Chapter 2 Cultural, Demographic, Socio-economic Background and Care Relations in Malaysia

In: Care Relations in Southeast Asia
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Rahimah Ibrahim
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Jo-Pei Tan
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Tengku Aizan Hamid
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Asmidawati Ashari
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1 Introduction

Malaysia encompasses an area of 330,803 square kilometres and shares its land borders with Thailand, Indonesia and Brunei Darussalam as well as the South China Sea maritime borders of Singapore, Vietnam and the Philippines. The country is divided into two parts: (1) Peninsular or West Malaysia situated to the south of Thailand and north of Singapore; and (2) East Malaysia, separated by the South China Sea, which is located on the island of Borneo bordering Brunei Darussalam and Kalimantan, Indonesia. The country is comprised of 13 states and three federal territories, of which 11 states and two federal territories, namely Kuala Lumpur and Putrajaya, are located in Peninsular Malaysia. Two other states, namely Sabah and Sarawak, and the federal territory of Labuan are located in East Malaysia. Kuala Lumpur is the nation’s capital city and Putrajaya serves as a federal administrative centre. The state of Selangor is the most populous state with 5.46 million people.

As a former British colony, vestiges of the colonial period remain in Malaysia’s political, legal and social systems. After gaining its independence in 1957, the federation of Malaya formed Malaysia along with Sabah and Sarawak in 1963. Malaysia practices parliamentary democracy, alongside a federal constitutional elective monarchy where the monarch is Head of State, a position rotated among nine hereditary rulers.

As one of the developing countries in the Southeast Asian region, Malaysia shares some of the demographic and social trends traversing many societies in the region. Asian families, including those in Malaysia, have been greatly romanticised for taking care of their own family buttressed by its generous welfare system (Mohd 2012), which is family based (Croissant 2004). In other words, both young and old people customarily rely on family for care and support, with an overarching notion of filial or religious obligation among family members, especially for old age support. However, these representations of the ‘ideal family’ have been challenged by the fast and drastic macro changes in its population structure, demographic transition, economic development and socio-cultural context leading to a phenomenon of compressed modernity which shapes the present welfare regime, policies and programs in the country within the context of care. Thus, this chapter presents a careful analysis of the historical, cultural, socio-economic, demographic, policy and legislative context, focusing on changes and continuity in the factors that can impact family and care relations in Malaysia.

2 Cultural Background

2.1 Culture and Customs

Early contacts across ethnic groups were established through strong trading links between Chinese and Indian traders with the Malays in the Peninsula (Hatin et al. 2011). Given its current diverse ethnic setting, people from Malay, Chinese, Aboriginal and Indian backgrounds have developed a cross-cultural socialisation in the country. The census in 2010 reported a population of 28.3 million people in Malaysia which was made up of: Malays and Bumiputeras (indigenous and native peoples) (67.4%), followed by the Chinese (24.6%), Indians (7.3%), and other ethnic groups (0.7%). According the 2010 census, the predominant ethnic group in Peninsular Malaysia was the Malays, constituting 63.1%. For Sabah, the predominant ethnic groups were the Kadazan/Dusun (24.5%) and Sarawak, the Ibans (30.3%). Major religions included Islam (61.3%), Buddhism (19.8%), Christianity (9.2%) and Hinduism (6.3%). The multi-religiosity in the country was fostered by its religious-freedom policy in which Malaysians had the right to practice their different religions. In addition, the people in Malaysia were multilingual, with Malay (Bahasa Malaysia), Chinese, Tamil and English being widely used of which Malay and English were the most prominent media of communication among the diverse ethnic groups. The demographic characteristics of Malaysia reflected its multicultural, multireligious and multilingual society. As a consequence of the multicultural, multireligious and multilingual cultural landscape, there were converging and diverging cultural conventions related to family life and care giving. The roles and responsibilities of family members were embedded across all religious beliefs, in addition to the strongly held cultural values of filial piety and family centred care (Hossain 2014; Ismail, Tan & Ibrahim 2009; Masud & Haron 2014). However, ethnic pluralism was initiated in the British colony through large-scale migration and spatial segregation among the groups and, hence, gave rise to a socially fragmented landscape and unequal multi-ethnic society (Aziz & Yusooff 2012).

