Infant and maternal deaths have drastically declined in Malaysia over the past 40 years due to the implementation of maternal care strategies in the national health care system, said International Planned Parenthood Federation regional director Dr Raj Karim today.

She said the key statistics illustrating this trend include the infant mortality rate, which fell from 75.5 deaths per thousand births in 1957 to 6.3 deaths in 2001, as well as the maternal mortality rate which fell from 320 per thousand births to 30 over the same period.

"The major problems that we faced were maternal and infant mortalities. In the 1960s and 1970s the government spend a lot of time, money and effort to build up rural health care infrastructure.

"This was later formalised by the setting up of the maternal and child health (division) in the Health Ministry," she said in her paper titled 'Reducing Maternal Mortality: The Malaysia Experience' at the Averting Maternal Death and Disability (AMDD) conference in Kuala Lumpur.

Raj said the integration of these strategies within the national health care grid was essential to ensure implementation was sustained over long term periods.

In addition to this, she stressed that proponents of this strategy successfully lobbied for maternal and child care initiatives to be included in rural development programmes as well as poverty alleviation schemes.

Rural problem

Raj said the problem also received high priority because of the differences in statistics for the different racial groups in Malaysia.

"The Chinese had much lower rates than the Malays and Indians. So we had to work to narrow the divide as well," she added.

Among the reasons for high mortality rates within certain communities, Raj said one was because of limited access to proper health care facilities.

"In the early periods, we found that most maternal and infant deaths occurred at homes and among those attended by traditional birth attendants," she said.

Although there were health care facilities available, she said a large number of people did not feel comfortable using the services. Another causal factor was the lack of training among midwives to deal with birth complications.

However, Raj said these problems were dealt with by improving staff skills, communication devices within rural health care facilities and increasing confidence in health care facilities.

Consequently, she said the shift in preferences from home deliveries to hospital deliveries has led to hospitals to suffer from overcrowding.

She said Malaysia now has to consider implementing strategies to cope with the overcrowding, including the setting up of low-risk delivery centres in urban areas as well as alternate birthing centres in rural areas.

The three-day AMDD conference was held for participants from more than 50 countries to discuss ways to improve maternal and child care facilities, particularly in developing countries.

Malaysia, considered one of the more successful countries, was called upon to share the country's experiences over the past four decades in the field.