Sabah, located in Southeast Asia, hosts the highest number of non-Malaysian citizens (27.7%), predominantly the Indonesian and Filipino migrants in comparison to other states in Malaysia. Sabah has inadequate data on migrants’ sexual and reproductive health and rights (SRHRs). Various migrant-related policies and laws are present, but they do not offer full protection and rights to legal migrants in terms of their SRHRs. The aim of the laws and policies appears to be controlling the migrants from having any negative impact on the locals, rather than protecting migrants’ health and rights. This affected their rights to marriage, having children, increase their vulnerabilities to labour trafficking and sexual abuse and access to health-care services. Female migrant workers and undocumented migrants form the most vulnerable subgroups of migrants. This narrative review highlights the status of SRHRs of migrants in Sabah and the migrant-related Malaysian laws and policies affecting their SRHRs.
Highlights
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Pregnant women migrants and migrants with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) will be deported.
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Stateless children have limited access to public health and education services.
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Female migrant workers face greater risks of sexual exploitation and abuse.
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Revision of Malaysian migrant-related laws and policies are warranted.
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In Sabah, more research on the status of migrants’ sexual and reproductive health and rights (SRHRs) is essential.
Introduction
There were more than 30 million migrant workers in the Asia and the Pacific region in 2013. This region is also experiencing feminisation of migration as women comprised 42% of migrants in Asia and 50% in Oceania . The flow of undocumented migrants in Asia Pacific is the largest compared to other regions in the world and is mainly between neighbouring countries . Myanmarese, Cambodians and Laotians accounted for 3.1 million of migrants in Thailand and half of them are undocumented . In Malaysia, half of the 1.8 million registered migrants were from Indonesia in 2010, and it was believed that the ratio of legal and undocumented migrants in Malaysia was 1:1 . Undocumented migrants are also referred to as irregular or illegal migrants; a person who, owing to unauthorized entry, breach of a condition of entry, or the expiry of his or her visa, lacks legal status in a transit or host country. The definition covers inter alia those persons who have entered a transit or host country lawfully but have stayed for a longer period than authorized or subsequently taken up unauthorized employment . In this paper, these terms will be used interchangeably.
Migrant workers usually come from a background of economic hardships and due to their lack of knowledge, skills and resources; they are generally employed in occupations that are at higher risk of work-related injuries. In addition, the perception that migrants are merely short-term labour investment and a commodity leads to health and occupational safety often being neglected by employers . Migrant workers’ barriers to health-care access are attributed to their lack of familiarity with the health-care system, language barriers and lack of awareness of their rights and entitlements to health care as provided by their medical insurance .
Migrants who are undocumented rendered them to be at an extreme disadvantage. Due to their irregular status, they face insecurities in terms of their employment, income and restrictions to their access to health care and education. In a systematic review on health and access to care among undocumented migrants living in the European Union, it was reported that mental disorders are common and obstetric needs and injuries were key reasons for seeking care . The barriers to accessing health care among undocumented migrants were fear of deportation , lack of awareness of rights and socioeconomics . Furthermore, as they are undocumented, they are not captured in the national statistics . They are also the most under-researched group, hence making development of interventions specifically targeting them difficult. Their illegal status also caused them to not dare to seek legal redress from any unjust treatment .
There are a myriad of issues surrounding migrants and one area that has been given little attention is the sexual and reproductive health and rights (SRHRs) of migrants. Research on SRHRs in the context of migration is limited in the Asia-Pacific region . SRHRs are not just pertaining to reproductive health per se, but it is influenced by one’s status, gender, economic status, ethnicity, religion and culture in which migration has an impact. Migrant workers may experience changes in their SRHRs conditions depending on the SRHRs situation in their country of origin and their destination country .
In Asia Pacific where patriarchal norms and cultural values still exist in society, women migrant workers are undervalued, especially those in the domestic work, as it is perceived to be a women’s work . Furthermore, the increasing social independence and economic power of migrant women workers threaten men’s masculinity and therefore men exploit women as a way to show their status, superiority and power over women . Female migrant workers are vulnerable to sexual violence, economic exploitation, physical and verbal abuse and labour rights violations .
