Thailand’s actual maternal mortality rate is up to five times higher than officially recorded numbers, according to recent findings from the Thailand Development Research Institute (TDRI).
The TDRI research, which analysed data from a variety of sources including the National Health Security Office, Central Office for Healthcare Information and the civil registry, found that significantly more women die in childbirth than that cited by official figures, said Worawan Chandoevwit, a TDRI researcher.
The TDRI’s latest available data, from 2011, cites the maternal death ratio as 36.69 deaths per 100,000 live births, or 290 maternal deaths annually. But the official records say only 8.9.
Similarly, official records from the Public Health Ministry in 2007 show a maternal death ratio of 12.2 deaths per 100,000 women, but the TDRI found that 421 women had died in childbirth that year, bringing the ratio up to 62.51 deaths per 100,000 live births.
Ms Worawan attributes the gap between the actual rate and that recorded in figures to a problem of data collection.
The ministry only uses hospital reports as a source of data, she said. Meanwhile, many women in rural provinces do not go to hospitals to give birth. The highest maternal mortality rates occur in the southernmost provinces, which fall under the Ministry of Health’s service region 12, and include Songkhla, Pattani, Yala, Narathiwat, Phatthalung, Satun and Trang, where the maternal death ratio is 69.29 dead per 100,000 live births.
Cultural factors may prevent mothers from having a safe delivery in hospital, said Ms Worawan, adding that in some areas pregnant mothers don’t want to give birth if the obstetrician is male.
Meanwhile, in the lower northern provinces and the central provinces, maternal mortality is also high due to pregnancies at a young age, attempted abortions among teenage mothers and the poor health of mothers over the age of 35.
High maternal mortality is often found in areas with low-income populations, according to Ms Worawan, who said the government should adopt policies to combat the deadly trend based on what is causing women to die in that region. “A national policy to reduce maternal deaths can’t be imposed in all areas. The ministry should study the causes in each area thoroughly,” she said.
According to a 2013 World Health Organisation report, Thailand’s maternal mortality rate (26 per 100,000 live births) is on par with countries such as Kazakhstan (26) the Republic of Korea (27), Brunei (27), Malaysia (29) and Armenia (29). Most developed countries, such as Japan, have a maternal mortality ratio of about five per 100,000 live births. Thailand’s record is still far behind those in developed countries, Ms Worawan said.
The TDRI research also found the budget for government-funded healthcare schemes was significantly lower than for the Universal Healthcare Coverage for Civil Servants’ Welfare (CSW) scheme.
The UC spent 52,000 baht, on average, on a patient’s healthcare in the past year while the CSW spent 98,000 baht. The UC budget is spent on a capitation method, where physicians are paid for each person assigned, while the CSW has an openended budget.
First published in Bangkok Post, 27 August 2015