India’s “rent-a-womb” industry.  Since 2022, India has laws banning commercial surrogacy which prohibits surrogates from receiving monetary compensation except for medical and insurance coverage in a bid to prevent further exploitation of women from lower socioeconomic income groups. However non-governmental groups are concerned this would push surrogacy underground. There were also concerns that India’s Assisted Reproductive Technology Act will create further barriers for couples from low-income groups. Additionally, in India, ART is only available to heteronormative couples and single women (widowed/ divorced). In Malaysia, where I am from, there are no specific laws or regulations for ART, however, guidelines are produced by the Ministry of Health and Malaysian Medical Council which stipulated that ART can only be done in general hospitals or specialised centres. The National Council of Islamic Religious Affairs had issued a fatwa prohibiting surrogacy for Muslims – but I digress. The overturned of Roe versus Wade in the USA is another worrying trend that was discussed during this session. However, there is also reassuring news regarding abortion care for women worldwide, with the landmark legalisation of abortion in Argentina and the use of teleconsultation through phone calls and WhatsApp for abortion. The success of teleconsultation for abortion was supported by a Lancet study which showed that “self-managed medication abortion with accompaniment group support is highly effective and for pregnancies less than 9 weeks gestation, is non-inferior to the effectiveness of clinician-managed medication abortion administered in a clinical setting”. There was a sound commitment from African governments to end FGM (female genital mutilation) and child marriage during the “Harmful practices: catalyzing innovation to end female genital mutilation and child marriage.” However, as an advocate of ending FGM in Malaysia, I was disappointed to hear little to nothing about the current situation regarding FGM and child marriage in Southeast Asia and Malaysia. Finally, one of the side events that struck me most was an event by Career Girls, a non-profit organisation that aims to provide girls around the world access to role models and diverse career choices. Only 22% of Africa has access to the internet, and internet access is expensive. Therefore, solutions to ensuring access to education must not be dependent on internet connectivity or the power grid. Career Girls employed the Rachel Plus (Remote Area Community Hotspot for Education and Learning) by World Possible, to allow students in areas of poor internet connectivity to access Career Girls website and online tools offline. Rachel Plus has 500 GB storage, has 5 hours plus battery life and allows 20-50 users on its platform which updates if plugged into the internet. I am inspired by how this technology had mitigated the connectivity issues faced by students in rural areas and allow them the same educational opportunities as their urban and richer counterparts. Overall, CSW67 has been an enlightening and educational experience for me. There are many other sessions that I wished I had the opportunity to attend if not for the time difference and my clinical workload. It was a great opportunity to not only learn from the sessions but to also network with like-minded individuals and experts. My main takeaway messages/ thoughts Involving women through all stages of decision-making process in the creation and use of technology is essential to reduce bias. AI and machine learning algorithms that do not include women may introduce the biases of its creator as we can see in the different diagnoses for women and men who suffer from chest pain by the Babylon app. Technology can be used to spread medical misinformation – health literacy should accompany digital literacy. If everyone has some basic knowledge about their own bodies and health and take responsibility of their own health, we can all fight misinformation. Too many women have undergone unnecessary surgeries for the perfect looking vulva, as an example. Digital equity should be solved in a multistakeholder approach. Governments and non-governmental bodies/ non-profit organisations should work hand-in-hand to decrease the gender digital gap. Related posts: Female Circumcision is Unnecessary: Girls are Perfect as They Are International Women’s Day | Royal Commonwealth Society Among the Garbage and the Flowers Art Exhibition, Paris from 10th-22nd Oct 2021 Dr. Hannah Nazri’s Recommended Readings on Women | Harvard Public Health Review Malaysia: FGM/C, Period Spot Checks, and Sexual Harassment | Harvard Public Health Review Maintaining Boundaries as Women in Leadership: Oh it is so difficult to be a career woman! Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
11 April 2023Kita mempunyai tanggungjawab untuk mewujudkan dunia yang lebih selamat untuk anak-anak perempuan kita, dengan memberi autonomi ke atas badan mereka. *Artikel ini pertama kali disiarkan dalam Bahasa Melayu di Ova Health. Artikel original dalam Bahasa Inggeris boleh didapati di sini. Imej oleh 이룬봉 dari Pixabay. Tidak terlalu baru-baru ini, sunat perempuan menjadi perhatian rakyat Malaysia apabila pakar bedah popular Malaysia yang berpangkalan di United Kingdom, Dr Amalina Bakri, membidas suara-suara sumbang terhadap keputusannya untuk tidak menyunatkan anak perempuannya yang baru lahir. Topik ini menjadi perbualan hangat di kalangan netizen-netizen dengan komen-komen yang tidak enak mengenai seksualiti kanak-kanak perempuan. Semasa kecil, saya telah menyaksikan saudara-mara wanita mengalami sunat perempuan, tetapi saya hanya mula memahami kesan pencacatan/ pemotongan alat kelamin wanita (FGM/C) sebagai wanita dewasa, setelah mendalami kesannya terhadap wanita dalam komuniti-komuniti di seluruh dunia termasuk komuniti saya sendiri. Apakah Sunat Perempuan? Pencacatan / pemotongan alat kelamin wanita atau sunat perempuan (FGM/C) adalah isu hak asasi manusia yang melibatkan golongan wanita dan gadis di seluruh dunia. Bergantung pada tempat seorang gadis dilahirkan dan tinggal, dia boleh dikenakan salah satu daripada empat jenis FGM/C seperti yang diklasifikasi oleh Pertubuhan Kesihatan Sedunia (WHO). Rajah 1: Klasifikasi WHO bagi Pencacatan/ Pemotongan Alat Kelamin Wanita (FGM/C), yang diambil daripada “Ending FGC: A Toolkit for Engaging Practitioners” oleh Asia Network to End FGM/C. Jenis 1 (Klitoridektomi): Pembuangan separa atau menyeluruh