KOTA KINABALU: New mother Noridah Saip is shocked.
The 40-year-old housewife, who already has five other children, gave birth to a boy, Mohamad Farhan Ramle, just last November.
“I’ve always given birth in government hospitals. I’ve never encountered any difficulty at all that put my babies’ lives at risk during delivery.
“I feel like the service I received was very good.
“I’m shocked to know that Sabah has the highest infant mortality rate in Malaysia, ” she said in an interview.
The Infant Mortality Rate, which tracks the number of deaths per 1,000 live births of children under the age of one, and used globally as an important indicator of children’s health in a country, has declined in Malaysia after years of improvement.
According to the Statistics Department's "Children's Statistics Malaysia 2019", the Infant Mortality Rate has gone up to 7.2 deaths per 1,000 live births in 2018, from 6.9 deaths in 2017 and 6.7 deaths in 2016 respectively.
This means for every 1,000 babies born in 2018, at least seven of them, on average, did not live past the age of one.
This is the first time that the Infant Mortality Rate has gone up in Malaysia since 1960, the year that the dataset was first released by the World Bank.
It also means that it is higher than the 7.1 deaths recorded by Malaysia 15 years ago in 2004.
The country’s overall Infant Mortality Rate for boys is also higher that that for girls in 2018 - 9.4 deaths per 1,000 live births for male babies compared with 8.2 deaths per 1,000 live births for female babies.
According to the report, the five states with the highest Infant Mortality Rates in Malaysia for 2018 were Sabah with 10.1 deaths per 1,000 live births, followed by Labuan (9.5), Putrajaya (9.2), Perlis (8.9) and Negri Sembilan (8.9). Authorities have blamed the high Infant Mortality Rate in Sabah on deaths among its migrant population, made up mainly of Filipinos.
The Health Ministry's Family Health division said it collected mortality notifications and reports through its 5 Mortality Reporting System (SU5MR) implemented since 2014.
The report noted that while there had been no significant increase in Infant Mortality Rate among citizens, for the infants among non-Sabah citizens, this had gone up by 60%.
The division said for 2017, its own data showed that the infant deaths among non-citizens in Sabah were higher than the national level.
"Non-citizens contributed to the increase of infant deaths in Sabah," it said in a statement.
When The Star interviewed Noridah, who is from Kampung Korina Kudat, she was taking shelter at SK Sikuati from floods that had inundated her home in Kudat, almost a three-hour drive from the state capital, Kota Kinabalu.
"The most important thing I think is to take care of you and your child, listening to the doctor’s advice and going for regular checkups, ” said Noridah, who was then still in confinement.
“Thanks to government officials and assistance, we managed to pull through and are safe from harm.”
Noridah is lucky; she and her self-employed husband live in a village, which is easily accessible and not too far from public health facilities.
With Malaysia already seeing a low fertility rate of 1.8 births per woman in 2018 and with nearly a quarter of the population expected to be aged 60 or over by the year 2040, and taking account of the higher Infant Mortality Rate and a growing anti-vaccination movement, are we failing our children? Or worse, compromising our future?
Health experts have cited poverty, inequalities to quality healthcare access, and insufficient government funds spent on healthcare services for the people, as the leading factors that contributed to the decline.
Consultant paediatrician Datuk Dr Amar Singh HSS pointed out that even the mortality rate for children under the age of five had also increased from 8.1 deaths per 1,000 live births in 2016 to 8.6 deaths per 1,000 live births to 2017.
“This means that out of 1,000 children in Malaysia, at least eight of them do not live past the age of five. And the figure goes up to as high as 15 or 16 in rural Sabah, based on statistics recorded by the Health Ministry.
“The increase in mortality rates tells us that our country is not developing. We are not progressing but regressing," he said.
Mortality rates, added Dr Amar, were a very sensitive indicator of the development of a country and children’s health
“This is related to how well we manage our children’s health, nutrition and the whole gamut, in raising them, ” he said.
“Different states will have different mortality rates. Some states may be higher.
“Urban places are doing much better on the west coast but if you look at places in Sabah or Kelantan, then the rates will definitely be higher, ” he said.
Dr Amar said there were still large pockets of poverty in the country - among the Orang Asli, the poor in rural Sabah, and those in the inner city areas.
“When we look at poverty-related factors, like among the ethnic groups of the Iban, Kadazan, Bidayuh, the Orang Asli and Penan, their Infant Mortality Rates are at least six times higher than the national rates, a terrifying figure, ” he said.
“If poverty is dealt with, our infant mortality rate will drop significantly, ” he said.
After 15 Orang Asli from the Bateq community in Kampung Kuala Koh, Gua Musang, Kelantan, died last year, Japanese anthropologist Dr Aya Kawai said in a forum that their Infant Mortality Rate was “significantly higher” than the national average.
Between 2011 and 2012, there were seven infant deaths out of 19 total births, which is 36.8%, much higher than the national rate of 0.64% in 2012.
Malaysians, said Dr Amar, spent an equivalent of about 4% of the country’s Gross Domestic Product (GDP) on healthcare, with the government forking out 2.2% and the people, another 1.8%.
“Many say healthcare is expensive but it is a basic right. Healthcare is only expensive because we allow private healthcare to flourish, ” he said, adding that more money was being spent on curative services - healthcare that treats patients with the intent of curing them - instead of prevention services.
“With 70% of our health budget going to hospitals instead of the community, we can never win in improving Infant Mortality Rates.
“The government has to look at the community health needs that are largely neglected, ” he said, pointing to the lack of intensive care beds for children at hospitals as another reason contributing to infant deaths.
“If we don’t have enough intensive care beds, nurses and resources to manage very ill children, then we will lose some there, ” he said, adding that intensive care was essential in treating prematurity problems, which was the topmost common cause of infant death.
Fifty percent of deaths involving children under five, he stressed, were preventable, with half of these cases due to parents having sought treatment late.
Human rights group Tenaganita's co-director Aegile Fernandez said both Malaysia and the people would only be better “until and unless healthcare and education are meant for all."
Earlier this year, three polio cases were discovered among children in Sabah’s huge migrant population, 27 years after the last such case was recorded in Malaysia in 1992.
All three had not been immunised against polio, the genetic strain of which has since been traced to the Philippines.
Sabah has since started a massive polio immunisation programme.
However, under Malaysia’s public healthcare system, children are protected against 11 other major diseases, including measles, mumps and pertussis.
“These migrants, including refugees and stateless people, are always in poverty and cannot afford to go to government hospitals or have nutritious food.
“When the women get pregnant, they often resort to home birth or end up abandoning the child, which may lead to infant deaths, ” said Fernandez, calling for them to be given equal access to public healthcare.
“Healthcare should be given to all to bring down the infant mortality rate.”
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