NATIONAL STRATEGIC PLAN OF ACTION

TOWARDS ACHIEVING MILLENNIUM

DEVELOPMENT GOALS (MDG) 4 & 5

By:DIVISION OF FAMILY HEALTH DEVELOPMENT

MINISTRY OF HEALTH MALAYSIAJANUARY 2011

CONTENTS

Tables ............................................................................................ 2Figures ........................................................................................... 3

Foreword ........................................................................................ 4

1 Background .................................................................................... 9

2. Millennium Development Goal 4: Reduce Child Mortality .............. 112.1 Situational Analysis ................................................................ 11

2.1.1 Infant Mortality Rate (IMR) .......................................... 112.1.2 Under-5 Mortality Rate (U5MR) ................................... 132.1.3 Proportion of One-year olds Immunised Against Measles ....................................................................... 15

2.2 Past and Future 162.2.1 Trend of IMR and U5MR with Interventions 162.2.2 Projection of IMR and U5MR 172.2.3 Targets for IMR and U5MR by States for 2015 18

3. Millennium Development Goal 5: Improve Maternal Health............ 193.1 Situational Analysis ................................................................ 19

3.1.1 Maternal Mortality Ratio (MMR) ................................... 193.1.2 Contributing Factors for the Maternal Death................ 213.1.3 Proportion of Births Attended by Skilled Health

Personnel ...................................................................22

3.1.4 Contraceptive Prevalence .......................................... 223.1.5 Adolescent Birth Rate ................................................. 24

3.2 Past and Future 253.2.1 Trend of MMR with Interventions ................................. 253.2.2 Projection of MMR ....................................................... 253.2.3 Targets for MMR by States for 2015 ........................... 27

4. Conclusion ..................................................................................... 28

5. The Way Forward ........................................................................... 28

6. References ..................................................................................... 29

7. Contributors .................................................................................... 30

1

TABLES

Table 1: Goals, Target and Indicators for MDG 4 and MDG 5 9-10

Table 2: Under-5 death, IMR by States, 1990 and Targets for 2015 18

Table 3: Maternal death, live births and MMR by states, 1998, 2000 and

2007

20

Table 4: Causes of Maternal Death 1997 and 2007 21

Table 5: Targets of MMR by States for 2015 27

2

FIGURES

Figure 1: Infant and Under-5 Mortality Rates, Malaysia, 1970-2008 11

Figure 2: Infant and Neonatal Mortality Rates in Malaysia,1990-2007 12

Figure 3: Top 6 causes of Infant Death (government hospitals) 12

Figure 4: IMR by states 2002-2006 13

Figure 5: Causes of Under-5 Death (government hospital) 14

Figure 6: Proportion of under-5 Deaths for hospitals and non hospitals

14

Figure 7: Under-5 Mortality Rates by States, Malaysia 2002-2006 15

Figure 8: Proportion of 1 year-olds immunised against measles 16

Figure 9: Intervention and Trend of infant and under-five mortality rates 1955-2007

16

Figure 10: Projection of infant and under-five mortality rates by 2015 17

Figure 11: Maternal Mortality Ratio, 1950-2008 19

Figure 12: Safe delivery and antenatal care 22

Figure 13: Contraceptive Prevalence Rate in Malaysia 23

Figure 14: Age Specific Fertility Rate among women aged 15-19 years by ethnic groups

24

Figure 15: Intervention and Trend of MMR, 1933-2005 25

Figure 16: Maternal Mortality Ratio 2000-2008 and Projection for 2015 26

3

FOREWORD

OPENING MESSAGEBY

Y.BHG. TAN SRI DATO’ SERI DR. HJ. MOHD ISMAIL BIN MERICANDIRECTOR GENERAL OF HEALTH MALAYSIA

25th June 2010 9:00am – 12noon

Bilik Gerakan, Level 4, Block E7, Putrajaya

MEETING ON ‘MILLENNIUM DEVELOPMENT GOAL (MDG) 4 DAN 5: HOW IS MALAYSIA FARING’

1. INTRODUCTIONThe Millennium Development Goals (MDG) was agreed upon by 189 world leaders at the United Nations Summit in September 2000. It consists of 8 goals, 21 targets and 60 indicators, with special relevance to population, development and health. The target year for achieving the MDGs has been set for 2015, with 1990 being the baseline. Of these 8 MDGs, only MDG4, 5 and 6 are directly related to health, though the health sector has a stake in the other MDGs as well.

Malaysia has set to achieve the various MDGs by 2015. MDG4 & 5 are of concern because, although Malaysia has made remarkable progress in the reduction of both child and maternal mortalities since independence, from the year 2000 both mortalities have been more or less stagnant. If we do not intervene now, Malaysia will not be able to achieve the set target for MDG4 & 5 by 2015.