klitoris luaran dan/atau pembuangan hud klitoris.Jenis 2 (Pemotongan): Pembuangan separa atau menyeluruh klitoris luaran dan labia minora (labia dalaman yang mengelilingi faraj) dan/ atau pembuangan labia majora (labia luaran).Jenis 3 (Infibulasi): Pemotongan dan membawa bersama labia minora dan/ atau labia majora untuk membuat ruangan yang sempit untuk saluran faraj.Jenis 4 (Pelbagai prosedur lain yang memudaratkan): Ini termasuklah menindik, menoreh, mengikis, membakar, dan menusuk alat kelamin wanita tanpa sebab kesihatan. Di Malaysia, sunat perempuan diamalkan oleh orang Melayu Islam, dan amalan ini rata-ratanya melibatkan penjaruman atau penusukan hud/ kelenjar klitoris (klitoris luaran) (Rajah 1 dan 2) (Jenis 4). Rakyat Malaysia hanya mengaitkan FGM/C jenis 1, 2, dan 3 dengan amalan ngeri yang dilakukan di benua Afrika yang telah menyebabkan kematian dan bukannya dengan sunat perempuan di Malaysia, kerana tiada kematian atau kesan buruk jangka panjang terhadap kesihatan wanita direkodkan dengan amalan sunat perempuan Malaysia. Walau bagaimanapun, baru-baru ini, jenis 1 FGM/C juga telah dilaporkan dengan pembuangan tisu kecil hud/ kelenjar klitoris oleh doktor-doktor Islam Malaysia yang tertentu. Mengapa Perlu Menyunatkan Bayi Perempuan? Rajah 2: Anatomi klitoris dan vulva (istilah untuk alat kelamin wanita luaran) oleh Sydney F Harris. Diambil daripada penerbitan saintifik oleh Dubinskaya et al. (2021). Hud klitoris adalah kulit yang melitupi kelenjar klitoris. Di Malaysia, ibu bapa menyunatkan anak perempuan mereka kerana tradisi dan kepercayaan agama yang salah (mempercayai bahawa amalan ini adalah wajib dalam Islam), serta kepercayaan bahawa tiada kemudaratan kesihatan amalan ini terhadap anak-anak perempuan mereka. Bidan tradisional yang melakukan amalan ini mengatakan sunat perempuan menghalang wanita daripada menjadi “liar”. Sunat perempuan selalunya dilakukan untuk meraikan kelahiran bayi perempuan. Ibu bapa sememangnya tidak berniat untuk mencederakan anak-anak mereka, dan benar-benar percaya sunat perempuan boleh meningkatkan rohani atau spiritualiti anak perempuan mereka. Walau bagaimanapun, amalan ini berakar umbi dalam kepercayaan yang bermasalah kerana ia membawa implikasi bahawa kanak-kanak perempuan dan wanita tidak mampu mengawal rangsangan seksual mereka, and langkah-langkah yang drastik perlu diambil. Mitos Tentang Sunat Perempuan Sunat Perempuan Adalah Satu Keperluan Sejagat Dalam Islam Di Malaysia, terdapat fatwa-fatwa yang berbeza mengenai sunat perempuan. Pejabat Mufti Wilayah Persekutuan Malaysia mengatakan bahawa sunat perempuan adalah wajib, dan memberikan garis panduan untuk hanya “mengemas” atau “menipiskan” hud klitoris, dan tidak sekali-kali dengan cara yang dikira sebagai pencacatan yang merosakkan klitoris seperti FGM/C. Walau bagaimanapun, Jabatan Mufti Negeri Perlis berpendapat bahawa sunat perempuan hanya perlu dilakukan selepas perbincangan dengan pakar-pakar kesihatan jika ada keperluan, dan tiada bukti wanita yang tidak disunat mempunyai dorongan seksual yang berlebihan. Di peringkat antarabangsa, Mufti Besar Mesir, salah satu pihak berkuasa yang tertinggi dalam Islam, mengisytiharkan bahawa sunat perempuan adalah dilarang dalam Islam. Pemeliharaan Budaya Terdapat satu tanggapan bahawa penentangan amalan sunat perempuan dan FGM/C oleh badan-badan bukan kerajaan dan masyarakat sivil adalah satu bentuk penjajahan baru oleh Barat, dan dilihat sebagai satu cara untuk orang luar untuk mengehadkan hak kita untuk mengamalkan budaya dan tradisi kita. Walau bagaimanapun, FGM/C diamalkan secara global tanpa mengira agama atau budaya: Jenis 1 FGM/C (klitoridektomi) telah diamalkan pada zaman Victoria di Britain untuk merawat “mania” atau “histeria” atau kemurungan wanita. Walaupun kurang diamalkan berbanding di Asia dan Afrika, FGM/C tanpa persetujuan masih diamalkan di Barat pada tahun 1950-an. Tambah lagi, adakah pembedahan kosmetik alat kelamin wanita (FGCS) seperti labiaplasti, satu bentuk FGM/C yang boleh diterima di Barat? Apabila membandingkan FGCS dan FGM/C, konsep persetujuan adalah penting. Seorang bayi perempuan berusia 6 bulan tidak boleh memberi persetujuan untuk sunat perempuan, manakala seorang wanita dewasa boleh memberi persetujuan untuk menjalani FGCS. Akan tetapi, adakah persetujuan yang diberi oleh seorang wanita dewasa untuk FGCS benar-benar maklum (informed consent) jika terdapat tekanan masyarakat untuk mempunyai bentuk vulva yang “sempurna”? Tidak ada satu bentuk vulva yang boleh diiktiraf sebagai sempurna. Sebaliknya, terdapat pelbagai bentuk vulva yang semuanya adalah sempurna. Namun, ramai wanita sanggup meletakkan badan mereka dibawah bius untuk ditidurkan bagi menjalani FGCS. Semua jenis pembedahan terutamanya pembedahan dengan bius untuk ditidurkan mempunyai pelbagai komplikasi. Perspektif Perubatan Tentang Sunat Perempuan Rangsangan seksual (libido) didorong oleh apa yang berlaku di dalam otak dan faktor-faktor lain termasuk hubungan seseorang dengan pasangan mereka, jadi dakwaan bahawa gadis atau wanita akan menjadi makhluk seksual yang liar tanpa sunat perempuan adalah tidak benar. Penjaruman, penusukan, atau pembuangan hud/ kelenjar klitoris mungkin tidak memberi kesan terhadap libido seorang wanita, namun sunat perempuan boleh menjejaskan keupayaan seseorang untuk mengalami orgasme. Namun, kajian perlu dilakukan untuk lebih memahami kesan sunat perempuan Malaysia dan disfungsi seksual wanita. Saya ingin menegaskan bahawa tidak ada faedah perubatan untuk melakukan sunat perempuan. Ketiadaan faedah perubatan harus menghalang mana-mana professional kesihatan daripada melakukan sunat perempuan. Di Malaysia, 20.5 peratus doktor Islam Malaysia mengaku melakukan penjaruman atau penusukan klitoris, dengan sebilangan kecil mengaku memotong klitoris (jenis 1 FGM/C). Purata panjang hud/ kelenjar klitoris (klitoris luaran) untuk bayi perempuan baru lahir adalah 0.67 ± 1.6 cm dalam satu kajian. Dalam kajian lain yang melihat pada kanak-kanak perempuan berumur 0 hingga 3 tahun, hud/ kelenjar klitoris adalah 0.87 cm dengan hud klitoris terpaut kuat pada kelenjar bayi perempuan baru lahir dan menjadi kurang terpaut apabila usia meningkat. Oleh itu, adalah amat sukar untuk memisahkan hud klitoris dari kelenjar klitoris untuk melakukan sunat perempuan dengan “selamat” seperti yang dicadangkan oleh Pejabat Mufti Wilayah Persekutuan Malaysia. Badan klitoris (termasuklah hud/ kelenjar klitoris) (Rajah 2) boleh membesar sehingga 3.7 cm dengan