Recently, the WHO (World Health Organization) together with its partner agencies published the World Maternal Mortality report 2000 to 2017. This is an extensive report detailing the trends of mothers dying in pregnancy, analysis of its causes and strategies to save mothers’ lives globally.
Looking at Malaysia in 2017, our maternal mortality stands at 29 per 100,000 births, which translates to 150 mothers dying during pregnancy. The same report alludes that measurement of these deaths may not be too accurate globally as some deaths remain unrecorded or undetected.
Malaysia may have similar problems especially with the large influx of undocumented immigrants in states like Sabah or areas deep in the interiors. In addition, many mothers suffer devastating near death events during pregnancy, which may result in permanent disabilities.
These cases are not recorded in the maternal mortality compilations which may reflect the tip of the iceberg for negative health outcomes as a consequence of pregnancy. In contrast, the maternal mortality rate and total number of maternal deaths in Japan, United Kingdom and Australia was 5 and 44, 7 and 52, 6 and 20 respectively.
One of the most critical goals of the global health agenda and in every country is to end preventable maternal deaths. To do this, the three most important factors are comprehensive antenatal and childbirth services available and accessible to all mothers, including contraceptive coverage to prevent unplanned pregnancies.
The antenatal coverage and delivery services in Malaysia is more than 95 per cent, with the Ministry of Health firmly committed to ensure all mothers are well taken care of during pregnancy and childbirth.
These may not be applicable to those underserved and vulnerable communities and, in particular, the undocumented immigrants or stateless mothers.
It is estimated that 40 per cent of pregnancies were unplanned and nearly half of those mothers who die during pregnancy need not die if they never got pregnant from a pregnancy which was not intended. The large gaping hole in the efforts to save mothers from dying in Malaysia is contraceptive usage and coverage.
The use of modern methods of contraception for the past 20 years had stagnated at 35 per cent, and these figures are for married women. The usage in the unmarried remains unknown and possibly much lower considering the devastating stigmatisation of premarital sex, which prevents access to contraceptives.
The 2018 Declaration of Astana repositions primary health care as the most effective way in delivering quality care in achieving the sustainable development goals and achieving the well being of all mothers. Access and uptake to contraceptive services and the availability of trained health care professionals in its provision are critical prerequisites.
Yet very little investment by the government is directed to primary care, and even less is allocated to contraceptive provisions and training of health care professionals. There are no national sexual and reproductive health training for health care workers, neither is there a sustained commitment to improve the uptake of contraceptives, which can be life-saving, with much of the resource allocation diverted to secondary and tertiary care.
A quick glance at Ministry of Health statistics showed that the No 1 reason for hospital admissions is childbirth, which accounts for nearly 19 per cent of all admissions. In a simplistic term, we are very good at looking after pregnant woman, we are less good at delivering sexual and reproductive health care once they had delivered, and we are the least good at investing in contraceptives to prevent unplanned pregnancies.
The question that is begging to be answered is how much is a mother’s life worth?
Not more than a box of contraceptive pills and the training towards its provisions with the seemingly reluctance in pushing for this important life-saving agenda?
No mother should die when giving birth to another life and Malaysia must reaffirm its stand to end all unplanned pregnancies and in so doing, saving mothers’ lives.
Dr John Teo is a consultant obstetrician & gynaecologist from Kota Kinabalu, Sabah.
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