Amongst the population in Malaysia, the Malays and Chinese made up more than two-thirds of the total population while almost 10% of the remaining population were Indians. Unlike some multicultural countries, Malaysia was not characterised by a dominant culture defined by a majority group to which other smaller ethnic groups assimilated. Not only the Chinese comprised a significant minority in Malaysia (37% in 1957; 28% in 1991; 26% in 2000; 24.6% in 2010), like the Malays, they had a strong desire to preserve and practise their cultural identity, traditional religion and customs. Similarly, the Indian population emphasised their identity development through religious practices, patriarchal family values and traditional customs. These factors not only buffered the assimilation effect of Malay culture but also led to divergence in family relationships and care support across these ethnic groups (dosm 2011).

2.1.1 Kinship, Filial Obligation and Religiosity

Like most Asians, Malaysian families were nurtured with the mentality of having the ‘family-as-centre’ of all activities emphasising the importance of family, kinship systems, and family interdependence (Chao & Tseng 2002). In fact, within a variety of kinship systems across ethnic groups, a high value was uniformly placed on familial obligation and harmony with a core of filial duty which were shaped through religiosity. Despite increasing westernization (Daud, Chew, Lee & Quek 2001), filial behaviour was one of the topmost cultural practices in the majority of Asian families as well as in the Malaysian family system, and parents played a vital role in inculcating filial practices in the younger generation (Ismail, Tan & Ibrahim 2009). Filial piety was a central quality of cultural practices in a family which included obedience and honouring of one’s parents and it was considered as the fundamental element to practice in the Malaysian family system.

The multi-ethnic groups in Malaysia embraced all the major belief systems: Malays practised the Islamic teaching, the Chinese generally were Buddhists or practised traditional Chinese religions, and majority of Indians practised Hinduism. Similarly, all these religious scriptures and scholarly treatise stressed the moral obligation of children to revere and respect their parents and provided for their support and care (Attwood & Croll 2006).

The pattern of family life and relationship among Malays was strongly shaped by the Islamic religion which ultimately determined the behaviour, values and beliefs among the Malays (Kling 1995). In Islam, the Quran stressed devotion for parents and the responsibility of children for their support and care (Philipps 1992) and children were perceived as ‘gifts’ from God requiring that parents provided for them. Thus, a family with many children was a ‘prosperous’ family, irrespective of their economic situation (Yaacob 2005). This belief may have had implications on the family planning practices and the use of contraception, thus, explaining the larger household size among Malays compared to the Chinese and Indians. Guided by their traditional religious beliefs and practices, the care relations and support exchange among Chinese were shaped accordingly and the duties of children to revere and support parents were clearly set out (Philipps 1992). The majority of the Indians practiced Hindu and Sikh cultures, and one of the principal values was filial respect and support for parents, which remained strong in the Indian community in Malaysia. Filial obligation among Malaysian families involved mutual responsibilities across generations which emphasised the children’s sense of indebtedness or obligations to parents in return for early care during childhood. Thus, the religious practice and traditional custom not only clearly defined the rightful attitudes and behaviours of children towards parents, but also obliged parents to support and provide for their children.

2.1.2 Age Hierarchies

Age hierarchy was another salient feature in the kinship system and intergenerational relations in Malaysian society. Seniority in age and social position were customarily accorded precedence and authority, thus ranking for, and support of, the older generation before all other obligations, or parent-care before child- or self-care (Attwood & Croll 2006; Yaacob 2014). Hence, a prominent feature of intergenerational care and support, combining obedience and sense of obligation, was the subordination of the younger generation to the will and welfare of parents and grandparents. A common ideal was centred on a prosperous old age surrounded and supported by many children in a multigenerational household. However, this ideal may not be feasible in contemporary Malaysian society which was challenged with drastic demographical changes and eroded filial obligations.

