The number of mothers dying during childbirth is one of the most important indicators of a country's development. The latest findings by the Thailand Development Research Institute (TDRI) showing the country's actual maternal mortality rate is many times higher than the official statistics are therefore shocking.
It is true that Thailand's universal health care has been successful in saving mothers' lives. The TDRI study, however, has put a big question mark over the Public Health Ministry's ability to give a more accurate picture of maternal mortality.
The study also exposes the glaring disparity in healthcare services and the failure to serve women's health needs, particularly those of poor rural women and Muslim mothers in the restive South.
According to a study on health justice by TDRI researcher Worawan Chandoevwit, the actual maternal death ratio is at least five times higher than the official recorded numbers.
The gap in maternal death rate statistics is consistent over the period 2007-2011 in her study. In 2007, the official record is 12.2 per 100,000 against the TDRI's finding which is six times higher at 62.51. It is 11.3 against 58.25 in 2008; 10.8 against 46.69 in 2009; 10.2 against 45.06 in 2010; and 36.69 per 100,000 against 8.9 in 2011.
To be fair, the gap results from different methods of data collection. The Public Health Ministry relies on state hospitals' reports while a large number of women still give birth at home. Meanwhile, the TDRI collects data from more sources including the National Health Security Office, the Central Office for Healthcare Information and the civil registry.
The Public Health Ministry should improve its data collection methods and boost healthcare access for rural women. The researcher is correct; the actual maternal death ratio shows the country cannot even be considered a middle-income one.
The TDRI study also exposes a depressing disparity in healthcare services. In Bangkok, the maternal death rate is 25.33 per 100,000, the lowest in the country. In the Muslim-dominated deep South, it is 69.29, the country's highest.
This means if you are a Muslim mother in the restive South, the chance of dying from pregnancy-related complications is more than double. The researcher is correct again; this is sheer injustice.
Interestingly, TDRI findings on the infant mortality rate are also higher than the official record at 6.63-7.29 per 1,000 births. The TDRI rate is 9.71-10.95 per 1,000. The number of infant deaths in the deep South is the highest in the country.
The urban/rural gap in healthcare services shown by the TDRI is not new. Previous official records for both maternal and infant mortality rates point to the same depressing rural/urban healthcare disparity. The statistics may be different, but the message is the same. The need is urgent to cater to the health needs of poor women in remote areas and their Muslim sisters in the deep South.
Traditional culture and widespread violence are often blamed for preventing better healthcare access in the deep South. This is partially true. The centralised health policy is also at fault. A lack of cultural understanding makes it hard to overcome local resistance.
Violence cannot explain the high incidence of mothers' deaths in other regions either. Much of it comes from policy makers' refusal to accept changing sexual behaviour among youngsters. A lack of inexpensive and legal access to terminate unplanned pregnancies has led to unnecessary deaths that do not appear in hospitals' reports.
The government wants to turn Bangkok into a medical hub for foreigners. It is a travesty when poor and ethnic women are still denied the proper health care to which they are entitled.