saraf dorsal klitoris dalam lingkungan 0.6 cm dari kelenjar klitoris di wanita dewasa. Purata bilangan serabut saraf dalam saraf dorsal klitoris di wanita dewasa adalah 10,281 serabut saraf. Bayangkan kesakitan yang teramat dialami oleh bayi perempuan yang disunatkan! Kesimpulannya, pemotongan klitoris yang sedikit sebenarnya adalah pemotongan yang banyak, kerana para doktor memotong tisu yang boleh membesar. Sunat perempuan boleh menyebabkan ketidakpuasan seksual di kemudian hari, disebabkan ketidakupayaan untuk mengalami orgasme dengan secukupnya, dan boleh membawa kepada masalah perkahwinan dan ketidakharmonian keluarga. Sunat perempuan bukan prosedur perubatan. Ia tidak diajar di sekolah perubatan di mana-mana seluruh dunia, jadi para doktor tidak sepatutnya melaksanakannya. Bagaimana Kita Boleh Menamatkan Sunat Perempuan? Kenalpasti Sebab-Sebab Di Sebalik Amalan Ini Kebanyakan amalan FGM/ C berakar umbi dalam pengawalan badan wanita, tetapi ia adalah kompleks dan tidak boleh ditangani dengan satu penyelesaian. Kita harus sentiasa ingat bahawa ibu bapa tidak ingin mencederakan anak-anak mereka. Tidak memahami kerumitan FGM/C, boleh membawa kepada isu-isu perkauman dan etnosentrisme. Kenali Dan Hormati Pandangan-Pandangan Yang Berbeza Daripada menetapkan sebarang tindakan yang tegar dan dogmatik, kita harus mengemukakan fakta-fakta tentang sunat perempuan kepada ibu bapa dan profesional kesihatan dengan penekanan kepada autonomi dan kesihatan anak-anak kita. Adakah ibu bapa patut memberi persetujuan untuk prosedur yang tidak mempunyai faedah perubatan? Adakah ibu bapa mempunyai hak milik tunggal ke atas badan anak-anak mereka? Ini adalah soalan-soalan yang perlu dikemukakan dan difikirkan secara mendalam. Pendidikan Harus Ditekankan Pendidikan seksualiti yang menyeluruh, yang meliputi sunat perempuan dan FGM/C di samping pendidikan tentang persetujuan dan keselamatan seksual perlu diperkenalkan di sekolah-sekolah. Kita mempunyai tanggungjawab untuk mewujudkan dunia yang lebih selamat untuk anak-anak perempuan kita, dengan memberi autonomi ke atas badan mereka. Untuk belajar lebih lanjut: Malaysian Doctors for Women and Children Rangkaian Asia untuk Menamatkan FGM/C Related posts: Female Circumcision is Unnecessary: Girls are Perfect as They Are A Medical Practitioner’s Toolkit to Ending FGM/C Suara Empuan: Terpaksa Berlapar Kerana Miskin Haid, Apa Kata Doktor | Peduli Merah Suara Empuan: Sanggup Mengandung Elak Datang Bulan, Apa Kata Doktor | Peduli Merah Malaysia: FGM/C, Period Spot Checks, and Sexual harassment | Harvard Public Health Review Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
2 April 2023An article written for a non-profit that sadly did not pass internal checks as this article may cause disharmony between neighbouring countries in Southeast Asia, so I have published it here! Featured image by Deon Black on Unsplash. Cited in ARROW / Orchid Project’s “Country Profile: FGC in Malaysia” (March 2024). Not too recently, female circumcision came to Malaysians’ attention when popular Malaysian UK-based surgeon, Dr Amalina Bakri, spoke out against the backlash at her decision to not circumcise her newborn daughter. The conversation online quickly grew heated and — perhaps unsurprisingly — ugly in parts, with comments revealing disturbing attitudes towards sexualising women and girls. As a child, I witnessed female relatives being circumcised, but the impact of female genital mutilation/cutting (FGM/C) only hit later in life, as I understood more about what it meant to women in communities around the world including my own. What is female circumcision? Female genital mutilation/cutting or circumcision (FGM/C) is a human rights issue that affects women and girls globally. Depending on where a girl is born and lives, she could be subject to one of four main types of FGM/C  as defined by the World Health Organisation. Figure 1 – WHO Classification of Female Genital Mutilation (FGM/C), taken from “Ending FGC: A Toolkit for Engaging Practitioners” by the Asia Network to End FGM/C In Malaysia, female circumcision is practised mainly by Malay Muslims and is known as sunat perempuan, and it mostly involves needling or pricking the clitoral hood/ glans (the external clitoris) (Figures 1 and 2) (Type 4). The Malaysian mindset associates FGM/C with types 1, 2, and 3 – the horrific practices that are/ were done in the African continent that had caused death, and not the Malaysian female circumcision as no deaths or long-term adverse effects on women’s health have been recorded. However, recently, type 1 FGM/C has also been reported with the removal of a small tissue of the clitoral hood/ glans by certain Malaysian Muslim doctors. Why circumcise a baby girl? Figure 2: Anatomy of the clitoris and vulva by Sydney F Harris. Taken from a scientific publication by Dubinskaya et al. (2021). In Malaysia, parents may want to circumcise their daughters due to tradition and erroneous religious beliefs (believing it mandatory in Islam) backed by the perceived lack of harm to their daughters. Traditional midwives who perform this practice say female circumcision prevents women from becoming “wild” or promiscuous. Female circumcision may take place during celebratory events to commemorate the birth of the baby girl. They certainly have no intention of harming their children, and truly believe it enhances their daughters spiritually. However, the practice has roots in the problematic belief that girls and women do not have control over their sexual drives, requiring extreme measures to be taken. Myths about female circumcision It’s a universal Islamic requirement In Malaysia, there are differing fatwas, or Islamic rulings, on female circumcision. The Malaysian Federal Mufti Office (Islamic directorate) says that it is compulsory, and gives guidelines to only remove the clitoral hood, and never in a way that counts as “mutilation.” However, the Mufti Department of Perlis State, Malaysia argues that female circumcision should only be done after discussions with experts if there is a need and that there is no evidence that women who are not circumcised have excessive sexual libido. Internationally, the Grand Mufti of Egypt, considered to be one of the highest authorities in Islam, declared that female circumcision is forbidden in Islam. Preservation of culture There is this idea that FGM/C advocacy has colonial roots, and is seen as a way for outsiders to limit the right to exercise one’s culture and