Age and seniority were traditionally very important aspects in family relationships in Southeast Asian communities. Among the Malays, the elder and senior members of the family were much respected and often hold the responsibility for all major family matters. They served as the source of advice and place for resolving family conflicts (Kling 1995). Younger family members were expected to show respect to the elderly in terms of obedience, proper manners, deference, body language and low-tone of language. In a Malay community, as kin members were often bound into cohesive family units, an elderly person was often expected to be taken care of by his/her kinship group or extended family members. An elderly Malay person, if he was alone, could either join his son’s family or his daughter’s family where he would be expected to become part of the family and involved in all aspects of family affairs (Yaacob 2014). Maintaining close familial relationships was not only an obligation but also a religious duty. Guided by Islamic teachings, a person was considered unfaithful to the religion if he disregarded his kin and family members and turned them down in times of need, especially his parents and other members of the immediate family.

The concept of filial piety strongly influenced and guided family relations among Chinese families in Malaysia. Traditionally, filial piety entailed a system of age and patriarchy. Not only parents and elders had greater authority and should be treated with respect, children were expected to be obedient and consult their parents for guidance throughout their adulthood. Respect and the act of honouring elders was also reflected in their form of ancestor worship. This practice led to the belief among the Chinese that they would be cursed by their ancestors if they abandoned their duty to care for their elderly parents (Sokolovsky 2001). Similarly, among Indian society, family solidarity was based upon the hierarchical principle. Elders were more authoritative than younger persons and so were men compared to women. A woman’s status and authority was largely dependent on her husband’s position within the family. The wife controled domestic affairs but exerted a lesser authority compared to her mother-in-law who was a senior in social hierarchy (Kakar 1978). These cultural norms and values accounted for the fact that institutionalisation was provided as a last resort by the government for specific vulnerable groups

2.2 Gender Role in Family Relations

Although there were similarities in relation to care and support across generations among the Malays, Chinese and Indians in Malaysia, contrasts nevertheless existed with respect to their distinctive cultural values and custom. Thus, the family ideologies and expectations of children among these three ethnic groups may be distinctive, specifically regarding gender roles within family.

The differences in gender roles, especially the expected provision and return for sons and daughters, often shaped by traditional values and family system, tended to be clearer in certain ethnic groups compared to others. For example, Malay families were based on a bilateral system with equal expectations for both sons and daughters in providing care and support to parents while, patriarchal Chinese and Indian families set out a clearer expectation of sons over daughters. These unique and indigenous notions across different ethnic groups may have had implications on the care responsibilities and support exchange within a community.

The bilateral family system, such as that which was prevalent in Malay families, emphasised equal rights of inheritance and both genders were taken into consideration regarding living arrangements, filial obligations and support for parents. For example, elderly Malay parents were expected to either join his (married) son or (married) daughter’s family; whereas married couples could decide to co-reside with the husband’s or wife’s family, with no specific residential rules. This may explain the fact that in general, there was no strong preference for either a son or daughter among Malays. However, matrilineal and matrilocal family was observed among the Minangkabau Malay in the state of Negeri Sembilan who practised a matriarchal family system which favoured daughters and family members from maternal side in inheritance and co-residence. There was often a greater tendency to follow traditional customs (adat) than Islamic law in relation to inheritance and the division of property (Yaacob 2014).

Chinese and Indian families in Malaysia were organised on the basis of a patriarchal system, which emphasised the dominance of male over female. Chinese families practised a patrilineal system whereby family lineage was only continued through male offspring and therefore, sons (especially the eldest) or children of sons were to be favoured in inheritance over the children of daughters. In addition, daughters-in-law tended to be treated more favourably in family relationships than daughters (Kuo & Hassan 1976). Sons, especially the eldest, were preferable to share residence with parents for old age support and care provision, reflecting patrilocal values among the Chinese. Similarly, among Indian families, men had greater authority within a patriarchal system and high expectations were set on sons, particularly the eldest, to take up core filial responsibility stressing obedience, sacrifice for and indebtedness to parents (Kakar 1978; Ranganath & Ranganath 1997).