2. MDG 4 AND 5

2.1 MDG 4 is to reduce child mortality by two-thirds, between 1990 and 2015 and the three indicators for monitoring the progress are:- Infant mortality rate (IMR) which steadily declined from 40.8

per 1,000 live births in 1970 to 13.1 in 1990 (reduction of 68% in 20 years), and it further reduced to 6.5 in 2000 (reduction of 50% in 10 years). The IMR in 2008 was 6.4 (reduction of only 1.5% in 8 years). The target by 2015 is 4.4 (based on two thirds of 1990 data i.e 13.1).

Under-5 mortality rate declined from 57 per 1,000 live births in 1970 to 16.8 in 1990 (reduction of 70% in 20 years) and it further reduced to 8.9 in 2000 (reduction of 47% in 10 years). In 2008, the rate was 8.1 (reduction of 9% in 10 years). The target by 2015 is 5.5 (two thirds of 1990 data i.e 16.8).

4

Proportion of 1 year old children immunized against measles increased from 70% in 1990 to 94.3% in 2008. The target is for more than 95% coverage by 2015.

Among the above three indicators mentioned, immunization against measles is achievable. The major cause of IMR and Under-5 are linked with the neonatal period (55%). The most common cause of neonatal deaths are immaturity, lethal congenital malformation and asphyxia neonatarum.

2.2 MDG 5 is to improve maternal health. There were two indicators initially for this goal; maternal mortality ratio (MMR) and safe deliveries. In 2005, another four indicators were added for universal access to reproductive health.

The two indicators that have been showing good progress are:- Proportion of birth attended by skilled health personnel,

which has increased from 92.9% in 1990 to 98.6% in 2008 (target - to achieve more than 90%).

Antenatal coverage which has increased from 78% in 1990 to 94% in 2008 (no target set)

However, there is poor progress since last decade in the following indicators:- Maternal mortality ratio (MMR) declined from 140 per

100,000 live births in 1970 to 20 in 1990 (reduction of 85% in 20 years). However, with the establishment of Confidential Enquiries into maternal deaths (CEMD) in 1991, the MMR was 44 per 100,000 live births. MMR declined from 44 in 1991 to 28.1 in 2000 (reduction of 32% in 19 years). Since 2000, MMR has plateauted and was 28.9 in 2008. The target by 2015 should be 11 (reduction of three quarters based on 1991 data), however, the target has been adjusted and agreed to 20.

Even though there is no target set, the contraceptive prevalence rate (CPR) has declined from 54.5% in 1994 to 51.9% in 2004 (CPR in Sri Lanka 70, Singapore 62 in 2004).

The other two indicators without any targets set are: Adolescent birth rate declined from 28 in 1990 to 13 in 2008 Unmet needs for family planning

3. SUMMING UP

I look forward to today’s discussion to see the big picture from the public health’s perspective and the specific interventions in obstetric and pediatrics services that can narrow the gaps and give maximum impact in the next five years.

5

OPENING MESSAGEBY

Y.BHG. TAN SRI DATO’ SERI DR. HJ. MOHD ISMAIL BIN MERICANDIRECTOR GENERAL OF HEALTH MALAYSIA

1st November 2010 9:00am – 1.00pm

Bilik Gerakan, Level 4, Block E7, Putrajaya

MESYUARAT PROGRES PERLAKSANAAN KE ARAH MENCAPAI SASARAN “MILLENNIUM DEVELOPMENT GOALS” MDG 4 dan 5

1. WHERE ARE WE?

This meeting is a follow up of the 1st meeting, which I chaired on 25th

June 2010. During that meeting, it was informed that Malaysia has committed to achieve the 8 MDGs by 2015, however, MDG4 & 5 are of concern because, both child and maternal mortalities from the year 2000 have been more or less stagnant.

Maternal and child mortality tragedies can be easily averted. We know how to prevent these needless deaths and effective interventions exist. This is what makes these deaths doubly tragic.

2. CALL TO ACTION

I have been informed that following the 25th June 2010 meeting, several other meetings have been held to discuss in depth the strategies required to attain MDG4 & 5. The presentations today from the public health, obstetric and pediatrics services will show us the approach and direction which we will be heading in the next five years. The specific interventions discussed should narrow the gaps and give maximum impact by 2015.

3. SUMMING UP

We have another 1,886 DAYS (5 years, 2 months) left. No child below five years old should die and no woman should die giving life in Malaysia. We must hold each other accountable. We have a tremendous responsibility to do what we must do - now!

6

TALKING POINTSY.BHG TAN SRI KETUA PENGARAH KESIHATAN

MESYUARAT KPK – KHAS BIL. 5/201022 NOVEMBER 2010

Millenium Development Goals (MDG 4&5)

1. Malaysia telah memberi komitmen untuk mencapai sasaran MDG menjelang 2015, namun MDG 4&5 dikhuatiri sukar untuk dicapai kerana tren kematian ibu dan kanak-kanak didapati mendatar semenjak tahun 2000. Semua negeri perlu sedia Pelan Tindakan dan pencapaian akan dipantau pada setiap Mesyuarat KPK Khas. Mulai tahun 2011, MDG 4&5 dijadikan sasaran dalam SKT Pengarah Kesihatan Negeri.

