Original Research
Maternal Health & Indigenous Communities

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

Background and Rationale

The Orang Asli, meaning “original people” in Malay, are the indigenous minority populations of Peninsular Malaysia. Comprising approximately 0.6% of the national population, the Orang Asli are ethnically diverse, encompassing 18 distinct sub-groups broadly categorised into three major groups: the Negrito (Semang), Senoi, and Proto-Malay (Aboriginal Malay). Despite Malaysia’s impressive economic development and well-established healthcare infrastructure, the Orang Asli continue to experience significant health disparities compared to the general population.

Maternal health among the Orang Asli has long been a concern for Malaysian public health authorities. Historical data have consistently shown higher rates of maternal and infant mortality among Orang Asli communities compared to other ethnic groups in the country. These disparities are driven by a complex interplay of factors including geographic isolation, lower socioeconomic status, cultural practices surrounding pregnancy and childbirth, and challenges in accessing modern healthcare facilities.

Antenatal care (ANC) is a cornerstone of maternal health services, providing opportunities for early identification of high-risk pregnancies, health education, nutritional supplementation, and management of complications. The World Health Organization recommends a minimum of four ANC visits during pregnancy, with the first visit occurring ideally during the first trimester. This study sought to examine the knowledge, attitude, and practice of antenatal care among Orang Asli women in the Jempol District of Negeri Sembilan, a state in Peninsular Malaysia with a substantial Orang Asli population.

Study Methods

The study employed a cross-sectional design and targeted women aged 15 to 49 years who had at least one prior antenatal care experience. Three Orang Asli villages in Jempol District were selected as study sites. All eligible women in these villages were invited to participate, and a total of 104 women were interviewed using a structured, pre-tested questionnaire administered through face-to-face interviews.

The questionnaire covered sociodemographic characteristics, reproductive history, knowledge of antenatal care (assessed through 20 items with correct/incorrect scoring), attitudes towards antenatal care (measured on a Likert scale), and antenatal care practices (including timing of first visit, frequency of visits, and place of delivery). Knowledge scores were categorised as good or poor using the mean score as a cut-off point, and the same approach was applied to attitude classification.

Sociodemographic and Reproductive Profile

The 104 women interviewed represented a community with distinctive sociodemographic characteristics. The majority had completed primary education, though a notable proportion had no formal schooling. Most households depended on agricultural work or manual labour, placing them in lower income brackets. These socioeconomic conditions provide important context for understanding the health-seeking behaviours observed.

The reproductive history of the women revealed patterns of concern. Approximately 70% had experienced home deliveries, a practice that carries elevated risk in the absence of skilled birth attendance. Furthermore, 44.2% of the women reported having at least one high-risk pregnancy in their reproductive history. A small but notable proportion — 13.5% — reported at least one stillbirth, while 3.8% had experienced more than one stillbirth. These figures underscore the obstetric vulnerability present within this population.

Knowledge Regarding Antenatal Care

Knowledge assessment revealed that fewer than half (44.2%) of the women possessed good knowledge about antenatal care. Knowledge scores ranged across the 20 assessed items, with the women demonstrating variable understanding of different aspects of care. While many women understood basic concepts such as the importance of attending antenatal clinics, knowledge was particularly poor regarding the importance of early antenatal booking, the purpose and significance of screening tests performed during antenatal visits, and the complications associated with diabetes and hypertension during pregnancy.

These knowledge gaps are particularly concerning because they relate directly to the ability of women to recognise warning signs and make informed decisions about seeking care. A woman who does not understand the purpose of blood pressure monitoring or glucose testing during pregnancy, for example, may not appreciate the urgency of attending regular check-ups or may delay seeking help when symptoms arise.

Attitudes Towards Antenatal Care

Attitudes were somewhat more encouraging than knowledge levels, with 53.8% of women demonstrating positive attitudes towards antenatal care. Notably, 88.5% of respondents agreed that early antenatal booking was important, and 82.7% agreed that the first antenatal visit should occur before the third month of pregnancy. These attitudinal findings suggest that Orang Asli women do recognise the value of antenatal care in principle, even when knowledge about its specific components may be limited.

The gap between positive attitudes and actual practice — a common finding in health behaviour research — was evident in this study. Despite the high proportion agreeing that early booking was important, only 48.1% actually attended their first antenatal check-up early in pregnancy. This attitude-practice gap points to barriers beyond individual volition, likely including transportation difficulties, distance from health facilities, competing demands on women’s time, and sociocultural factors.

Antenatal Care Practices

While 92.3% of women reported attending antenatal clinics during their pregnancies, the quality and timing of this attendance tell a more complex story. Late booking — defined as first attendance after the first trimester — was common, limiting the window for early detection and management of pregnancy complications.

The high rate of home delivery (approximately 70%) is a significant finding with implications for maternal safety. Home deliveries in the absence of skilled birth attendants carry elevated risks for both maternal and neonatal complications, including postpartum haemorrhage, obstructed labour, and neonatal asphyxia. While traditional birth practices hold cultural significance within Orang Asli communities, they require contextualisation within a framework that prioritises maternal and neonatal safety.

Cultural and Structural Determinants

Understanding these findings requires appreciation of the broader cultural and structural context in which Orang Asli women make healthcare decisions. Orang Asli communities have historically maintained strong connections to traditional healing practices and have sometimes viewed modern medical interventions with scepticism or apprehension. The influence of elders, traditional midwives (known as bidan kampung), and community leaders in shaping attitudes towards pregnancy and childbirth remains significant.

Geographic isolation compounds these cultural factors. Many Orang Asli settlements in Jempol District are located in remote or semi-remote areas, requiring significant travel time and expense to reach the nearest health facility. This physical barrier, combined with lower education levels and limited financial resources, creates a cascade of obstacles to optimal antenatal care utilisation.

The Malaysian government, through the Department of Orang Asli Development (JAKOA), has implemented various programmes to improve healthcare access for indigenous communities. These include mobile health clinics, community health workers, and subsidised healthcare services. However, the findings of this study suggest that these programmes may need to be strengthened and better tailored to address the specific knowledge gaps and attitudinal barriers identified.

Recommendations

The researchers emphasised the need for culturally sensitive health education programmes specifically designed for Orang Asli communities. Such programmes should address knowledge gaps identified in this study, particularly regarding the importance of early booking, screening tests, and recognition of danger signs. Community health workers who are themselves Orang Asli or who have established trust within these communities may be more effective health educators than external professionals unfamiliar with local customs.

Improving physical access to healthcare facilities through mobile clinics, improved transportation, and strategic placement of maternal and child health services near Orang Asli settlements remains essential. Additionally, efforts to integrate traditional birth practices with evidence-based obstetric care — rather than dismissing cultural traditions — may improve engagement with antenatal services while maintaining respect for indigenous cultural identity.

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