Malaysia, located in Southeast Asia, consists of 13 states and three federal territories. Sabah is Malaysia’s easternmost state and one of the two states (the other is Sarawak), which forms East Malaysia. Sabah hosts the highest proportion of non-Malaysian citizens at 27.7% (886,400), and they are primarily found in Sandakan and Tawau . In Sabah, the two predominant migrants are the Indonesians (85%) and the Filipinos (15%) . This is not surprising given the close geographical proximity between Sabah, Southern Philippines, Sulawesi and North Kalimantan, Indonesia ( Fig. 1 ). These migrants consist of refugees, migrant workers and even illegal migrants, who are not documented in the national statistics of foreigners in the country.
Female migrant workers in Malaysia are exposed to various forms of human rights violation. In addition, they receive lower wages in comparison to foreign male workers. They are prohibited from getting married or becoming pregnant and risk deportation if they do so. Female domestic workers are especially vulnerable as their freedom of movement is restricted. They are also exposed to long working hours with no compensation, and, at times, they are vulnerable to physical, psychological and sexual abuse by their employers. Furthermore, undocumented female migrant workers are vulnerable to sexual exploitation, and some are tricked into prostitution . Malaysia has ascended to the Convention on the Elimination of Discrimination against Women and the International Conference on Population and Development Programme of Action, in recognising women’s SRHRs. However, Malaysia’s stand on women’s SRHRs has yet to be fully extended to migrants in the country.
This narrative review examines the status of SRHRs of undocumented or low-skilled migrant workers in Sabah, and the influence of migrant-related Malaysian laws and policies affecting their SRHRs. The information presented in this paper is a result of general assessment of published books, journal articles, national reports and official web pages. The paper is divided into the following sections: demography of Sabah, the history of migration in Sabah, the impact of migration on the health of migrants in Sabah, gender inequity among migrants workers in Sabah; marriage migration, labour trafficking, sexual violence and human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) and access and rights to sexual and reproductive health and services.
Demography of Sabah
Sabah population comprises 11.3% (3.2 million) of the total Malaysian population (28.3 million) . From 2005 to 2013, the service sector was the major contributor to Sabah’s gross domestic product . Sabah has the highest poverty rate in Malaysia, although this figure has dropped significantly from 30.4% in 1990 to 8.1% in 2012 . The life expectancy for the male population is around 75 years, while for the female population it is higher around 78 years, and the total fertility rate was estimated to be 1.7 . Sabah population is highly diverse with 32 officially recognised ethnic groups . The largest ethnic group is the ‘Other bumiputera (indigenous people)’ followed by Kadazan-Dusun, Bajau, Chinese, Malay, Murut, and ‘Others non-bumiputera’ .
In 2011, Sabah was home to 171,459 of migrant workers and is still the favourite destination for migrants in Malaysia. This was due to the proximity to Indonesia and the Philippines, economic opportunity, historical and cultural affinity, presence of family and kin, the role of estate supervisor, no families and hardship back at home . A study on Indonesian migrant workers in Tawau revealed that more women migrate to Sabah in comparison to men due to their spouses and presence of partners, family or friends in Sabah .
Demography of Sabah
Sabah population comprises 11.3% (3.2 million) of the total Malaysian population (28.3 million) . From 2005 to 2013, the service sector was the major contributor to Sabah’s gross domestic product . Sabah has the highest poverty rate in Malaysia, although this figure has dropped significantly from 30.4% in 1990 to 8.1% in 2012 . The life expectancy for the male population is around 75 years, while for the female population it is higher around 78 years, and the total fertility rate was estimated to be 1.7 . Sabah population is highly diverse with 32 officially recognised ethnic groups . The largest ethnic group is the ‘Other bumiputera (indigenous people)’ followed by Kadazan-Dusun, Bajau, Chinese, Malay, Murut, and ‘Others non-bumiputera’ .