2. Strategi sedia ada perlu disemak untuk penambahbaikan dan cabaran dalam penjagaan kesihatan ibu dan kanak-kanak perlu dikenalpasti dan diatasi. Perkara berikut perlu diberi keutamaan;

- Combined clinics- Red Alert system- Klinik Pra-kehamilan - Menyediakan perkhidmatan perancang keluarga di

hospital - Memaklumkan klinik kesihatan berkenaan bagi setiap

kes yang di discaj dari hospital agar lawatan postnatal boleh dijalankan

- Membuat semakan dan mengukuhkan perkhidmatan ‘retrieval services’

3. Pengarah Kesihatan Negeri juga perlu memastikan tindakan berikut diambil;

mempengerusikan mesyuarat Kematian Ibu dan kanak-kanak peringkat negeri. Unit Kawalan Amalan Perubatan Swasta disarankan menjadi ahli tetap mesyuarat , kerana terdapat kematian ibu dan anak di hospital swasta dan rumah bersalin.

Pegawai Kesihatan Daerah menjalankan mesyuarat Kesihatan Ibu dan Kanak-kanak pada setiap bulan.

Semua doktor dan anggota kesihatan primer menjalani kursus dalam perkhidmatan bagi pengendalian kecemasan obsterik.

Semua doktor dan jururawat baru di credentialed dalam perkhidmatan obstetrik dan pediatrik sebelum dihantar ke peringkat kesihatan primer.

7

Pengarah hospital hendaklah membuat audit dan pemeriksaan mengejut ke wad, dewan bedah, wad bersalin dan persekitaran.

Pakar Perunding O&G dan pediatrik Negeri mesti menjalankan ‘ward round’ setiap hari dan sentiasa dapat dihubungi. Mereka hendaklah membimbing pegawai-pegawai dibawah seliaan mereka supaya kompeten dan mahir.

- Memastikan pakar O&G bertugas di wad bersalin 24 jam dan memberi perkhidmatan kaunseling perancang keluarga

- Semua jururawat yang telah menjalani latihan post basik ditempatkan mengikut disiplin

- Memperkukuhkan aktiviti lawatan rumah mengikut jadual yang ditetapkan

- Ketua Jururawat Kesihatan Daerah mengaktifkan kembali aktiviti lawatan ke hospital yang berdekatan setiap hari untuk mendapatkan maklumat terkini berkaitan dengan ibu mengandung, kanak-kanak bawah 5 tahun, kematian dan kelahiran

8

9

1. BACKGROUND

In September 2000, 189 Heads of State endorsed the United Nations

Millennium Declaration. The declaration was translated into eight

Millennium Development Goals (MDGs) to be achieved by 2015.

Progress towards achieving the MDGs is monitored through

measurable targets and indicators for each MDG.

Table 1: Goals, Targets and Indicators for MDG 4 and MDG 5

Goals and Target

Indicators for Monitoring Progress

Target in 2015(MALAYSIA)

Goal 4: REDUCE CHILD MORTALITY

Target : Reduce by two-thirds, between 1990 and 2015, the under 5 mortality rate

i. Under 5 mortality rate

5.5/1000 live births

ii. Infant mortality rate 4.4/1000Livebirths

iii. Proportion of one-year-old children immunized against measles.

>95.0%

Goal 5: IMPROVE MATERNAL HEALTH

Target 5A: reduce by three quarters, between 1990 and 2015, the Maternal Mortality Ratio

i. Maternal mortality ratio

11/100,000 Live births (reduction of ¾ based on 1991 data)

ii. Proportion of births attended by skilled health personnel

>95.0%

Target 5B : Achieve by 2015, Universal Access To Reproductive Health

i. Contraceptive prevalence rate

60% (for modern methods)

ii. Adolescent birth rate

7/1000 female population 15-19 years

10

Goals and Target

Indicators for Monitoring Progress

Target in 2015(MALAYSIA)

iii. Antenatal care coverage (at least one visit and at least four visits)

> 95.0 %

iv. Unmet need for family planning

25.0% (modern methods)36.2% (2004) for modern methods

11

2. MILLENNIUM DEVELOPMENT GOALS (MDG 4): REDUCE CHILD MORTALITY

2.1 Situational analysis

Malaysia has shown good progress with MDG 4. The progress

made is evidenced by the reduction of the under-5 mortality rate

(U5MR) and also IMR.

2.1.1 Infant Mortality Rate (IMR)

The infant mortality rate has reduced from 39.4 per 1,000

live births in 1970 to 13.0 per 1,000 live births in 1990

and then to 6.2 per 1,000 live births in 2008.The infant

mortality rate was halved from 1990 to 2000. It has since

stabilised around 6 per 1000 live births. (Figure 1.)

Similarly the neonatal mortality rate (deaths in the first 28

days after birth) has been halved from 1990 to 2008,

from 8.5 per 1000 births to 4.0 per 1000 births (Figure 2).