tradition. However, FGM/C is practised globally regardless of religion or culture: Type 1 FGM/C (clitoridectomy) was practised in Victorian Britain to treat “mania” or “hysteria” or depression in women. Though less common than in Asia and Africa, FGM/C without consent was still practised in the West in the 1950s. Arguably, is female genital cosmetic surgery (FGCS) such as labiaplasty a socially acceptable form of FGM/C in the West? When comparing FGCS and FGM/C, the concept of consent is an important one. A 6-month-old baby girl is not able to consent to female circumcision, whereas an adult woman can consent to undergo FGCS. But is consent truly informed where there is societal pressure for the perfect-looking vulva? There is no such thing as the perfect-looking vulva and many women put their bodies under unnecessary danger and stress under general anaesthesia when they undergo FGCS. Any surgical procedure, including FGCS, is not without complications. A medical perspective on female circumcision Sexual drive (libido) is driven by what happens in the brain and other factors including one’s relationship with their partner, so the assertion that girls or women will be wild and unsatiated sexual beings without female circumcision is simply not true. However, while needling, pricking or nicking the clitoral hood/ glans may not impact one’s libido, it may impact one’s ability to experience orgasm. More studies need to be done to look into the Malaysian female circumcision and female sexual dysfunction. I would like to emphasise that there is no medical benefit to performing female circumcision. The lack of documented medical benefit in needling, pricking, or nicking the clitoris should deter any healthcare professional from performing the procedure. In Malaysia, 20.5% of Malaysian Muslim doctors admitted to needling or pricking the clitoris, with a small number admitting to cutting the clitoris (type 1 FGM/C). The mean clitoral hood/ glans (the external clitoris) length of female newborns is 0.67 ± 1.6 cm in a study. In another study looking at 0 to 3-year-old girls, the clitoral hood/ glans length is 0.87 cm with the clitoral hood highly adherent to the glans in newborns and becoming more retractile as age increases. Thus in female infants, it can be difficult to retract the clitoral hood from its glans to “safely” perform needling or pricking the clitoral hood separate from the actual tissue as suggested by the Malaysian Federal Mufti Office (Islamic directorate). The clitoral body (including hood and glans) (Figure 2) can grow up to 3.7 cm with the clitoral dorsal nerves within 0.6 cm of the clitoral glans in a female adult. The mean number of nerve fibres in those dorsal nerves in adults is 10,281 nerve fibres. Imagine the immense pain inflicted on the female infant undergoing female circumcision! A little cut may be too much, as doctors are cutting growing tissue that could lead to sexual dissatisfaction later in life, due to the inability to experience orgasm adequately, which can lead to marital issues and family disharmony. Female circumcision is not a medical procedure. It is not taught in medical schools anywhere, so doctors should not be performing them. How can we end female circumcision? Acknowledge the reasons behind these practices. Much of FGM/C is rooted in control of women’s bodies, but they are complex and cannot be addressed with a single solution. We must always remember that parents do not wish to harm their children. Not understanding the complexity of FGM/C, can lead to racial biases and ethnocentrism.  Recognise and respect different perspectives. Rather than prescribing a course of action, we should present parents and healthcare professionals with the facts with an emphasis on the autonomy and health of our children. Should parents be able to consent to procedures that have no medical benefit? Do parents have sole ownership over the bodies of their children?  Emphasise education. Comprehensive sexuality education, which covers female circumcision and FGM/C on top of sexual consent and safety, needs to be introduced in schools.  We need to create a safer world for our girls, and giving them agency over their bodies is a necessary step. To learn more: Malaysian Doctors for Women & Children Asia Network to End FGM/C Related posts: A Medical Practitioner’s Toolkit to Ending FGM/C Suara Empuan: Terpaksa Berlapar Kerana Miskin Haid, Apa Kata Doktor | Peduli Merah Suara Empuan: Sanggup Mengandung Elak Datang Bulan, Apa Kata Doktor | Peduli Merah Malaysia: FGM/C, Period Spot Checks, and Sexual Harassment | Harvard Public Health Review Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
8 March 2023First published on the Royal Commonwealth Society (RCS) website on 8th March 2023. Leading up to the International Women’s Day 2023, I had the wonderful opportunity to catch up with three amazing women: Associate Fellows of the Royal Commonwealth Society, Christina Dymioti and Valentina Hynes, and a member of the Royal Commonwealth Society Gibraltar Branch, Denise Matthews. I hope you will be inspired by their breadth of experience, passion for community empowerment and success. From left to right: Valentina Hynes, Denise Matthews, and Christina Dymioti. Tell us about yourself and your work. Christina Dymioti (CD): I am the director of Fashion Heritage Network Cyprus, a project I developed through my participation in Royal Commonwealth Society-Clarions Futures Youth Exchange Programme between Cyprus and UK. We work with a growing inter-communal group of young Cypriots, especially fashion designers who aspire to promote Cypriot heritage through sustainable fashion. Our work is showcased through fashion exhibitions, fashion shows, workshops, and participation in various local and international cultural events. Valentina Hynes (VH): I am the founder and CEO of SVH Inc. CIC – which are acronyms for Strong Vibrant, Happy, and Incorporated. SVH Inc. provides workplace wellbeing solutions for organisations as part of their employee onboarding, employee experience management and transformation process through mental health training and workshops, speaking engagements and away day experiences. As a specialist in wellbeing and happiness at work, I see myself as a connector who helps people build bridges from diversity to inclusion, from poor mental health to happiness, and disengagement to engagement. Denise Matthews (DM): I come from a fiercely entrepreneurial family. My entrepreneurial journey started