In 2011, Sabah was home to 171,459 of migrant workers and is still the favourite destination for migrants in Malaysia. This was due to the proximity to Indonesia and the Philippines, economic opportunity, historical and cultural affinity, presence of family and kin, the role of estate supervisor, no families and hardship back at home . A study on Indonesian migrant workers in Tawau revealed that more women migrate to Sabah in comparison to men due to their spouses and presence of partners, family or friends in Sabah .
History of migration in Sabah
The entry of Filipino and Indonesian migrants into Sabah has been well documented and dates back to the colonial period where they were employed as plantation estate workers . In the late 1960s, the civil war in southern Philippines led many people to flee their country and seek refuge in Sabah . These Mindanao refugees are some of the earliest Filipinos in Sabah. Subsequently, in 1971, the implementation of the New Economic Policy in Malaysia saw another cohort of Filipinos entering Sabah. Many local natives left agricultural and plantation sectors in rural areas and migrated to urban towns in search of employment in the formal economy. They were also not interested in the 3-D (dirty, difficult and dangerous) jobs of the construction and services sectors. Therefore, Filipino and Indonesian migrants were brought in to fill the labour shortages to fuel the state’s economy . Later, by the late 1970s, more migrants entered Sabah to look for work, including undocumented ones. Filipino refugees who are only found in Sabah are currently categorised as ‘people of concern’ by the United Nations High Commissioner for Refugees (UNHCR), and there were an estimated 80,000 of them by December 2013 (UNHCR, 2013).
Due to the increasing migrant population in Sabah, the Sabah Federal Special Task Force (FSTF) was formed in 1989 to handle and control issues related to them. From March to August 1997, the reported number of foreigners by the FSTF was 585,796; 70.6% of them were undocumented . Of the undocumented migrants, 71% were Indonesians, and the remaining were Filipinos. In 2011, the number of foreign workers in Sabah was estimated to be 8.9%, and there was also a large proportion of unaccounted irregular foreign workers . In spite of this large number of Filipinos in Sabah, there was no consulate dedicated to them in Sabah. The Philippine Government’s contention claim to Sabah was one of the main reasons that hindered the establishment of a consulate office here . However, there was an Indonesian Consulate, although with limited capacity, to handle the migrants’ issues here .
The impact of migration on the health of migrant workers in Sabah
Indeed, migration can offer better economic opportunities and livelihoods for migrants; however, it can also put them at a disadvantage due to the need to adapt to the new environment, reduced security in life, experiences of alienation and discrimination, reduced socio-economic status and language barrier. Generally, due to the prerequisite of the policy of mandatory testing based on the Malaysian Immigration Act, 1959, that stipulates that migrants should pass health tests before they are allowed to work in Malaysia, legal migrants in Malaysia are healthy upon entry. However, low wages, poor living conditions and lack of access to basic necessities during their stay in destination country increase their susceptibility to health problems . The more worrisome group is the undocumented migrants in Sabah who are unregulated and unprotected by Malaysian migrant work and health policies and laws; therefore, this predisposes them to health risks . They also face problems with access to healthcare due to social stigma, cost and legal status . All this can affect their health and wellbeing ; including their SRHRs. In Sabah, undocumented migrants, who are often poor, do not practise contraception, do not receive antenatal care and often deliver in an unsafe environment generally carried out by untrained birth attendants. They often present late with complications and have very poor outcomes. Documented migrants accounted almost 10% of maternal deaths in Malaysia, and this occurred especially in Sabah, while the figure for non-documented migrants (12.8%) was higher in 2012 . The maternal mortality rate in Sabah was the second highest (42.1/100,000 live births) in the country . The female population was believed to be the most marginalised and unprotected labour group in Malaysia .
Gender inequity among migrant workers in Sabah
Marriage migration
SRHRs among migrants is an issue to be reckoned with in Malaysia. Under the Malaysian laws, the unskilled and semi-skilled migrant workers are prohibited from getting married while working in Malaysia or they risk deportation if they do so . They are also not allowed to bring in their family members. The Indonesian Labour Migration Survey (ILMS) found that more than half of the Indonesian migrants surveyed desired to gain citizenship in Sabah . This was not surprising as citizenships allow them access to basic facilities such as education, health care, better economic opportunities and one way to gain citizenship for female migrants was through marriage.