Figure 1: Infant and Under-5 Mortality Rates, Malaysia, 1970-2008

12

Figure 2: Infant and Neonatal Mortality Rate Malaysia, 1990-2007

Source: Department of Statistics, Malaysia

Among the leading causes of infant mortality are the

broad class of conditions classified as “certain conditions

originating in the perinatal period”, followed by

“congenital malformations, desformations and

chromosomal abnormalities” (Figure 3).

Figure 3 : Top 6 causes of Infant Death (government hospitals)

Source: Health Informatics Centre, MOH

13

Figure 4 shows the states that have achieved higher IMR

for 2006 in comparison to the national average of 6.2 per

1,000 live births.

Figure 4: Infant Mortality Rates (IMR) by states 2002-2006

Source: Health Informatics Centre, MOH

2.1.2 Under-5 Mortality Rate (U5MR)

There was a large reduction in U5MR from 57 per 1,000

live births in 1970, to 16.8 per 1000 live births in 1990

(Figure 1). Since 1990, the U5MR has declined at a

slower pace to reach 8.1 in 2008.The leading causes of

under-5 mortality are those arising in the perinatal period

followed by congenital malformation, infectious and

parasitic diseases, respiratory diseases, and circulatory

diseases (Figure 5). More than three quarters of under-

five deaths occurred in hospitals. Data from the under-

five survey shows an increase in the number of deaths

taking place in hospitals (Figure 6), thus increased use of

healthcare facilities, but also suggesting that there may

be delays in seeking treatment.

14

6.2

Figure 5: Causes of Under-5 Death (government hospitals)

Source: Health Informatics Centre, MOH

Figure 6: Proportion of Under-five Deaths for Hospitals and Non-Hospitals

Source: Under-5 Mortality Study 2006

.

15

Under-5 mortality rates vary in different states, with some

states consistently above the national figure of 7.9 per

1,000 live births. (Figure 7)

Figure 7: Under-5 Mortality Rate by States, Malaysia, 2002-2006

16

7.9

source: Health Informatics Centre, MOH

2.1.3 Proportion of one-year olds immunised against measles

Malaysia has achieved almost full coverage of

immunisation of one year-olds against measles. In 2008,

94 per cent of one year-olds were immunised for

measles, in combination with mumps and rubella (MMR),

up from 70 per cent in 1990. Figure 8 shows the

improved immunisation coverage by state. The

apparently low rates for W.P. Kuala Lumpur can be

explained by parents seeking immunisation from the

private sector and by parents taking their children to the

neighbouring state, Selangor, to be immunised. There is

weakness in the reporting system of immunisation

coverage from the private to the public sector, leading to

the inaccuracies. States showing more than 100%

coverage was due to immunisation given to children from

other states, under registration of live births and

coverage of foreigners. Besides routine Immunisation, a

catch-up program of measles vaccination to all school

children was carried out in 2006. This is essential in

providing universal protection against measles in the

community.

Figure 8: Proportion of 1 Year- Olds Immunised Against Measles

17

2.2 Past and Future

2.2.1 Trend of IMR and U5MR with Intervention

Factors contributing to the success in the reduction of

child mortality are summarised in Figure 9.

Figure 9: Interventions and Trends of IMR and Under-5 Mortality 1955-2007

Source: Family Health Development Division, MOH

2.2.2 Projection of IMR and U5MR

Figure 10 shows projection of infant and under-5

mortality rates for 2015. The target is to reduce further

IMR and Under-5 Mortality Rate to 4.3 and 5.5

18

respectively and this is translated to 2460 infant deaths

and 2009 under-5 deaths by 2015. The targets are

calculated based on the estimated number of live births

for each state, using 2008 data.

Figure 10: Projection of Infant and Under-5 mortality rates by 2015

Source : Department of Statistics

2.2.3 Targets for IMR and U5MR by States for 2015

Table 2 below shows the target for 2015 by states.

Table 2: Under-five and Infant Mortality by state, 1990 and target for 2015

   STATES U5MR per 1,000

live birthsIMR (per 1,000

live births)

1990 Target Number 1990 Target Number

19

for 2015

of deaths

for 2015(Target)

for 2015

of deaths for 2015(Target)

Malaysia 16.8 5.5 2009 13.1 4.4 2460Johor 16.6 5.7 254 13.4 4.6 308Kedah 18.8 6.2 178 14.6 4.9 224Kelantan 17.6 6.3 196 13.5 4.5 218Melaka 13.8 5.0 66 11.1 4.2 89Negeri Sembilan

15.6 4.8 74 12.7 3.7 95

Pahang 20.7 5.9 135 15.9 3.4 154Perak 17.7 4.9 156 13.2 4.4 183Perlis 20.7 7.2 23 16.9 5.6 27Pulau Pinang 12.2 6.5 81 10.2 3.4 105Sabah 21.4 8.3 110 16.3 5.6 142Sarawak 12.7 4.6 170 10.0 3.3 208W.P Labuan NA 9.7 7 NA 3.5 12Selangor a 14.6 3.3 342 11.7 1.5 427