at the age of 22, when I launched my first company in PR and promotional work. After taking time out to start a family and living abroad, I returned to Gibraltar in 2016 to set up One Media and Events. I also became an award-winning City Chapter Director for the global organisation, Startup Grind (SG). For over two decades, I have been dedicated in launching successful business events in the local community to foster entrepreneurship, advocate for social responsibility, and leverage networks to achieve exposure for Gibraltar. Valentina Hynes is a mental health first aid instructor, an accredited and certified DiSC psychometric profiler, an author, speaker and an Associate Fellow of The Royal Commonwealth Society. How do you promote gender equity in your personal lives and at your workplace? VH: Being the eldest of four children in an African family, especially amongst the Igbos of Nigeria, gender equity is very much part of the culture. I was brought feeling empowered to not only dream big, but to work hard. This upbringing shaped my unique view of the world. If you can dream it, you can achieve it. If you support the girl child and woman, you empower progress and wealth. I am proud that my organisation is 80% is female-led. I also teach my boys that equity is not about giving equal opportunities to everyone, but meeting people at their level, and providing them the necessary resources to level up. DM: Being an example for change and challenging gender stereotypes and biases is part of my day-to-day life, personally and professionally. I will find ways to encourage and support women and gender minorities to achieve their goals and ambitions, also by supporting women-owned businesses and organisations. It is a requirement that the events we host are inclusive and accessible to all, regardless of gender or other characteristics, and ensure that our discussions include advocating for diversity in hiring practices, offering flexible work arrangements and are family friendly. Denise Matthews won the 2018 “Rookie of the Year” Award in San Francisco during the director’s retreat organised at the SG Global Conference for being the best new chapter in a city with a population of only thirty thousand. In February 2020, at the SG Global Director’s Retreat event in San Francisco, again Denise picked up four awards including Director of the Year won for the first time by a female director from a total of 600 other city chapters worldwide. How do you think the Commonwealth can play a role in promoting gender equity? CD: The Commonwealth is a great platform to raise awareness, advocate for change, and facilitate collaborations with civil society organisations and stakeholders across member countries. As a social entrepreneur, I believe more funding should be provided for young women’s projects. Investing in young women empowers them to take charge of their lives and to become changemakers in their communities. Supporting their projects is a powerful way to address the structural and cultural barriers that prevent them from achieving their full potential. DM: The Commonwealth is a diverse community of nations with a shared commitment to democracy and human rights. It has the potential to be a powerful force of change and can leverage its unique position to advocate for gender equity on a global scale by ensuring the participation of women from all spheres of life in decision-making processes and campaigning for gender equitable and sustainable international policies. Christina Dymioti is an active member of the Greek & Cypriot diaspora community in the UK. She is a member of the Greek Orthodox Community of Sheffield, the NEPOMAK UK and the Local Conference of Youth on Climate Change in Cyprus. Promoting gender equity is a top priority for her in her personal life and in the various organisations she is involved in. If you have a magic wand, what would you wish for the next generation of girls and women? VH: I would remove travel barriers for girls and women, affording them opportunities to experience the world, so they grow exponentially in a multi-dimensional way. When people are exposed to different cultures and societies, they become empowered. Developing and supporting exchange programmes ranging from fashion design, music, tech, literature etc. would empower more women to aspire for more and to pay it forward. CD: To live in a world where gender equality is the norm, where girls and women have the same access to education, healthcare, and job opportunities as their male counterparts. I wish for girls and women to have a stronger voice in their communities, to be able to participate fully in decision-making processes and have their opinions and ideas taken seriously. Society benefits when women are empowered to lead and contribute to their communities. DM: Equal access to education, healthcare, safe and supportive environments, equal pay for equal work, representation in leadership positions. Also, women tend to put our needs last, however, you must take good care of yourself first because you will be better at meeting the needs of others with good mental health. Lastly, I wish for strong body image positivity and self-love. One piece of advice to younger girls and women Finally, all three advised the importance of believing in oneself, surrounding oneself with positive influences, and to be fearless in taking on challenges. Denise Matthews also advised to see challenges as opportunities to learn and grow; to become an even stronger and more resilient version of oneself. Valentina Hynes advised to not limit one’s growth to one aspect, to try “a little bit of this, a little bit of that, until you find your own purpose”. Christian Dymioti emphasised the importance of keeping pushing forward and never give up, as well as staying true to oneself and values, and never let anyone feel like you’re not capable of greatness. Related posts: International Women’s Day: RCS Europe | Royal Commonwealth Society Among the Garbage and the Flowers art exhibition, Paris from 10th-22nd Oct 2021 How Hubris and Misogyny Affect Patient Care | Harvard Public Health Review Countering Everyday Extremism Against Women: The Other Pandemic Maintaining Boundaries As Women In Leadership: Oh It Is So Difficult To Be A Career Woman! International Women’s Day 2019: Four Inspirational Women in Science | Royal Commonwealth Society Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