The expectation of children was expressed in significantly different ways among the different ethnic groups. The Chinese and Indian had clear-cut obligations for their children, engendered by debt and financial contributions for their parents’ well-being, while the Malays had more diffused obligations for children engendered by gifts and, the long-term return was expressed in a more subtle way (Li 1989). Remittance between parents and children tended to flow in both directions (Yaacob 2005). Malay parents supported children who were not economically independent; while working children were required to support aged parents and younger siblings when parents became incapable of financially supporting the needs of family.

Interestingly, the division of labor within the Malay, Chinese and Indian families followed the traditional sex-differentiated pattern where the male was seen as the breadwinner and protector of the family while the female was seen as the caregiver and caretaker of the household. Traditionally, boys were socialised and trained to inherit their family business while girls were nurtured to be good homemakers in preparation for marriage and motherhood. For example, among traditional, rural families, there was a common scenario of women’s economic dependency on men such as an unmarried girl on her father, a wife on her husband or an elderly mother on her son. The gendered role of care responsibility may have explained the growing trend among Malay women to leave employment or opt for early retirement as a result of the demands and pressures of familial matters (Yaccob 2005).

2.3 Child Preferences

Despite there being little evidence for child preference in Malaysia, Malay and Indian parents did not show a consistent sex preference while preference for a son was more pronounced among Chinese parents. The reason for preferring a son was commonly associated with traditional values of old age support, continuation of the family name and the completion of male tasks in the home (Callan & Kee 1981).

3 Socio-economic Background

3.1 Modernisation and Economic Development

Economic development in Malaysia was impressive after its independence in 1957, transforming from a resource-based economy dependent on agriculture and primary commodities to a modern industrial economy based on large-scale manufacturing and technological industries (Hill, Yean, & Mat Zin 2012). Under various national development plans, the country’s Gross Domestic Product (gdp) grew from RM5.1 billion in 1957 to RM766 billion in 2010 (dosm 2012b).

Industrialisation played a major role in the 1971–1990 New Economic Policy (nep) and 1991–2000 New Development Policy (ndp) (Embong 1996; Jomo 2013; Shari 2000). The nep was a key policy that led to government intervention in social restructuring to reduce socio-economic disparities among the ethnic groups through poverty eradication measures, as a response to the 1969 post-election race riots (Embong 1996; Jomo 2004). It shaped the First Outline Perspective Plan (opp) to reduce poverty in Peninsular Malaysia from 49% to 16% between 1971 and 1990 (Jomo 2004; Mohd 2012). Succeeding the nep was the ndp which guided the Second opp (1991–2000) with greater emphasis on attaining rapid growth, industrialisation and structural change (Jomo 2004). In 1983, the government announced its initiatives on privatisation policy which led to the adoption of Guidelines for Privatisation in 1985 and the Privatisation Master Plan in 1991 (Nambiar 2009).Economic liberalisation and privatisation has undermined the role of the state in promoting economic growth, and restructuring the society since the mid-1980s (Embong 1996; Jomo 2013). The Third opp (2001–2010), linked to the National Vision Policy (also known as Vision 2020), also focused on developing and modernising various economic sectors and generating high sustainable growth. As a result, the country’s economic progress was built upon its political stability which hinges on delicate social fabric and inter-ethnic distributional policies (Doraisami 2012).

The interventionist nature of the Malaysian State along with the rapid growth in export-led industrialisation contributed to the success in poverty reduction (Shari & Mat Zin 1995). Historically, the nation had a long track record of combating poverty through specific social programs directed at certain groups that include farmers, fishermen, cash-crop smallholders, estate workers, agricultural laborers and indigenous peoples. The incidence of poverty, calculated as households with monthly gross income below the Poverty Line Income (pli), declined to 3.8% for the poor and 0.7% for the hard-core poor (those living below the food pli), totalling around 4.5% of all households in 2009. It was noted that the pli had different cut off points for the different regions of West and East Malaysia. The pli for Peninsular Malaysia (RM763) was lower than that for Sabah (RM1,048) and Sarawak (RM912). Urban and rural differences were also taken into account but the overall pli calculation (in terms of food and non-food needs) for Malaysia in 2009 was RM800 per month (dosm 2012b).

