Original Research
Maternal Health

Knowledge, Attitude and Practice on Antenatal Care Among Orang Asli Women in Jempol, Negeri Sembilan

Authors: Rosliza AM, Muhamad JJ

Affiliation: Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia

Published: Malaysian Journal of Public Health Medicine, 2011; Volume 11, Issue 2, Pages 13–21

Last reviewed: March 2026

Background

Maternal health is a cornerstone of public health, and access to quality antenatal care (ANC) is widely recognised as essential for reducing maternal and neonatal morbidity and mortality. The World Health Organisation recommends that all pregnant women receive comprehensive antenatal care, including early registration, regular check-ups, screening for complications, and health education. In Malaysia, while overall maternal health indicators have improved substantially over the decades, significant disparities persist among indigenous populations.

The Orang Asli, meaning “original people,” are the indigenous peoples of Peninsular Malaysia, comprising approximately 0.7% of the national population. The Orang Asli communities are characterised by lower socioeconomic status, more limited access to healthcare services, and poorer health outcomes compared to the general Malaysian population. Studies have documented higher rates of malnutrition, communicable diseases, and reproductive health complications among Orang Asli communities.

This study focused on Orang Asli women in three villages in the Jempol district of Negeri Sembilan state, examining their knowledge, attitudes, and practices regarding antenatal care. Understanding these factors is essential for designing culturally appropriate interventions to improve maternal health outcomes among this vulnerable population.

Study Design and Methods

A cross-sectional study was conducted among women aged 15 to 49 years who had at least one previous antenatal experience in three Orang Asli villages in Jempol district. All eligible women were invited to participate, and data were collected through structured, pretested questionnaires administered via face-to-face interviews. This approach was chosen to accommodate varying levels of literacy among participants.

The questionnaire assessed demographic characteristics, obstetric history, knowledge about antenatal care components and danger signs of pregnancy, attitudes towards antenatal services, and actual practices regarding clinic attendance, booking timing, and delivery choices. Statistical analysis was performed using IBM SPSS Statistics Version 19, with 95% confidence intervals calculated for key proportions.

Principal Findings

Antenatal Care Attendance Patterns

While 92.3% of the 104 women interviewed reported having attended an antenatal clinic during previous pregnancies, the pattern of attendance revealed concerning gaps. Critically, only 48.1% had presented for their first antenatal check-up at an early stage of pregnancy. Late booking for antenatal care is associated with missed opportunities for early detection of pregnancy complications, delayed initiation of preventive measures such as iron and folic acid supplementation, and increased risk of adverse maternal and neonatal outcomes.

The prevalence of late antenatal booking among this population (approximately 52%) significantly exceeded the target of 20% set by Malaysia’s Ministry of Health. This disparity underscores the need for targeted interventions to promote early antenatal registration among Orang Asli women, potentially through community-based outreach, mobile health services, or the engagement of traditional birth attendants as referral agents.

Home Delivery Practices

Perhaps the most striking finding was that approximately 70% of the women had a history of home delivery. While home delivery is not inherently unsafe when attended by skilled birth attendants, in the context of limited access to emergency obstetric care, it carries significantly elevated risks for both mothers and newborns. The high rate of home delivery among Orang Asli women reflects a combination of factors, including geographic remoteness, cultural preferences, trust in traditional birth attendants, and potential discomfort with facility-based care.

Knowledge, Attitudes, and High-Risk Pregnancies

Knowledge assessment revealed that 44.2% of women (95% CI: 34.7–53.7%) had good knowledge regarding antenatal care, while more than half (53.8%; 95% CI: 44.3–63.1%) demonstrated positive attitudes. However, knowledge was notably poor in specific areas, including the importance of early antenatal registration, the purpose of screening tests, and the complications associated with diabetes and hypertension during pregnancy.

The study found that 44.2% of women had experienced at least one high-risk pregnancy, a rate that is substantially higher than the national average. This elevated prevalence of high-risk pregnancies, combined with high home delivery rates and delayed antenatal booking, creates a potentially dangerous combination that could contribute to preventable maternal and neonatal complications.

Implications for Indigenous Maternal Health Policy

The findings have direct implications for Malaysia’s efforts to improve maternal health equity. The significant association between attitudes towards antenatal care and actual practices (including home delivery and late booking) suggests that attitudinal change, alongside improved access, should be a priority in intervention design.

Culturally sensitive approaches are essential when working with Orang Asli communities. Health education materials should be available in appropriate languages, and health promotion messages should be delivered through trusted community channels. The integration of traditional practices with modern antenatal care, rather than their replacement, may be more effective in increasing uptake among communities with strong cultural ties to traditional birthing practices.

The establishment of mobile health clinics that bring antenatal services to remote Orang Asli settlements, training of community health volunteers from within Orang Asli communities, and strengthening referral pathways between community-level care and hospital-based emergency obstetric services are among the strategies that could address the barriers identified in this study.

Broader Context: Antenatal Care in Malaysia

Malaysia has made significant strides in maternal health, with the national maternal mortality ratio declining from over 500 per 100,000 live births at independence to well below 30 per 100,000 in recent decades. However, this aggregate progress masks persistent disparities, particularly among indigenous communities, rural populations, and migrant groups. Research such as this study helps to illuminate these disparities and provides the evidence base for targeted interventions.

Prior to the COVID-19 pandemic, the prevalence of late ANC booking in Malaysia varied between 28.2% and 56.6% across different studies and geographic settings, consistently exceeding the Ministry of Health’s 20% target. The pandemic further disrupted antenatal care access and utilisation, highlighting the fragility of maternal health gains and the need for resilient, community-embedded service delivery models.

Limitations

The study’s restriction to three villages in a single district limits generalisability to Orang Asli communities in other parts of Peninsular Malaysia, which may differ in ethnolinguistic characteristics, geographic accessibility, and exposure to health services. The cross-sectional design captures a snapshot of knowledge, attitudes, and practices but cannot establish temporal relationships or track changes over time. Self-reported data on delivery practices and antenatal attendance may be subject to recall bias, particularly for women reporting on experiences from several years prior.