**1. Introduction**

Migration of women is an important component of international migration, with women comprising nearly half (48%) of the 258 million international migrants worldwide in 2017 [1]. In Malaysia, 19% of the 2.0 million documented migrant workers in 2019 were women [2]. The country also houses an estimated 2 to 3 million undocumented migrants [3], which increases the number of female migrants significantly. Although women represent a substantial proportion of less skilled migrant workers in Malaysia, appropriate migration and gender-sensitive policies are still lacking. As a result, female migrants are more vulnerable and prone to human rights violations [4,5].

Sexual and reproductive health and rights (SRHRs) are fundamental human rights, which lies with the right of individuals and couples to freely decide the number, timing, and spacing of children and have adequate information to make those decisions, and the right to attain the highest standard of sexual and reproductive health [SRH] [6]. SRHR was conceptualised during the 1994 International Conference on Population and Development (ICPD) in Cairo, where reproductive health was defined as a "state of complete physical, mental and social well-being, not merely the absence of disease and infirmity, in all matters relating to the reproductive system, and its functions and processes" [6] and was subsequently built on evolving international agreements [7].

SRH addresses a wide range of health issues, including contraception, unintended pregnancies, unsafe abortions, gender-based violence (GBV), pregnancy and childbirth complications, human immunodeficiency virus (HIV) and other sexually transmitted infections (STIs), and infertility and reproductive cancers, and are seen as essential elements to achieve social, economic and environmental development goals [7].

Maternal and child health services are the cornerstone of Malaysia's public health system and are available nationwide as part of the integrated primary care services provided at public health clinics, maternal and child health clinics, and community clinics under the Ministry of Health (MOH), Malaysia. The scope of maternal and child health services includes maternal and perinatal health services (pre-pregnancy, antenatal, intrapartum and postnatal care), child health services (childhood immunisation and health, development and growth assessment), and woman's health services (family planning services, and cervical and breast cancer screening) [8]. SRH services are also provided by the National Population and Family Development Board, under the purview of the Ministry of Women, Family and Community Development, non-governmental organisations like the Federal Reproductive Health Associations Malaysia (FRHAM), and private practitioners [9].

Improving access to SRH is central to development, as reflected under target 3.7 of the Sustainable Development Goals (SDGs) which calls for "universal access to sexual and reproductive health-care services, including for family planning, information, and education" by 2030 [10]. Although providing SRH services to marginalised communities including migrant workers are key to fulfilling the SDGs [11], the 2017 Voluntary National Review of SDGs by the Malaysian government did not identify migrant workers as a vulnerable group to improve delivery of healthcare services [12].

Women emigrating for employment face intersecting vulnerabilities of gender, social class, and ethnicity [13] and often encounter physical, psychological, and sexual violence [14,15]. Despite the ratification of the Convention on the Elimination of Discrimination against Women (CEDAW) and commitments to the ICPD Programme of Action [16], Malaysia has not fully recognised the migrant workers' SRHRs [17,18]. Female migrant workers in Malaysia still face SRHR-related difficulties, mainly through the prohibition of pregnancy during employment [19,20].

In its concluding observations on the combined third to fifth periodic reports of Malaysia, the Committee on the Elimination of Discrimination against Women were concerned about the barriers faced by non-citizen women, including female migrant workers, when accessing healthcare [21]. Financial constraints are a major healthcare access barrier, as healthcare charges for non-citizens are considerably higher when compared to citizens for services at public facilities [17,18,22]. In addition, healthcare personnel are required to report undocumented migrants seeking medical care to the Immigration department, deterring women from seeking needed care due to fear of arrest and detention [23,24].

Therefore, this study aims to explore key informants' views on the provision of SRH services for low-skilled, documented, and undocumented migrant women in Malaysia, including SRH education, contraception, abortion, antenatal and delivery, and the management of GBV.

### **2. Materials and Methods**

We used qualitative methods in an exploratory, iterative design to explore policy and the provision of SRH services for migrant workers in Malaysia.