During the same period (2009–2011), household inequality was moderate (gini ratio stood at 0.441 in 2009), yet there was a notable increase in total household debt (RM667 billion or 110% of disposable income in 2011). In 2009, the mean and median household income were at RM4,025 and RM2,641 per month (dosm2011, 2012a). During 2012, there was a growth in the household income of the general population with the highest growth in Kuala Lumpur. The 2012 Household Income Survey reported an increase of 7.2% to RM5000 and particularly in Kuala Lumpur, where there was a rise of 14.9% from RM5488 to RM8586 (dosm 2012a).

Despite the nation’s economic growth, becoming an upper middle-income country, average Malaysian families were struggling to make ends meet in the face of a high inflation rate, slower income rise (average of 2.4% per annum) and surging living costs. Those in the middle-income group, accounting for about 40% of total households in Malaysia (dosm 2012b), tended to be burdened by more housing loans in comparison to the low-income households, comprising another 40% of the country’s population. While the recent economic plan strategically aimed at improving the livelihood of the bottom 40% of households and empowering vulnerable groups (i.e. women, elderly and disabled population), the middle-income group was likely to be burdened by economic difficulties with minimal support from state-initiated programs. Amidst this desire for economic growth, the country faced significant fiscal challenges, including weak public finances, lower government debt ratings, and ongoing political tension (Gomez 2012; Hal 2010). This middle-income trap was going to continue under the 10th Malaysia Plan, which aimed at enabling the country to achieve the status of “prosperous economy” country by 2020. Furthermore, plans to reduce public subsidies for fuel and sugar, as well as plans to raise tariffs on electricity in 2014, could further burden the growth in the middle-income population who were likely to be sandwiched by the responsibilities of caring for the dependent children and ageing parents.

3.2 Urbanisation and Migration

In terms of urbanisation, through rapid development, the urban population in Malaysia increased from 9% to 71% between 2000 and 2010 (dosm 2012b). Data from the Department of Statistics Malaysia also indicated that the two federal territories of Kuala Lumpur and Putrajaya had a 100% level of urbanisation, followed by other states, namely, Selangor (91.4%) and Pulau Pinang (90.8%). Lesser urbanisation levels were found in the east coast (i.e. Kelantan), central region (i.e. Pahang) and in Perlis of Peninsular Malaysia. Rapid urbanisation was closely linked with industrialisation and the rapid development in infrastructure, society and economy within those states that were more urbanised. In Malaysia, national development plans incorporated strategies for the country to become a fully developed nation with a high income by the year 2020 (Huff 2001). Migration intensified in the last few decades, in particular, internal migration.

Recent data indicated that 90% of total migration was internal and the remainder was immigration into Malaysia from other countries. The predominant migration was within the state (61.3%), followed by inter-state migration (28.5%); as for rural to urban intra-state migration, the rate increased by only 0.5% after 2010. Migration within states and across-state borders led to increased density in several states along the west coast of Peninsular Malaysia, which included Kuala Lumpur. According to dosm (2012b), the capital Kuala Lumpur was the most densely populated state (6,891 persons/km2), followed by Penang (1,490 persons/km2) and the Federal Territory of Putrajaya (1,478 persons/km2).

The national migration survey also found that the majority of the migrants were aged between 15 and 34 years. The migration of the younger generation was pulled by the opportunities of employment, socio-education infrastructure, tertiary education and career or personal development (Green & Canny 2003), and pushed by factors such as the lack of job opportunities, career development and public infrastructure in the states which were less urbanised. This population movement not only caused changes in living patterns among Malaysians but also caused breakdown of the circuit of care provision and familial support, especially among multigenerational households. In addition, migration of older generation into urbanised cities was reported for health reasons, loss of spouse, or care taking of grandchildren.

