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National Health And Morbidity Survey 2016 : Maternal And Child Health (MCH) Volume II : Findings

8.1. ANTENATAL CARE

Contributors : S Maria Awaluddin, Rosnah Sutan, Shamala Devi Karalasingam, Noraziah Aboo Bakar, Chan Ying Ying,
Maria Safurah Mohammad, Norzawati Yoep, Faizah Paiwai, Hazrin Hashim, Rahama Samad, Muslimah Yusof,
Majdah Mohamed, Noor Ani Ahmad, Mohd Azahadi Omar, Tahir Aris

8.1.1. Introduction

Antenatal care coverage is one of the key health indicators used to track achievement progress
1
4
towards the Millennium Development Goal and 5 . Antenatal care is one of the four pillars of safe
motherhood. Antenatal care services are provided with the aim to improve pregnancy outcomes
through a series of monitoring activities in the management plan. These services are the foundation
of any maternal and child health care services provided by public and private facilities. In Malaysia,
these services are implemented through a coordinated integrated healthcare approach in the public
2
3
health system. The perinatal care manual was introduced in 2001 and revised in 2013 to help
healthcare providers in managing all stages of pregnancies: pre-pregnancy care, antenatal care,
intrapartum care and postnatal care. This manual has been implemented widely and is emphasised
through healthcare training and supervision as a program guidance for monitoring and evaluation.

Appropriate risk identification, management by type of providers and level of facilities as well as
appropriate referrals are the concepts of management under the pillars of primary health care. The
risk approach system using colour codes was formulated according to this concept and has been
implemented in Malaysia since 1987 and underwent 3 reviews for improvement .The primary
4
healthcare concept in providing this service has always been monitored through a district specific
approach in term of its accessibility, acceptability, adequacy, quality, continuity, equality,
technologically appropriateness and sustainability to fulfil disease preventive community health needs.

Empowering mothers and their family through good communication helps convey the messages on
risks and symptoms in pregnancy at every antenatal visit hence ensuring the pregnant women
towards a safer pregnancy. Antenatal visits also provide an opportunity to furnish information on birth
spacing, which is recognized as an important factor in improving infant survival. WHO recommends
a minimum of four antenatal visits based on a review of the effectiveness of different models of
antenatal care. It is important for pregnant women to start attending antenatal care visits before 12
1
weeks of gestation, for early risk identification, intervention and treatment aiming to reduce maternal
and perinatal morbidity and mortality. The National Health and Morbidity Survey 2016 were conducted
with an objective to determine the prevalence of maternity care service utilization among pregnant
women in Malaysia.

8.1.2. Findings

Table 8.1.2.1 showed that 97.4% (95%CI: 96.85-97.7) of respondents received adequate antenatal
visits as suggested by WHO with a minimum of 4 total visits. Antenatal care coverage in adolescents
aged 15-19 year was 94.0% (95%CI: 89.14-96.71), in the minority group (others) at 93.3% (95% CI:
87.86-96.37) and in non-Malaysians at 93.2% (95% CI: 88.11-96.19). Women with tertiary education
had four or more antenatal visits at 98.2% (95%CI: 97.60-98.72) as compared to women with no
formal education at 95.7% (95% CI: 75.56-99.38). 93.4% (95%CI: 74.43-98.57) of unemployed
women and 89.3% (95% CI: 69.05-96.89) of students had adequate antenatal visits. Women with

1. Indicators for Monitoring the Millennium Development Goals: Definitions, Rationale, Concepts and Sources [Internet]. New York: United Nations; 2012 Nov
19. 5.5 Antenatal care coverage (at least one visit and at least four visits); 2012 Mar 5 [cited 2013 Jul 1]; [about 3 screens]. Available
from:http://mdgs.un.org/unsd/mi/wiki/5-5-Antenatal-care-coverage-at-least-one-visit-and-at-least-four-visits.ashx
2. MOH.Perinatal care manual.2002. 1st edition.
3. MOH. Perinatal care manual, 2013. 3nd edition
4. Ravindran J, Shamsuddin K, Selvaraju S. Did we do it right? An evaluation of colour coding system for antenatal care in Malaysia. Med J Malaysia,
vol58(1), 2003, pp37-53.Available from: http://www.e-mjm.org/2003/v58n1/Colour_Coding_System.pdf