KUALA LUMPUR, August 28 — Putrajaya and Labuan have recorded the country’s highest maternal mortality ratio (MMR) at a whopping 45.9 and 40.8 deaths per 100,000 live births in a five-year average.
Health Minister Dzulkefly Ahmad sought to justify these extremely high MMR rates in the two federal territories by pointing to a small denominator – very low live births – as he noted that Putrajaya and Labuan recorded four and three maternal deaths respectively in a five-year period.
According to his written Dewan Rakyat reply to Kuala Pilah MP Adnan Abu Hassan on August 18, besides Putrajaya and Labuan, the five-year average MMR in six states far exceeded the national five-year MMR average of 24.2: Kelantan (30.8), Negeri Sembilan (30.0), Sabah (29.7), Kuala Lumpur (28.5), Penang (25.6), and Johor (25.1).
In 2023, Malaysia recorded an MMR of 25.7, a slight decline from 26.0 in 2022, according to the health minister.
“The maternal mortality ratio in Malaysia achieved SDG 3.1 (Sustainable Development Goal), which is under 70 maternal deaths per 100,000 live births by 2030,” said Dzulkefly.
According to the International Classification of Diseases 11th Revision (ICD-11), maternal deaths are defined as the deaths of women while pregnant or within 42 days of termination of pregnancy, from pregnancy-related causes, but excluding accidental or incidental causes of death.
Even as the health minister touted Malaysia’s achievement of the SDG maternal mortality goal, the United Nations Population Fund (UNFPA) said in a 2022 report on sexual and reproductive health that Malaysia must address its stagnating MMR to achieve its aim of becoming a high-income nation.
The UNFPA Malaysia report launched in 2023, as cited by Ova, noted that poor quality maternal health care appeared to be a more significant barrier to reducing MMR in Malaysia than insufficient access.
Interestingly, World Health Organization (WHO) data shows higher MMR rates for Malaysia than the country’s official data quoted by Dzulkefly in his parliamentary reply.
WHO data showed an MMR rate of 26.4 in 2023, higher than the 25.7 quoted by Dzulkefly. For 2022, WHO reported Malaysia’s MMR at 37.6, much higher than the 26.0 cited by the health minister. Both figures quoted by Dzulkefly are Department of Statistics Malaysia (DOSM) figures.
During the Covid-19 pandemic, Malaysia’s MMR skyrocketed to 68.2 in 2021, according to DOSM. WHO reported a lower figure at 52.1.
Aside from the 2021 spike, which was also experienced by the world, Malaysia’s MMR has stagnated at between 26 and 30 for nearly two decades since 2006. In the late 1980s, Malaysia’s MMR was in the 50s; the year 1985 saw an MMR of 62.7, according to WHO data.
According to the “Trends in maternal mortality 2000 to 2023: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division” report released last April 7, South-Eastern Asia (which Malaysia is classified under) was estimated to have MMR of 114 in 2023.
All European regions were estimated to report single-digit MMR figures below 10 that year, while the region of Australia and New Zealand had an estimated MMR of only 3.
The global maternal mortality report estimated an MMR rate of 8 for the United Kingdom, 6 for Singapore, and 4 for South Korea in 2023. Compared to Europe and these other developed countries, the United States was an aberration, with an estimated MMR in the double digits at 17.
In Dzulkefly’s written Dewan Rakyat reply, he said Malaysia has maintained high coverage of maternal health care services, citing the National Health and Morbidity Survey (NHMS) 2022 that found 98.1 per cent of pregnant mothers receiving antenatal care with at least four visits, 98.4 per cent of births are in a hospital, and 95 per cent of mothers receive periodic examinations in clinics after giving birth.
The health minister did not explain why Malaysia’s MMR has stagnated in the high 20s for nearly two decades – more than double the rate of developed countries – nor why Putrajaya and Labuan reported above-40 maternal mortality rates, aside from citing a small denominator in the federal territories.
According to the global maternal mortality report, MMR is classified as “very low” if it is less than 20 maternal deaths per 100,000 live births and “low” for less than 100.
Dzulkefly told Parliament that the Ministry of Health (MOH) has taken several measures to improve services to reduce maternal deaths, including a campaign on a child’s first 1,000 days, improving pre-pregnancy health care for women with chronic conditions, as well as specific interventions to address the main cause of maternal mortality, like giving thromboprophylaxis to pregnant women and postnatal mothers with the risk of pulmonary embolism.
The MOH is also increasing the quality of health care services, such as training on managing obstetric emergency cases, besides improving access to specialist services.
