As Blaxter suggested that “poor people living in wealthier neighbourhoods have better health than poor people living in poorer neighbourhoods”, the effect of locality on one’s health is undeniable. This essay will explore how locality affects pregnancy and childbirth. This will be done with reference to Siti’s pregnancy experience other than the general trends observed in Malaysia.
Locality determines the availability and accessibility of healthcare services. With medicalization of pregnancy and childbirth, prenatal and postnatal care, institutionalized delivery and immunization have significantly reduced maternal and fetal mortality ratio. Siti was glad that healthcare services such as the health clinic, hospital and pharmacy were within reach, thus enabling her to monitor her pregnancy development conveniently.
Commonly, urban areas have better healthcare facilities as these highly-populated areas are more capable in attracting human and capital resources. Healthcare institutions in the city normally possess more and better manpower and equipments. This was why Siti gave birth in a hospital located in the city instead of delivering in a nearby health clinic. Table 1 shows that less urbanized states such as Kelantan generally have lower doctor-patient ratio as compared to more urbanized states like W.P.Putrajaya. As a result, the pregnant women staying in less urbanized areas may have longer waiting time and lower probability to see a doctor.
Furthermore, Table 1 shows the antenatal visit coverage is also in line with the level of urbanization. This is probably due to improved accessibility made possible by the better transport systems and the shorter distance between houses and healthcare institutions in urban areas.
Table 1 Level of urbanization, doctor-patient ratio and antenatal visit coverage in states of Malaysia
State Level of Urbanization
Antenatal Visit Coverage (1st visit, %)
W.P.Putrajaya 100.0 1:320 181.72
W.P.Kuala Lumpur 100.0 1:425 115.38
Penang 90.8 1:740 97.56
Johor 71.9 1:1273 96.71
Pahang 50.5 1: 1145 93.42
Perlis 51.4 1:784 80.02
Kelantan 42.4 1:1644 69.28
The different healthcare distribution in the urbanized and the less-urbanized areas reflected Tudor-Hart’s ‘inverse care law’ which proposed that healthcare provision is inversely proportional to its need. This low availability and accessibility to healthcare in less-urbanized areas cause preventable or treatable health problems to prevail and persist. One concrete example would be the higher maternal mortality ratio observed in under-developed countries such as Niger.
Some may argue that affordability is a bigger barrier to the healthcare services. However, this is not so in Malaysia, as heavy subsidy from the government has made healthcare services inexpensive. For instance, Siti was only charged RM1 for the 9-month antenatal check-up. Therefore, like Siti, most Malaysian pregnant women use government healthcare services....