26 November 2022As part of the 16 days of activism, the Asia Network to End FGM/C (female genital mutilation/ cutting) has released two toolkits, one of which is a toolkit I had written for activists and civil society organisations who need to engage with healthcare professionals to end FGM/C in Asia. This is a great start for laypersons to understand the health implications of FGM/C, its medicalisation, and the different practices of FGM/C and its subtypes in Asia. It also includes strategies to communicate with healthcare professionals as well as contentious areas of debate within the FGM/C discourse. We need to understand that FGM/C is not restricted to a particular culture, religion, or geographical location, but a universal phenomenon of misogyny and act of violence against women and girls. Powered By EmbedPress Related posts: Malaysia: FGM/C, Period Spot Checks, and Sexual Harassment | Harvard Public Health Review How Hubris and Misogyny Affect Patient Care | Harvard Public Health Review Countering Everyday Extremism Against Women: The Other Pandemic Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
8 March 2022First published on the Royal Commonwealth Society (RCS) website on 8th March 2022. As the RCS Working Group Lead for Equality in Europe I believe that we should recognise the contributions and achievements of women* every day. Nonetheless, structural and individual discrimination prevents and impedes women from achieving their full potential. Not one country can claim that they have achieved gender parity. Discrimination, bias and stereotypes are pervasive in all parts of a woman’s life since birth; whether it is through the lack of support to pursue one’s interest in education and a career, unequal pay, as well as the lack of funding of women’s health research, and society’s desensitisation towards women’s pain and suffering. It is important to acknowledge the intersectionality of race, culture and socio-economic factors to understand gender issues. International Women’s Day grew out of the efforts to promote the rights of women and is celebrated annually on 8th March to celebrate the achievements of women today and throughout history, as well as recognising the biases and stereotypes that women face. This year’s International Women’s Day themes are #BreaktheBias (International Women’s Day) and ‘Gender equality today for a sustainable tomorrow’ (United Nations). Today, I ask three inspirational women from RCS Branches within Europe to speak about their own achievements and experiences in navigating an unequal world. *Please note that I use an inclusive definition of “woman” that includes anyone who identifies partly or wholly as a woman, transfeminine, or is otherwise significantly female-identified. Professor Daniella Tilbury Daniella is an academic leader and change-maker in sustainable development credited with having developed the initial frameworks for this area of learning. She serves as the Regional Co-ordinator, Europe for the Royal Commonwealth Society and an executive member of RCS Gibraltar. Powered By EmbedPress Shefali Verma Shefali is the Vice Chairman of the RCS Wales Branch and is actively involved in non-profit work to support women suffering from domestic abuse and slavery in the UK. Powered By EmbedPress Francesca Makey Francesca is the Literary Lead of the RCS Gibraltar Branch, a secondary English teacher and a cancer survivor. She is a passionate advocate of women’s health. Powered By EmbedPress Related posts: Among the Garbage and the Flowers art exhibition, Paris from 10th-22nd Oct 2021 How Hubris and Misogyny Affect Patient Care | Harvard Public Health Review Countering Everyday Extremism Against Women: The Other Pandemic Maintaining Boundaries As Women In Leadership: Oh It Is So Difficult To Be A Career Woman! International Women’s Day 2019: Four Inspirational Women in Science | Royal Commonwealth Society Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
11 February 2022First published on 8th February 2022 for Lebanon, Issue 1 of The Clarendon Collective (now defunct). “A Picnic by the Sea” is part of my ongoing effort to explore the intersections of memory, identity, and displacement. Where my professional writing often addresses systemic issues in healthcare and equity, my poetry allows me to capture the unspoken moments of fragility, resilience, and the quiet weight of lived experience. This poem draws on the intimacy of childhood memory and the dissonance of crisis, placing the tenderness of belonging alongside the precarity of exile. It is a meditation on how joy and fear can coexist, and how the sea – often a place of leisure – can also become a site of peril and survival. In conversation with my other reflections on independence, heritage, and belonging, this piece expands my writing into the emotional and symbolic, offering another way of bearing witness to resilience in the face of uncertainty. In those years, when Papa and Mama took her to the sea To collect seashells, to build sandcastles, to spend time with her As the scintillating jewel in the heavens shone its mighty rays over the Mediterranean Sea Whose gentle waves rippled and glistened invitingly Beckoning the children to bathe in its cooling waters till they were cold and wrinkly… There would be food so delicious that Mama always brought Of dolma, labeneh, hummus with tahini Grilled Mana’eesh with Za’atar, salata addas and baklava, too sweet to eat! In those years, when Papa and Mama took her to the sea To play ball, to play Frisbee, to be together The fiery orb amicably flicked its flaming fingers over the Mediterranean Sea Whose welcoming waves ambled back and forth temptingly Beckoning the children to bathe in its cooling waters till they were cold and wrinkly… There would always be delicious food that Mama brought… Ah memories! What an extravagant, nonsensical thought In this tumultuous conflict Between human lives and the wrathful vengeance of Neptune. As a giant lump rises in her throat, tears trickling down her cheeks, her tired legs kicking wildly to keep afloat In the furious waves, as if emboldened by the chants of hatred and despair Don’t bring any more of those home, we’re full up She clings desperately to the boat only to be flung into the bowels of the Channel As seawater filled her lungs, she gasped Mama! Sabin, L. (2021, December 1). ‘Group of Hastings fishermen block RNLI lifeboat crew’ from helping migrants at sea. The Independent. https://www.independent.co.uk/news/uk/home-news/fishermen-rnli-crew-migrants-rescue-hastings-b1966959.html Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
