TEMPLATE DESIGN © Malaysia’s Progress in Achieving Millennium Development Goals: 5 Siva Achanna, (FRCOG) and Nik Mohd Nasri Ismail, (FRCOG) Department of Obstetrics & Gynaecology, Faculty of Medicine & Health Sciences Universiti Sains Islam Malaysia, Malaysia. Objectives Malaysia is a rapidly developing economy, comprising a multi-ethnic population. The fifth MDG deals with the reproductive health status of women, and aims for reduction of maternal mortality ratio (MMR) by 75% and provision of universal access to reproductive health by After declining substantially until the mid-1990s, the MMR has reached a plateau. Further declines may be tardy if high-risk women do not practice effective family planning. Greater efforts are required and attention needs to be focused on specific target groups and pockets of the population, such as the poor, marginalized and lesser educated groups with unmet need for contraception. The objective of this study is to evaluate and analyze the progress so far made in Malaysia to achieve the basic targets and indicators within MDG 5. In the seventies, Malaysia faced several difficulties to overcome geographical inequalities and accessibility towards health and educational services. These challenges have been met through synergy of policies, strategies and programmes that were implemented to improve maternal health taking into account the sensitivities of the socio- cultural, religious and traditional environment of the multi-ethnic communities of women in both West and East Malaysia. Setting: Malaysia Methods Ministry of Health Malaysia introduced the Confidential Enquiries into Maternal Deaths (CEMD) set up in The confidential enquiries into maternal deaths have allowed identification of key deficiencies in the training and capacity of midwives and doctors 2. The proportion of births attended by skilled health care personnel (an accredited midwife, doctor or nurse) trained in skills is monitored. In terms of universal access to reproductive health, various measures contributing to the health and well- being of mothers were viewed through prevention, implementation and surveillance of the various targets and indicators are undertaken (Fig.1). The basic targets and indicators were: 1.Maternal mortality ratio 2.Proportion of births attended by skilled health personnel 3.Contraceptive prevalence rate 4.Adolescent birth rate 5.Antenatal coverage In the seventies, marked disparities in the MMR levels of the different ethnic groups were seen which narrowed out by the nineties(Fig.2). Results The MMR was 44 per 100,000 live births at the inception of CEMD in 1991, and the rate declined to 28.1 in 2000 and subsequently witnessed a plateau at 27.3 in Further reduction of maternal mortality became a challenge because of indirect causes of maternal deaths that require specialized skills, multidisciplinary case management and prevention of pregnancies in the high- risk mothers. Every maternal death is a tragedy 4,5 and is the raison d’etre for the establishment of confidential enquiry system. High MMR is noted among the indigenous (orang asli) and undocumented immigrants in Sabah. Factors contributing to the reduction of MMR are the national commitment to improve maternal health through the allocation of resources for health care, access to professional care during pregnancy and childbirth and increasing access to quality family planning services and information. The proportion of births attended by skilled health personnel has increased since 1990, and since 2004, has been consistently above 95%. Safe deliveries in all states increased from 74.2% in 1990 to 97.6% in 2008 (Fig.3). The contraceptive prevalence rate doubled from 26.3% in 1974 to 52% in 1984, staying at 50% thereafter 6. Steps are taken in training health-care providers and introducing effective family planning among high-risk mothers(Fig. 4). Conclusions References To improve maternal health further, education and empowerment of women are essential to enhance better reproductive health services. The scope of Maternal and Child Health (MCH) facilities needs further appraisal and urgent implementation. Malaysia is now working to advance up the economic value chain and enhance its competitiveness. The “unmet need for contraception” and further reduction of maternal mortality are the 2 indicators of MDG 5 that need further comprehensive attention. With only 3 years left, much can be achieved through strong political will, interagency co-operation, health infrastructural development, quality initiatives and total dedication of health care givers. 1.W.J.Graham, J. Hussein. Universal reporting of maternal mortality: An achievable goal? Int J Gynecol Obstet 2006;94: Suleiman AB, Mathews A, Jegasothy R, Ali R, Kandiah N. A strategy for reducing maternal mortality. Bull World Health Organ 1999; 77: Malaysia: The Millennium Development Goals at Lewis G. Confidential enquiries into maternal deaths, WHO. Beyond the numbers: reviewing maternal deaths and complications to make pregnancy safer. Geneva: WHO; 2004: Siva Achanna, Postpartum Haemorrhage: A continuing Tragedy in Malaysia. Med J Malaysia; 2011; 66: Malaysia achieving the millennium development goals, successes and challenges, MDG 5: Improve Maternal Health OPTIONAL LOGO HERE The adolescent (15-19 years) birth rates declined from 28 births per 1,000 adolescents in 1991 to 13 in The antenatal first-visit coverage increased from 78% in 1990 to 94.4% in The average number of antenatal visits was nine in Efforts to improve the contraceptive prevalence rate and “unmet needs” of family planning amongst pockets of vulnerable high-risk mothers, living in remote, inaccessible areas are ongoing (Fig. 5).