SEATTLE — The World Health Organization (WHO) defines Maternal Mortality as a maternal death during pregnancy or within 42 days of the termination of the pregnancy, from any cause related to or aggravated by the pregnancy or its management. In 1950, Malaysia had the high Maternal Mortality Rate (MMR) of 540 deaths per 100,000 live births. However, thanks to programs implemented throughout Malaysia, the MMR has drastically declined. By 1990, Malaysia’s Maternal Mortality Rate decreased to 50 deaths per 100,000 live births, and in 2010, the MMR of Malaysia was 26 deaths per 100,000 live births. Malaysia has been successful in reducing its Maternal Mortality Rate due to the implementation of two major programs: the Maternal and Child Health Program (MCH), and the Confidential Enquiry into Maternal Deaths (CEMD).
The MCH was instituted throughout Malaysia after the country gained independence from the British in 1957. The goal of the program was to target maternal mortality especially in rural areas, where it was most prevalent. The main causes of maternal mortality are hemorrhages, hypertension, sepsis and embolisms. The MCH helped to prevent these causes and reduce the MMR by building clinics throughout the country, most often in rural areas, which would provide antenatal care and intra natal and postnatal care. The MCH also helped to decrease the Maternal Mortality Rate by providing rural areas with trained midwives. One main contributing factor to maternal mortality is the presence of unskilled birth attendants who are not able to treat complications that arise. By providing rural areas with trained midwives, the MCH was able to lower the number of deliveries performed by traditional birth attendants (TBA) and therefore lower the number of maternal deaths.
The MCH worked remarkably well. Malaysia now has much wider accessibility to health care. A study described by Hematram Yadav’s paper “A Review of Maternal Mortality in Malaysia” shows that there were 122 Ministry of Health hospitals, six special medical institutions, 809 health clinics, 1,919 rural clinics, 89 maternal and child clinics and 146 mobile clinics throughout Malaysia in 2005. Wider access to healthcare is a huge contributing factor to Malaysia’s drop in maternal mortality. Another contributor is the CEMD program. The CEMD works to examine the deaths reported and to provide recommendations for how to further reduce the MMR. For example, in their 2006 to 2008 study, the CEMD reported that more than 60 percent of deaths occurred during the postnatal period and that the risk of maternal death was significantly higher in mothers who had already had six or more children or women over the age of 40. The CEMD also realized that certain factors helped to contribute to MMR, including geographic isolation and financial constraints.
Some of the recommendations from the CEMD based on their 2006 to 2008 study were that road safety—the use of helmets and seatbelts—should be taught as a part of antenatal education. The CEMD also recommended that all at-risk patients in the pregnancy and postpartum periods should be offered thrombo prophylaxis (a measure to prevent coronary thrombosis). By directly targeting specific concerns, the CEMD is also making a significant impact and helping to reduce the MMR. The declining fertility rate has also helped lower Malaysia’s MMR. Family Planning is part of the services given by the MCH. The institution of a National Family Planning board and Family Planning institutions have decreased the MMR by increasing the contraceptive rate. While the fertility rate was 6.3 children per woman in 1960, by 2010, it was 3.3 children per woman.
Another significant factor that has helped to decrease Malaysia’s Maternal Mortality Rate is the reduction of poverty throughout Malaysia. The poverty rate in the country was 49.3 percent in 1970, but by 2002, it had drastically fallen to a level of 5.1 percent. Malaysia has come a long way in reducing its Maternal Mortality Rate. However, as Dr. Thaneemalai Jeganathan of the Obstetrical and Gynecological Society of Malaysia points out, the goal should be that “no mother dies while delivering a baby.” While this may have seemed impossible for Malaysia 60 years ago, Malaysia is much closer to making this a reality.
– Ashrita Rau
Sources: International Medical University, Asia One, AIPA Secretariat, Dr. HJ Ab Rahman Abdullah,
Photo: Shuhada Hasim Portraits