Terengganu 20.2 6.0 135 15.3 5.1 173 W.P. Kuala Lumpur

12.0 4.9 80 9.6 1.3 95

Calculation were made based on 9.0 % reduction per year from 2008‘a’ : Including PutrajayaN.A.: Not Available

3. MILLENNIUM DEVELOPMENT GOALS (MDG 5): IMPROVE MATERNAL HEALTH

3.1 Situational Analysis

3.1.1 Maternal Mortality Ratio (MMR)

20

Long-term trend of the maternal mortality ratio for

Malaysia shows impressive declines (Figure 11). The

MMR has undergone a most remarkable transformation

in the country’s medical history; a decline from 530 per

100,000 live births in 1950 to 28.9 maternal deaths per

100,000 live births in 2008 (Dept. of Statistics, 2010). A

steep decline occurred in the MMR in the decade

between 1970 and 1980 when it fell from 141 to 56 per

100,000 live births, a decline of 40 per cent. The rapid

decline continued throughout the 1980s such that by

1990 the MMR was just 19 per 100,000 births. Since

2000, the MMR has remained relatively stagnant at

around 28-30 per 100,000 live births (Figure 11). Further

reductions in the maternal mortality ratio will be more

difficult given the fairly low levels achieved thus far and

will require a different strategic thrust. Table 3 shows the

status of maternal mortality by states.

Figure 11: Maternal Mortality Ratio 1950-2008

0

100

200

300

400

500

600

1940 1950 1960 1970 1980 1990 2000 2010 2020

Dea

ths

per 1

00,0

00 li

ve b

irth

s

Maternal mortality ratios, Malaysia 1950-2008

Source: 1950-1990 DOS; 1991-2008 CEMD, MOH.

15

25

35

45

1990 1995 2000 2005 2010

Table 3: Maternal deaths, Live Births and Maternal Mortality Ratios by State, 1998, 2000 and 2007

State 1998 2000 2007Number

of Maternal Deaths

Live Births (LB)

MMR (per

100,000 LB)

Number of

Maternal Deaths

Live Births (LB)

MMR (per

100,000 LB)

Number of

Maternal Deaths

Live Births (LB)

MMR (per

100,000 LB)

21

Johor 19 57,091 33.3 12 67,907 17.7 29 56,865 51

Kedah 15 39,814 37.7 10 41,263 24.2 11 33,630 32.7

Kelantan 13 45,123 28.8 9 40,641 22.1 9 33,646 26.7

Melaka 7 15,951 43.9 2 15,672 12.8 2 13,260 15.1

Negeri Sembilan

2 19,142 10.4 1 19,394 5.2 5 16,866 29.6

Pahang 13 29,156 44.6 7 29,724 23.5 7 24,725 28.3

Perak 8 47,956 16.7 12 48,786 24.6 9 35,990 25

Perlis 1 4,692 21.3 0 4,656 0 2 3,927 50.9

Pulau Pinang

8 26,039 30.7 1 26,826 3.7 5 22,196 22.5

Sabah 21 54,738 38.4 68 56,352 120.7 20 47,535 42.1

Sarawak 8 46,083 17.4 7 50,689 13.8 11 41,840 26.3

Selangor 20 81,354 24.6 28 90,514 30.9 20 94,324 21.2

Terengganu 4 24,995 16 5 25,502 19.6 4 22,213 18

WPKL 14 32,844 42.6 6 31,617 19 3 25,031 12

Malaysia 153 524,978 29.1 168 549,543 30.6 137 472,048 29.0

Source: Department of Statistics

3.1.2 Contributing factors for the Maternal Death

The leading causes of maternal deaths can be classified

into two broad categories: direct and indirect deaths.

Direct obstetric deaths are those resulting from obstetric

complications of the pregnant state (i.e. pregnancy,

22

labour and the puerperium), from interventions,

omissions or incorrect treatment, or from a chain of

events resulting from any of the above. Indirect obstetric

deaths are those resulting from a previously existing

disease or a disease that developed during pregnancy

and which was not due to direct obstetric causes but

which was aggravated by the physiological effects of

pregnancy. The number of deaths by causes from the

Confidential Enquiry into Maternal Deaths (CEMD) for

1997 and 2007 are shown in Table 4.

