The Millennium Development Goals (MDGs) is a set of eight targets that each of the 192 member states of the United Nation and some other international organizations have agreed to achieve by the year 2015. The goals are targeting essential developmental and socio-economic issues of the states, generally in health related areas, and are indicated by specific measurable indices. The areas of concern are to eradicate extreme poverties, to achieve universal primary education, to promote gender equality among women, to reduce child mortality rate, to improve maternal health, to combat HIV/AIDS, malaria and other diseases such as tuberculosis, to ensure environmental sustainability and to encourage global partnership for development.
The fifth element of the Millennium Development Goals spells out targets to achieve in improving maternal health. There are 2 targets attributed to this goal, the first being a reduction by three quarters, between 1990 and 2015, the maternal mortality ratio; and to achieve, by 2015, a universal access to reproductive health. Under each of these goals, there are specific indicators to chart the progress towards achieving the goals.
Malaysia has seen a heightened national concern and has been involved in international effort to promote health in general, and particularly the maternal and child health throughout the post independence era. Even before the Safe Motherhood Initiative that was launched in the 1980s, this country has gone through impressive reduction of the reported maternal mortality ration, which was halved between 1957 and 1970, from around 280 to 141 per 100,000 live births. The figure continued to come down to under 20 per 100,000 live births, which is a level very close to that of mostly advanced countries.
According to the United Nation Development Programme report in 2004, Malaysia approached the reduction of the maternal mortality through six key elements. These includes improved access to, and quality of care of, maternal health services including family planning, and by expanding health care facilities in rural and urban areas. Malaysia has invested in upgrading the quality of essential obstetrics care in rural clinics and district hospitals, with focus on emergency obstetrics care services. Streamlining and improving of the efficiency of referral systems and feedback systems to prevent delays in service delivery. On the human resource angle, Malaysia has invested in training and increasing the professional skills of trained delivery attendants to manage pregnancy and delivery complications. A comprehensive monitoring system was implemented which focuses on periodic reviews of system investigation, including reporting of maternal deaths through confidential enquiry systems, and to work closely with communities to remove social and cultural constrains in improving acceptability of modern maternal health services.
It is doubtlessly challenging, and requiring tremendous amount of commitment, human and financial resources, and innovative programmes to further reduce the maternal mortality to a lower level, even to sustain the maternal mortality at the current low level. Continued monitoring of maternal deaths, improvement in access and quality of care is of utmost importance to further lower maternal mortality. The shift from direct to indirect cause of maternal mortality requires greater involvement of multidisciplinary professionals and sectors, including Non-Governmental Organisations and religious leaders to address more complex factors of maternal mortality.
Based on the evident and accounts of development gains over the last recent decades, Malaysia has kept itself on-track in achieving its ambition and goals. For this country to become a fully developed nation by 2020, this positive weather of growth needs to be carefully sustained and improved, including continuous human development, especially with emphasis on higher education and trained skills. Essential issues that need to be continuously addressed are such as poverty and inequality, education, gender issues, health improvement, sustained development, issues pertaining to foreign migrants, improvement of information systems and partnership with multisectorial agencies for development.
Economically, the vast majority of remaining poor households are Bumiputeras, and are mainly concentrated in the agricultural sectors especially in the least developed states. Addressing the ethnic group disparities in maternal mortality continues to be a challenge for the health policy makers. At the same time, the high maternal mortality rate among immigrant women, comprising 42 percent of maternal deaths in this country in the year 2000. Migrant women face a limited accessibility to maternal health services, especially those lacking of valid travel documentation. This limited accessibility problem will cascade to a bigger problem resulting from unwanted pregnancies such as complicated trial of abortion, and abandonment of newborns.
Over the past decades, there has been a shift in preference of delivery at home to institutional delivery centers such as the hospitals, the health clinics and the alternative birthing centers (popularly known as the ABC in rural setting). Therefore, there is a need to increase and establish more of these facilities to provide safe deliveries closer to communities and to prevent overcrowding of the maternity units in the hospitals. These facilities must be equipped with full range of antenatal and maternal services such as family planning, management of complicated pregnancies and counseling services, as well as staffed by skilled professionals and adequately equipped for basic essential obstetric care and provision for referrals.
With the advancement of the information technology era, we are seeing more and more well informed and educated clients, together with the rise in educational level of Malaysian women. The societies nowadays are better empowered to make their own decisions and informed choices regarding healthcare, delivery and family planning. There health service provider, therefore, has to be better prepared and equipped to meet the raised expectations of the clientele, and to be able to provide necessary information to facilitate autonomy in client’s decision making. Good use of information and communication technology will eventually lead to positive changes in health seeking behaviour and healthy lifestyles.
Even though maternal deaths have become rather relatively low in Malaysia, there is still a need to ensure the preservation of quality, accuracy and reconciliation of data obtained from the government registration system. As proposed by the UNDP Malaysia report, for analytical purpose, it would be helpful to have the adjusted and the unadjusted annual maternal death figures to be made readily available. Provision of regular and detailed reporting of contraceptives prevalence rate would provide a better comprehensive profile of maternal health.
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