Lack of access to maternal healthcare services puts refugee women at risk
Pregnant women from refugee communities in Malaysia have limited access to adequate maternal healthcare services, such as antenatal and postnatal care, skilled birth attendants, emergency obstetric care, and family planning services, leading to a high rate of maternal mortality.
According to a study conducted by the United Nations High Commissioner for Refugees (UNHCR) in 2019, the maternal mortality rate among refugees in Malaysia was estimated to be 62 per 100,000 live births, which is significantly higher than the national average of 36 per 100,000 live births.
The same study also found that the leading causes of maternal mortality among refugees in Malaysia were postpartum hemorrhage and hypertensive disorders. There is no updated available data since 2019 and, from what we witness in our clinics, there is no reason to believe the situation among this group has improved.
Lack of legal status limits access to healthcare
Malaysia is not a signatory to the 1951 Refugee Convention and does not have domestic laws recognising and protecting refugees. This means that refugees do not have legal status in the country, which limits their access to healthcare, work and education.
While refugees registered with UNHCR Malaysia are entitled to a 50 per cent discounted foreigners’ rate in public healthcare services, most of them still cannot afford the reduced rate fee.
Accessing private health facilities will cost a refugee between RM100 and RM500 (Malay ringgit; about NZD36 and NZD184) for antenatal or postnatal screenings, while deliveries and emergency obstetric care can cost thousands of ringgit in both public and private facilities.
“With my husband’s income, rental and family expenses are barely covered. If we book an antenatal check-up at a private clinic, we could spend up to MYR600 (about NZD220),” says Nur*, a Rohingya refugee woman in Malaysia expecting her second child.
Threats of arrest and detention when seeking healthcare
The Ministry of Health’s Circular 10/2001 requires healthcare providers to report undocumented migrants, including refugees and asylum seekers, to the police or immigration services. As such, refugees who lack UNHCR documentation risk threats of arrest and detention when seeking treatment at public medical care facilities, especially when they are unable to pay medical fees. This results in fear and distrust of public healthcare staff.
Further obstacles refugees face are the lack of health awareness and language barriers, which prevent many pregnant refugee women from seeking care until late in their pregnancy, if at all.
To address the needs of refugees and asylum-seekers in Malaysia, Médecins Sans Frontières (MSF) is providing free basic healthcare and mental health services through our clinic in Butterworth, our mobile clinics in Penang and in our activities in immigration detention centres.
Services should be made more inclusive for refugees to ensure they have access to safe, adequate and affordable maternal healthcare.
MSF support to refugees in Malaysia
MSF refers patients to specialist and advanced healthcare, and supports an increasing number of victims of sexual and gender-based violence, including victims of human smuggling, both women and men. In 2022, our team in Malaysia conducted a total of 4,081 sexual and reproductive healthcare consultations, including antenatal, postnatal care and family planning, at our clinic in Penang.
We also refer unregistered refugee patients with heightened medical or protection needs to UNHCR for expedited registration, to facilitate their access to healthcare.
“The number of sexual and reproductive health consultations carried out by MSF clinic staff doubled from 200 consultations per month in early 2022 to some 500 consultations per month by the end of the year,” says Dirk van der Tak, MSF head of mission in Malaysia.
“This could be an indication of greater awareness of sexual and reproductive health services offered by MSF among refugee women,” says van der Tak. “But it could also mean that the need to access adequate maternal healthcare services for refugee women continues to increase.”
Healthcare services must be inclusive for refugees
“There is still a high number of consultations for late-in-term pregnancies we see in our clinics,” says van der Tak. “Additionally, in the first quarter of 2023, around 15 per cent of our consultations were related to teen pregnancies.”
“This continues to be a concern, as adolescent mothers are at greater risk of complications such as eclampsia (life-threatening high blood pressure in pregnancy), anaemia, or increased risk of adverse outcomes such as premature birth or stillbirth,” van der Tak continues. “The number of girls we see in our clinic is likely to be a fraction of those in need of services.”
While the number of antenatal consultations has increased in our clinics, this is only a small number of women who have accessed the services they need compared to the overall reproductive health needs of refugees in the country.
“There are 183,790 refugees and asylum-seekers registered with UNHCR in Malaysia as of the end of January 2023, 34 per cent of whom are women,” says van der Tak.
“Many more refugees in the community are struggling to access basic healthcare. Services should be made more inclusive for refugees to ensure they have access to safe, adequate and affordable maternal healthcare.”
*Name changed to protect identity
 United Nations High Commissioner for Refugees (UNHCR) titled "Maternal Health Among Refugees and Asylum-Seekers in Malaysia: An Assessment of Policies, Services and Barriers." The report was published in June 2020.