Table 4: Causes of Maternal Death, 1997 and 2007

Causes 1997 2007No. Percentage No. Percentage

Postpartum Haemorrhage 31 19.6 23 16.9Hypertensive Disorders in Pregnancy

24 15.2 25 18.4

Obstetric Embolism 18 11.4 24 17.7Associated Medical Conditions 36 22.7 20 14.7

Obstetric Trauma 9 5.7 6 4.4Antepartum Haemorrhage 3 1.9 2 1.5Puerperal Sepsis 3 1.9 3 2.2Abortion 5 3.2 6 4.4Ectopic Pregnancy 2 1.3 7 5.1Unspecified Complications of Pregnancy & Puerperium

7 4.4 8 5.9

Associated with Anaesthesia 5 3.2 1 0.7Others 15 9.5 11 8.1Total 158 100 136 100

Source: Ministry of Health, Malaysia

3.1.3 Proportion of Births attended by Skilled Health Personnel

Skilled attendants at delivery are one of the fundamentals

necessary to reduce maternal mortality, particularly

mortality due to direct causes. The proportion of births

attended by health personnel increased from 92.9 per

23

cent in 1990 to 96.6 per cent in 2005 and to 98.6 per cent

in 2008 (Figure 12). The data covers all public and

private institutions reporting to the Ministry of Health.

Some omissions may occur in the case of deliveries in

private institutions, but those are captured by the

Department of Statistics and verified with the Ministry of

Health.

Figure 12: Safe Delivery and Antenatal Care

3.1.4 Contraceptive Prevalence

The National Population and Family Planning

Development Board conduct National Family Life

Surveys (NFLS) on a 10 yearly basis, starting from 1974.

A baseline study on family planning in 1966 in Peninsular

Malaysia estimated contraceptive prevalence rate (CPR)

at 8.8 per cent for married couples. In 1984, the NFLS

recorded a prevalence of 51.4 per cent and the most

recent survey, in 2004, estimated prevalence was at 51.8

per cent. (Figure 13)

Figure 13: Contraceptive Prevalence Rate (CPR) In Malaysia

24

Source: Population profile, Malaysia 1999

National Family Life Surveys 2004

For modern methods, prevalence has remained almost

unchanged at around 30 per cent since 1984. The use of

traditional methods declined from 22 per cent in 1984 to

16 per cent in 2004. The pill is the most popular method

of contraception. However, the percentage of married

women in the reproductive age using the pill declined

from 18 percent in 1974 to 13 percent in 1994 and 2004.

There has been a noticeable increase in the use of IUD,

condom, and injection as well as female sterilization

since 1974. The rhythm method is by far the most

popular traditional method, with a prevalence rate of

about 9 per cent in 1994 and 2004. The practice of other

traditional methods such as jamu, majun, other herbs,

exercise and incantation has declined substantially since

1984 (National Family Life Survey 2004).

3.1.5 Adolescent birth rate

The adolescent birth rate measures the annual number of

births to women 15 to 19 years of age per 1,000 women

in that age group. It represents the risk of childbearing

among adolescent women 15 to 19 years of age. It is

also referred to as the age-specific fertility rate for women

25

aged 15-19. High birth rates among young women pose

risks of maternal mortality and health. Adolescent

mothers also have their access to higher education

curtailed or have had to terminate their secondary

education. Those who are unmarried face a variety of

social and economic challenges and problems. Figure 14

shows the age-specific fertility rates among women aged

15-19 years by ethnic groups in Malaysia.

Figure 14: Age-specific fertility rates among women aged 15-19 years by ethnic groups

Source: Department of Statistics, MalaysiaOthers includes non citizens

3.2 Past and Future

3.2.1 Trend of MMR with Intervention

Figure 15: Interventions and Trend of Maternal Mortality Ratios, 1933-2005

26

3.2.2 Projection of MMR

Further reductions in the maternal mortality ratio will be

more difficult given the fairly low levels achieved thus far

and will require a different strategic thrust (Figure 15). It

is targeted that by the year 2015, the MMR will be 11 per

100,000 live births (based on estimated live births in

2008) and this is translated to an estimated 54 deaths.

(Figure 16 and Table 5)

Figure 16: Maternal Mortality Ratio 2000-2008 and projection for 2015

27

3.2.3 Targets of Maternal Mortality Ratio (MMR) by States for 2015

28

Table 5: MMR by States for 1991, 2000, 2008 and target for 2015

STATES 1991 2000 2008 2015 (Target)

MMR Number

Perlis 63 0 24.7 0 0

Kedah 62 20.3 26.4 11.0 4P. Pinang 23 4 36.2 12.7 3Perak 30 26.1 30.9 10.6 4Selangor 30 21.9 23.6 6.8 7F. T Kuala Lumpur 13 20.8 20.5 11.0 3F. T Putrajaya NA 0 0 0 0

N. Sembilan 58 29.3 42.3 11.0 2Melaka 49 58.2 46.0 13.8 2Johor 56 37.4 19.9 11.8 7Pahang 85 40.2 36.4 11.2 3Terengganu 27 29.3 4.4 12.5 3Kelantan 52 33.8 38.7 10.7 4Sabah 57 27.9 32.1 13.0 7F. T Labuan NA NA 0 0 0Sarawak 19 27.9 36.0 11.08 5Malaysia 44 28.8 28.2 11 54

Source: Department of Statistic Malaysia and CEMD, Malaysia

4. CONCLUSION

29

Malaysia has thus made important progress towards the MDG 4 and

MDG 5 targets, but a lot more needs to be done, including: improving

service provision especially referral, feedback and retrieval systems;

and increasing the coverage of maternal and child health services to

marginalized groups such as aborigines, the urban poor, immigrants

and unmarried women. No significant progress has been made on

MDG 4 and 5 since the last decade in Malaysia. The decline is very

limited and slow. MDG 4 and 5 requires reducing child and maternal

mortality at a much faster rate than the current state.