29 January 2022An interview by Syiffa Rosman of Peduli Merah for Suara Empuan series on the topic of starvation to prevent periods due to period poverty (kemiskinan haid). The article was first published on 25th January 2022 in Bahasa Melayu (Malay Language) here. Republished on this website with permission. Suara Empuan merupakan siri wawancara oleh Peduli Merah bertujuan mengangkat pengalaman perempuan yang sering diremehkan. Moga siri ini dapat memberikan keberanian dan maklumat asas kesihatan kepada pembaca. Ikuti siri wawancara bersama Dr Hannah Nazri mengenai kemiskinan haid. Peduli Merah: Kami ingin dapatkan pendapat Dr Hannah berkenaan isu kemiskinan haid di mana ada kes-kes wanita yang memilih untuk mengandung bagi mengelak kitaran haid. Adakah ini suatu senario yang sihat? Jika Dr Hannah ada nasihat dan saranan tentang isu ini boleh kongsikan kepada kami? Dr Hannah: Ini juga adalah keputusan yang ekstrem dan bukan senario yang sihat. Bayangkan, wanita tersebut sanggup mengalami kehamilan, yang seperti saya tegaskan, meletakkan stres fisiologi tambahan kepada badan mereka. Ini juga membuktikan persepsi rumahtangga tersebut yang lebih menjurus kepada pemikiran bahawa produk-produk sanitari bukanlah satu keperluan dan hanyalah masalah wanita. Persepsi ini adalah anti-wanita. Tambah lagi, wanita yang hamil perlu mendapatkan penjagaan perubatan yang optimal untuk kesihatan ibu dan anak. Ini boleh meletakkan tekanan berlebihan kepada keluarga tersebut dari segi masa dan kewangan dalam jangka masa terdekat dan panjang. Pada pendapat saya, anak yang dilahirkan ke dunia ini sepatutnya adalah kerana mereka dikehendaki oleh ibu bapa mereka tanpa sebab lain, bukan untuk menyelesaikan masalah keluarga. Sebenarnya, terdapat pelbagai alternatif produk-produk haid seperti menstrual cup yang boleh menjimatkan wang kerana ini boleh diguna pakai berkali-kali buat jangka masa yang panjang. Namun, bukan semua wanita selesa dengan anatomi masing-masing dan ada situasi-situasi di mana menstrual cup tidak sesuai buat wanita tersebut. Kos untuk membeli menstrual cup juga mungkin menjadi penghalang. Jika sebuah keluarga mempunyai pendapatan isi rumah yang rendah, umpamanya, <RM 2500 (golongan B40), dan pengeluaran kewangan yang tinggi untuk membayar sewa, kereta dan pelbagai keperluan lain seperti makanan, susu untuk anak, tadika dan sebagainya berjumlah rata-rata >RM2,300 di Kuala Lumpur, membeli menstrual cup yang rata-rata berharga RM100-200, walaupun sekali, bukanlah satu prioriti. Selain dari menstrual cup, terdapat juga pad sanitari yang diperbuat dari kain yang mungkin lebih sesuai untuk golongan yang berpendapatan rendah. Namun, kita tidak harus membuat andaian tersendiri mengapa pad sanitari kain bukan pilihan yang popular untuk golongan ini tanpa menyelidik faktor-faktor budaya dan sosial. Sekali lagi, saya ingin tegaskan, kerajaan haruslah menjadi lebih proaktif dalam menangani kemiskinan haid. Kita tidak boleh bergantung kepada badan-badan NGO untuk menyelesaikan masalah ini. Peduli Merah: Berkenaan pengurusan sanitari pula, ada sesetengah wanita memilih untuk memakai pad atau produk sanitari dalam jangka masa yang lama dan mengabaikan penukaran pad secara berkala. Apakah kesan yang boleh berlaku disebabkan tindakan ini? Dr Hannah: Kelembapan yang terperangkap dalam pad atau produk sanitari adalah tempat pembiakan bakteria dan kulat yang kondusif. Memakai pad untuk jangka masa yang lama boleh menyebabkan jangkitan bakteria dan candidiasis (kulat). Geseran kulit vulva dengan pad yang lembap boleh menyebabkan ruam dan ini boleh menyebabkan anda lebih terdedah kepada jangkitan. Risiko untuk mendapat toxic shock syndrome dari pemakaian pad adalah rendah berbanding dengan pemakaian tampon dan menstrual cup. Toxic shock syndrome, di mana bakteria memasuki peredaran darah dan mengeluarkan toksin, jarang berlaku namun boleh membawa maut.   Oleh itu, saya sarankan wanita supaya menukarkan pad untuk memastikan anda kering sekerap mungkin. Ini bergantung kepada jenis pad dan aliran darah haid. Menukar pad pada setiap 3-4 jam disarankan untuk aliran darah yang tinggi, manakala menukar pad pada setiap 6-8 jam adalah untuk aliran darah biasa. Walaubagaimanapun, jika anda mendapati bahawa anda menukar pad anda setiap 45 minit-1 jam, atau anda mendapati bahawa haid anda mengganggu kehidupan seharian anda, sila rujuk kepada pakar perubatan anda. Nota Editor Nursyuhaidah A Razak Isu kemiskinan haid yang berlaku di Malaysia telah menjejaskan setiap kategori wanita. Menurut artikel dikeluarkan Utusan Malaysia pada Oktober 2021, ada remaja yang pilih untuk mengandung kerana tidak mampu beli tuala wanita. Malah, ketika kempen #PeduliMerah digerakkan oleh Gerak Malaysia pada Disember 2019, saudari Sheyliza mendedahkan kepada Gerak Malaysia ada wanita tanpa kerakyatan di Sandakan sanggup melahirkan anak setiap tahun kerana lebih selesa mengandung supaya tidak perlu menghadapi masalah datang bulan dan menanggung kos bulanan tuala wanita. Saudari Viviantie yang juga sukarelawan aktif dalam membantu komuniti tanpa kerakyatan di Sabah juga mendedahkan perkara yang sama apabila dihubungi Peduli Merah. Sehingga kini, belum ada data kukuh bagi menyokong pendedahan ini. Oleh yang demikian, pihak kerajaan perlu berperanan melakukan siasatan lanjut dan penyelesaian terutamanya di Sabah. Sebelum kita merasakan amat tidak logik pendedahan ini, harus difahami, kebanyakan anak-anak di perkampungan air di Sabah hanya minum air masak bukan susu. Anak-anak tidak dihantar ke sekolah kerana diskriminasi, kebanyakannya bekerja di pasar dan mengambil upah angkat barang. Kemiskinan haid akan memberi kesan jangka masa panjang jika tidak diberi perhatian serius. Bagi mengupas isu ini dengan lebih mendalam, ikuti wawancara Peduli Merah bersama sosiologis Dr Fatimah Al-Attas pada masa akan datang. Artikel wawancara ini tidak dibenarkan sama sekali disiar ulang tanpa kebenaran. Sekiranya anda mengalami masalah kesihatan, disarankan berjumpa doktor dan dapatkan pemeriksaan kesihatan. Oleh: Syiffa Rosman Pewawancara Siri Suara Empuan Peduli Merah. Jika anda mempunyai pengalaman atau pandangan untuk dikongsikan, boleh hubungi pedulimerah@gmail.com Related posts: Suara Empuan: Terpaksa Berlapar Kerana Miskin Haid, Apa Kata Doktor | Peduli Merah Malaysia: FGM/C, Period Spot Checks, and Sexual Harassment | Harvard Public Health Review Bagaimana Hubris dan Ketidaksaksamaan Gender Memberi Kesan Negatif Terhadap Pengalaman Pesakit | Code Blue English: How Hubris and Misogyny Affect Patient Care | Harvard Public Health Review Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