In Malaysia, there are regulations, acts and constitutions that govern marriages involving migrants in terms of granting citizenship. These may differ with the gender and social class of the migrant. The foreign spouse of a Malaysian man is entitled to be registered as a citizen, and this is clearly spelt out in the federal constitution and the Immigration Act 1959/1963 (Act 155). However, this does not apply to a foreign husband of a Malaysian woman. In general, foreign husbands do not have the right to stay, except for those who were skilled, professionals or investors, while a foreign wife faces a multitude of challenges while procuring citizenship.
Limited data are available on marriage migration in this region. The Malaysian government does not publish official statistics on the number of international marriages yearly; however, the Ministry of Home Affairs releases figures to the media, thus some data are available to the public. Between 2001 and June 2005, while there were almost 34,000 marriages between local men and foreign women, 11,112 local women got married to foreign men in Malaysia . Between 2000 and 2012, statistical records from the Sabah Islamic Religious Affairs Department showed that almost 11,000 Muslim foreign women married local men and about 8900 Muslim foreign men married local women . The prohibitions imposed by the immigration policies did not stop marriages among migrants and the local population. Loopholes in regulations and procedures have been used by migrant workers in Malaysia to gain legality .
A study done in Tawau, Sabah, showed that there are almost 60% of Indonesian women migrant workers who were married and living with their spouses in Sabah. However, less than half of that proportion practised any form of contraception. The desire to have children led them to stop using contraception . Most marriages of migrant worker were performed through customary or religious rites and solemnised by people in their community . These marriages were not recognised by the Malaysian laws leading to problems in registration of children born making them ‘stateless children’ or children without documents . By 2009, there were approximately 52,000 stateless children in Sabah . These children were not entitled or had very limited access to public health and education services as well as contributing to a dramatic increase in the number of illegal immigrants. This situation was alarming and concerning at local, national and international levels .
The Malaysian government is yet to find a solution to address the issue of stateless children in Malaysia. There were concerns that granting these children with Malaysian citizenship may alter the demographic make-up of Sabah . Furthermore, undocumented migrants were perceived by the locals to be the cause for increasing crimes and social problems . Local authorities and media viewed the children as criminal elements . Recently, the Sabah Community Development and Consumer Affairs Ministry proposed a resolution; to hire these children as legal foreign workers when they are older making them legal citizens .
The issue of stateless children can be solved by claiming citizenship from their parent country of origin, and this could be done in the Indonesian consulate in Sabah; the consulate issues birth certificates and passports for the children of its nationals. However, Filipino migrants found travelling to their consulate expensive, which is located in Kuala Lumpur, Peninsular Malaysia. Furthermore, it was difficult for Filipino refugees with IMM13 cards (given to refugees and their descendants) to leave Sabah. Many also did not know the existence of mobile registration units that visit Sabah occasionally. Nevertheless, despite existing measures to prevent one’s statelessness, the migrants preferred to remain undocumented and wait for Malaysian citizenship as they perceived themselves to be ‘Malaysians’ .
Labour trafficking, sexual violence and HIV/AIDS
The FSTF indicated that large numbers of migrant women were hired as domestic workers and in hair saloons, restaurants, recreation clubs, supermarkets, stores and nightclubs . Commercial sex worker may volunteer or be forced, independent or through agents . In Malaysia, prostitution or activities related to it were liable to punishment under the Penal code section 372 . The Immigration Act 1959/1963 bars the entry and employment of ‘prohibited classes’ of individuals, including ‘any prostitute, or person, who is living or receiving or who, prior to entering Malaysia, lived on or received, or proceeds of prostitution’ . The law and the stigma surrounding ‘sex’ made it impossible to determine the actual number of migrants involved in commercial sex, sexual violence or abuse. Data were limited to few qualitative researches, media reports, which were often sensationalised and from organisations or individuals who were concerned with this issue . The number of sex workers was usually derived from arrests of suspected foreign sex workers, which would depend on frequency of police raids. Table 1 shows an old data on the number of sex workers in Sabah and a few states in Malaysia. This gives a broad picture of the migrant workers involved in this activity .