Five years remain until the 2015 decline to achieve the MDGs.

Progress is possible, if child and maternal health are sufficiently

prioritized at the implementation level and supported by strong political

commitment. The strategies need to be streamlined and our challenge

now is to scale up the time tested interventions with regular monitoring

and evaluation by the middle (state) and high level (ministry)

programme management team.

5. THE WAY FORWARD

Plan of Action developed for achieving MDG targets by 2015 are

available in the appendices attached.

5.1 National Strategic Plan of Action (Public Health) – Appendix 1

5.2 National Strategic Plan of Action (Obstetric) – Appendix 2

5.3 National Strategic Plan of Action (Paediatric) – Appendix 3

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6. REFERENCES

1. Yearbook of Statistics 2007, Department of Statistics2. A Study on Under Five Deaths in Malaysia in 2006, Ministry of Health3. The Third National Health and Morbidity Survey 2006 Volume 1 and

Volume 2.4. The Millennium Development Goals Report 2005, United Nations at

http://unicef.org/rightsite/sowc/statistics.php5. The Millennium Development Goals Report 2009, United Nations6. Report : National Seminar Towards Achieving The Health Millennium

Development Goals (MDGs),13-14 June 2005, Kuala Lumpur (MOH)7. Report on The Public Forum on The Right to Health: Achieving Health

MDGs, Human Rights Commission of Malaysia8. Malaysia Achieving The Millennium Development Goals 2005, UNDP9. Report on the Confidential Enquiries into Maternal Deaths in Malaysia

1997-2000, Ministry of Health10. Report on the Confidential Enquiries into Maternal Deaths in Malaysia

2001-2005, Ministry of Health11. Annual Report, Ministry of Health 200712. Annual Report, Ministry of Health 200513. Annual Report, Family Health Development Division (FHDD), Ministry

of Health 200914. Vital Statistics Malaysia Special Edition (2001- 2006)15. National Health and Morbidity Survey 111 (Volume 1)16. http://www.who.int/making_pregnancy_safer/topics/mdg/en/index.htm 17. National Adolescent Health Plan of Action, 2006 to 202018. Malaysia’s Health 2006, Ministry of Health19. FFPAM-RRAAM Consultation, Increasing Access to the Reproductive

Right to Contraceptive Information and Services; Progress at ICPD 15, 21st October 2008

20. The MDGs and Beyond: Pro Poor Policy in a Changing World Number 19, January 2010. International Policy Centre for Inclusive Growth, Poverty Practice, Bureau for Development policy, UNDP

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7. CONTRIBUTORS

(alphabetical order)

1. Dr. Asits SannaPegawai Kesihatan Keluarga Negeri, Jabatan Kesihatan Negeri Sabah

2. Dr. Arpah AliKetua Penolong Pengarah, Bahagian Perkembangan Perubatan

3. Dr. Che Asiah Bt TaibPegawai Kesihatan Keluarga Negeri, Jabatan Kesihatan Negeri Pahang

4. Dr Chin Choy NyokPakar Perunding Kanan Pediatrik, Hospital Tengku Ampuan Afzan, Pahang

5. Pn. Dasimah Bt AhmadKetua Penyelia Jururawat, Bahagian Kejururawatan, KKM

6. Dr. Faridah Abu BakarPegawai Kesihatan Keluarga Negeri, Jabatan Kesihatan Negeri Perak

7. Dr. Ghazali IsmailPakar Perunding Kanan O&G, Hospital Sultan Ismail, Johor Bahru

8. Dr. G. ThavamalarPegawai Kesihatan Keluarga Negeri, Jabatan Kesihatan Negeri Selangor

9. Dr. Hussain Imam Haji Mohammad IsmailPakar Perunding Kanan & Ketua Disiplin Pediatrik, Institut Pediatrik Hospital Kuala Lumpur