23 January 2022An interview by Syiffa Rosman of Peduli Merah for Suara Empuan series on the topic of starvation to prevent periods due to period poverty (kemiskinan haid). The article was first published on 20th January 2022 in Bahasa Melayu (Malay Language) here. Republished on this website with permission. Cited in the Human Rights Commission of Malaysia (SUHAKAM)’s report “Towards a Dignified Menstruation for All: A Human Rights Imperative” (2025). Suara Empuan merupakan siri wawancara oleh Peduli Merah bertujuan mengangkat pengalaman perempuan yang sering diremehkan. Moga siri ini dapat memberikan keberanian dan maklumat asas kesihatan kepada pembaca. Ikuti siri wawancara bersama Dr Hannah Nazri mengenai kemiskinan haid. Peduli Merah: Berikutan pengalaman kemiskinan haid Endang Hyder yang berlapar untuk elak datang haid (merujuk kepada rekod kesihatan beliau berkenaan gangguan polar pemakanan sejak remaja), bolehkah Dr Hannah jelaskan secara ringkas bagaimana rutin pemakanan memberi kesan kepada kitaran haid seseorang? Dr Hannah: Ternyata apa yang mungkin berlaku kepada Endang Hyder adalah amenorrhoea iaitu ketiadaan haid selama 3 bulan atau lebih, yang boleh disebabkan oleh penukaran diet yang menyebabkan kehilangan berat badan dalam masa yang singkat serta stres. Ini kerana untuk badan wanita mengalami ovulasi (kedatangan haid adalah petanda bahawa ovulasi berlaku iaitu proses di mana ovari mengeluarkan telur ke rahim) dan seterusnya hamil, badan wanita perlu menjadi kaya dengan nutrien-nutrien penting supaya sekiranya wanita tersebut menjadi hamil, badan wanita boleh menanggung pertukaran fisiologi kehamilan serta memastikan kandungan tidak meletakkan beban kesihatan ke atas badan wanita. Berat badan ideal untuk kitaran haid yang normal bergantung kepada ketinggian seseorang (BMI = body mass index). Peduli Merah: Gangguan kitaran haid kerana ‘berlapar’ ini boleh berlaku pada setiap perempuan atau ada faktor-faktor lain yang boleh memberikan kesan berbeza kepada seseorang perempuan yang memilih untuk ‘berlapar’ bagi mengelak datangnya haid? Dr Hannah: Gangguan kitaran haid boleh berlaku kepada setiap perempuan apabila berlapar sehingga berat badan susut secara mendadak. Antara faktor-faktor yang boleh menyumbang kepada berat badan yang terlampau rendah adalah senaman yang berlebihan dan stres. Selalunya kita boleh lihat amenorrhoea berlaku kepada atlet wanita profesional. Apa yang penting adalah untuk memastikan senaman atau aktiviti sukan adalah seimbang dengan kadar pemakanan. Ingat ya, kedatangan haid bermakna ovulasi telah berlaku tetapi tiada persenyawaan antara telur dan sperma. Oleh itu, gangguan kitaran haid dan ketiadaan haid berpanjangan adalah petanda ketidaksuburan. Badan kita ini smart – kalau berat badan terlalu rendah atau terlampau tinggi untuk ketinggian kita, kita akan mengalami gangguan kitaran haid untuk mengelakkan kemungkinan hamil yang boleh meletakkan stres fisiologi yang berlebihan kepada badan kita. Peduli Merah: Pihak kami terima pelbagai respon berkaitan ‘berpuasa’ untuk elak datang haid misalnya kenyataan bahawa berpuasa pada bulan Ramadhan tidak sama sekali mengganggu kitaran haid mereka. Apa komen Dr Hannah berkenaan ini? Dr Hannah: Berpuasa pada bulan Ramadan jarang menyebabkan penurunan berat badan yang ekstrem, ya. Di Malaysia, bila kita berpuasa, kita akan bersahur sebelum masuk waktu Subuh dan kemudiannya berbuka pada pukul 7.30 malam (waktu Maghrib). Oleh itu, kita hanya tidak makan tengah hari. Dengan budaya pemakanan kita yang agak berat iaitu makan nasi berlauk pada waktu tengah hari, secara keseluruhannya tidak makan pada waktu tengah hari adalah tabiat yang lebih sihat. Dan lazimnya bila kita berbuka puasa, kita akan binge eat atau makan berlebihan dengan pelbagai lauk-lauk dan manisan. Jadi berat badan kita yang hilang semasa berpuasa tidak semestinya berkekalan. Sekali lagi, saya ingin ingatkan, jika stor-stor nutrien badan kita habis digunakan bagi memastikan supaya badan kita berfungsi dengan normal, dan tidak diisi semula dengan pemakanan yang seimbang, kita akan mengalami gangguan kitaran haid. Kerana badan kita tidak optimal untuk menampung aktiviti-aktiviti fisiologinya apatah lagi menampung bayi. Peduli Merah: Apakah nasihat Dr Hannah kepada para wanita bagi mengelakkan mereka membuat pilihan yang agak ekstrem dan akhirnya akan memberi kesan jangka masa panjang kepada tubuh mereka?  Dr Hannah: Saya faham kenapa wanita-wanita ini membuat pilihan yang ekstrem. Memang naluri wanita sebagai seorang anak, isteri atau ibu untuk mengetepikan keperluan peribadi kerana keluarga dan orang yang tersayang. Tetapi, kita tahu bahawa produk-produk sanitari adalah satu keperluan sama juga seperti keperluan-keperluan harian lain. Saya berasa amat sedih untuk membaca tentang wanita-wanita ini terdesak untuk berlapar untuk menghentikan haid. Oleh itu, saya berasa hipokrit untuk memberi nasihat agar wanita-wanita ini mengamalkan kesederhanaan dalam pemakanan tanpa mengetahui dengan terperinci tentang situasi mereka. Ternyata penyelesaian masalah ini terletak kepada kerajaan untuk memastikan: pertama, pendidikan haid agar wanita boleh membuat keputusan berkenaan dengan kesihatan mereka. Kedua, subsidi buat produk-produk sanitari untuk golongan yang memerlukannya dan memastikan pelajar-pelajar wanita boleh mendapatkan produk-produk sanitari secara percuma seperti yang dilakukan di United Kingdom, di samping menyediakan produk-produk sanitari alternatif seperti menstrual cup. Artikel wawancara ini tidak dibenarkan sama sekali disiar ulang tanpa kebenaran. Sekiranya anda mengalami masalah kesihatan, disarankan berjumpa doktor dan dapatkan pemeriksaan kesihatan. Oleh: Syiffa Rosman Pewawancara Siri Suara Empuan Peduli Merah. Jika anda mempunyai pengalaman atau pandangan untuk dikongsikan, boleh hubungi pedulimerah@gmail.com Related posts: Malaysia: FGM/C, Period Spot Checks, and Sexual Harassment | Harvard Public Health Review Bagaimana Hubris dan Ketidaksaksamaan Gender Memberi Kesan Negatif Terhadap Pengalaman Pesakit | Code Blue English: How Hubris and Misogyny Affect Patient Care | Harvard Public Health Review Like what you read? Subscribe to my blog. About the Author: Hannah Nazri Follow me [...] Read more...
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