3.2.2. Migrants Pay Out-of-Pocket for Sexual Reproductive Health Services

Family planning is freely available to local patients at public clinics, as part of a comprehensive package of maternal and child health services for citizens. This medical doctor explained that financial constraints may deter some female migrants from seeking contraception at public clinics, as non-citizens must pay for services.

*"To be honest, migrants have to pay for the contraception-for injectable hormonal therapy or any sort of contraception-they have to pay! As opposed to locals, where contraception is free. So, the problem still comes back to financial issue. So, if they are willing to pay and can a*ff*ord, and if they understand the importance to not conceive within the next two years, then they will pay for it. But most of them-no [they won't pay]." MD-13 PUBLIC CLINIC*

Migrant workers pay out-of-pocket for contraception at private clinics, as SRH services are not covered by the government-mandated migrant health insurance (SPIKPA) or employer-provided healthcare.

3.2.3. Private Practitioners Promote Expensive Contraceptives and Fail to Provide Information on SRH

Medical practitioners interviewed informed that although a wide range of contraceptives are available at private clinics, most migrants prefer injectable hormonal contraceptives, especially the commonly available Depo-Provera injections. This interviewee explained that private doctors do not sufficiently advise women on contraceptive options, such as on the use of long-acting contraceptives like intrauterine contraceptive devices (IUCDs) or implants, because these options are less lucrative than injectable hormonal contraceptives.

*"Not many GPs [general practitioners] even want to talk about it! But they keep telling them to use Depo-Provera because it is profitable! In a year, if you are coming [to the clinic for] 4 times. So, RM 60* × *4* = *RM 240. [Whereas, the] IUCD is RM 200 for 4 years. So, you are not going to see her for the next few years. It [the IUCD] is more economical for the woman, but it is less profitable for the doctors!" MD-12 CSO*

While the private practitioners interviewed acknowledged that there is a substantial market for contraceptives among migrant women due to perceived need, participants explained that the awareness and willingness-to-pay are low for the prevention of STIs, specifically the use of condoms.

*"I got quite a number of them coming for depo injections [Depo-Provera injections]. Contraception, in the form to prevent pregnancy-yes. But to prevent STDs [sexually transmitted diseases], they have to buy la* . . . *Condoms and all that, they have to just find ways to buy it* . . . *But I have had quite a number of them who come in for depo injection. So, they do know about it, and they do come." MD-2 PRIVATE GP*

This participant implied that migrants were not willing-to-pay for condoms, as this was not seen as essential. Likewise, there is very little information provided by medical practitioners regarding the use of condoms in the prevention of STI.