10. Dato Dr. H.S.S AmarPakar Perunding Kanan Pediatrik , Hospital Permaisuri Bainun, Ipoh

11. Dr. Hamimah Bt SaadPakar Perubatan Keluarga, Klinik Kesihatan Putrajaya

12. Pn. Habesah Bt Ab. LatifKetua Penyelia Jururawat, Jabatan Kesihatan Negeri Pahang

13. Dr. Irene CheahPakar Perunding Kanan Neonatologi, Institut Pediatrik Kuala Lumpur

14. Prof. Dr. Jamiyah Bt HassanPakar Perunding Kanan O & G, Pusat Perubatan Universiti Malaya (PPUM)

15. Dr. J.Ravichandran Pakar Perunding Kanan O & G, Hospital Sultanah Aminah, Johor Bahru

16. Dr. Jasvindar KaurPembangunan Kesihatan Komuniti, Institut Kesihatan Umum

17. Dr. Jafanita JamaludinKetua Penolong Pengarah, Bahagian Perkembangan Perubatan, KKM

18. Pn. Jama’iah Bt Alang Abd RaisKetua Penyelia Jururawat ( Perubatan), Jabatan Kesihatan Negeri Pahang

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19. Dr. Kamaliah bt Mohamad NohTimbalan Pengarah ( Kesihatan Primer), Bahagian Pembangunan Kesihatan Keluarga (BPKK), KKM

20. Dato Dr. Mukudan KrishnanPakar Perunding Kanan O&G dan Ketua Disiplin Obstetrik & Ginekologi Hospital Raja Permaisuri Bainun, Ipoh

21. Dr. Mymoon bt. AliasTimbalan Pengarah (Kesihatan Keluarga), BPKK, KKM

22. Dr. Muhaini Othman Pakar Perunding Kanan Perubatan, Hospital Serdang, Selangor

23. Dr. Mohamed Rouse Bin abd MajidPakar Perunding Kanan O&G, Hospital Tengku Ampuan Afzan, Pahang

24. Pn. Mahawa MananKetua Penyelia Jururawat Kesihatan, BPKK, KKM

25. Dr. Majdah bt Hj. MohamedKetua Penolong Pengarah (Kanan), BPKK, KKM

26. Dr. Norliza Ahmad, Pengarah Bahagian, Lembaga Penduduk dan Pembangunan Keluarga Negara (LPPKN)

27. Dr. Nik Rubiah Nik Abd. RashidKetua Penolong Pengarah Kanan, BPKK, KKM

28. Dr. Norsiah bt AliPakar Perubatan Keluarga, Klinik Kesihatan Tampin, Negeri Sembilan

29. Dr. Noridah Bt Mohd. SallehKetua Penolong Pengarah Kanan, BPKK, KKM

30. Dr. Nooraziah Bt Zainal AbidinKetua Penolong Pengarah Kanan, Bahagian Perkembangan Perubatan, KKM

31. Pn. Noorakidah Bt ShamaanPenyelia Jururawat, Jabatan Kesihatan Negeri Perak

32. Pn. Norizan Mashttah Bt MardanPenyelia Jururawat Kesihatan, BPKK

33. Dr. Paramjothi P.Pakar Perunding Kanan O&G, Hospital Selayang, Selangor

34. Dr. Rohaizat Bin Haji YonTimbalan Pengarah KananCaw Pembangunan Profesion Perubatan,Bahagian Perkembangan Perubatan, KKM

35. Dr. Rachel KoshyKetua Penolong Pengarah (Kanan), BPKK, KKM

36. Dr. Rohana IsmailKetua Penolong Pengarah (Kanan), BPKK, KKM

37. Pn. Rokiah bt Don

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Pengarah, Bahagian Pemakanan, KKM

38. Dr. Rosila YahayaKetua Penolong Pengarah (Kanan), BPKK, KKM

39. Dr. Rozita Ab RahmanKetua Penolong Pengarah (Kanan), BPKK, KKM

40. Dr. Safurah JaafarPengarah, Bahagian Pembangunan Kesihatan Keluarga, KKM

41. Dr. Soo Thian LianPakar Perunding Kanan Pediatrik, Hospital Wanita dan Kanak-Kanak Likas, Kota Kinabalu

42. Dr. Soon RueyPakar Perunding Kanan O&G, Hospital Wanita dan Kanak-Kanak Likas, Kota Kinabalu

43. Dr. Safiah BahrinKetua Penolong Pengarah (Kanan), BPKK, KKM

44. Dr. Sahaini HassanKetua Penolong Pengarah Kanan, Cawangan Kawalan Amalan Perubatan Swasta, KKM

45. Pn. Tan Phaik SimmPenyelia Jururawat Kesihatan, BPKK, KKM

46. Pn. Tumerah Bt SwandiKetua Jururawat Kesihatan, BPKK, KKM

47. Dr. Wong Swee LanPakar Perunding Kanan Pediatrik, Hospital Tuanku Jaafar, Seremban

48. Dr. Wan Hamilton Wan Hassan Pakar Perunding Kanan O & G, Hospital Serdang, Selangor

49. Dr. Yogeswary SithamparanathanPakar Perunding Kanan Pediatrik,Hospital Tuanku Ampuan Rahimah, Kelang

50. Dr. Zaleha bt Abd. HamidKetua Penolong Pengarah (Kanan), BPKK, KKM

51. Pn. Zainun Bt YahayaPenyelia Jururawat, Jabatan Kesihatan Negeri Selangor

We would also like to thank all those who sent feedback and suggestions during the various workshops and meetings for the preparation of this document.

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