Furthermore, cross-country migration was also an issue highlighted in the national development policies. In 2010, there were 1.6 million (or 12.8% of total workers in the country) foreign workers in Malaysia compared with 0.8 million in 2000, the majority of whom tended to be low or semi-skilled workers (mof 2013). Thus, it can be seen that urbanisation and migration had significant implications on the population distribution of the country.

3.3 Education and Employment

3.3.1 Education

Education was the core agenda for the National Development Plan of the country after independence in 1957. After the 2nd Malaysia Plan (1971–1975), in addition to general education, greater emphasis was given to establish vocational and technical training schools as a measure to alleviate youth unemployment, especially among those who were not interested in general education. The emphasis on the education sector was also reflected in public expenditure and the National Development Plan, which was proposed every 5 years. For instance, in 2011, a total of 5.9% of the country’s gdp was spent on education, increasing from 4.3% in 1995. In addition, the most recent 10th Malaysia plan (2010–2015) aimed to strengthen the education system for further human capital development through programs for improving pre-school enrolment rates, identifying high performing schools, establishing a Literacy and Numeric Screening (linus) programme, and improving the quality of teaching professionals.

Improved education attainment was closely related to family life, in particular, employment opportunities, which subsequently led to changing expectations of their role among women, delayed age of marriage and motherhood. From 1970 to 2000, there was a decrease in terms of primary school enrolment, from 38.2% to 29.8% due to shrinking in the number of young children (aged 6–12 years). This was a reflection of the decrease in family size. There was also evidence of a narrowing gap in education attainment between sexes. It was recorded that the difference in attainment between the sexes declined from 5.5 percentage points (2000) to 4.7 percentage points (2010). The 2010 Census documented a change of trend in post-secondary education compared to the 2000 Census. Among the population aged 15 years and above, there was a higher percentage of females (68.9%) who obtained post-secondary school qualifications such as a certificate, diploma or degree than their male counterparts in 2010 (66.8%); while the trend was opposite in 2000 (male: 62.6%; female 57%). A similar pattern was reported across the main ethnic groups, where the largest gap between male and female in 2010 was among the Chinese (3.2%), followed by Bumiputera (1.6%) and Indians (0.4%). These changing trends have very important implications on family life among Malaysians.

In general, the opportunity to pursue a higher educational level increased the overall participation rate in the workforce, especially among women. While rapid economic development and growth in Malaysia boosted new employment opportunities benefiting both men and women, increased accessibility to the educational attainment of women enabled them to be gainfully employed in all economic sectors such as manufacturing, business, service and agriculture, in addition to their traditional role in the unpaid domestic sector of the economy.

3.3.2 Employment

Over the years, the Malaysian labor market expanded with higher rates of employment among people of the working age population of 16 to 64 years. The percentage of the economically active population has risen to 67.0% or 13.6 million in 2012 from 62.7% or 11.9 million in 2008, according to Table 2.1 In comparison, the employment rate was still considerably higher among males (79.0% in 2008 and 80.7% in 2013) than females (45.7% in 2008 and 52.4% in 2013). However, the Economic Planning Unit (epu 2011) also reported a fourfold increase in workforce participation among women (6.7%) compared to men (1.7%) during the same period. The rise of employment levels of women over the last four decades was supported by governmental policies. The National Policy for Women (npw) was used as a guide for women’s participation in the development process and to integrate women in all sectors of national development, in line with their abilities and needs in order to improve the quality of life, eradicate poverty, abolish ignorance and illiteracy. In the 6th Malaysia plan (1991–1995), a special fund for the development of women became a significant and integral step towards empowering women in Malaysia.

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As a result of educational attainment and employment opportunities for women, there was an increase in the number of dual-earner families with both husband and wife working. This scenario led to a change in the traditional family structure and challenged the male-breadwinner model that prescribed the division of labor between men and women among many Malaysian families. Thus, it can be seen that women not only had a key role as primary carer within the family but also played a vital economic role as well. Mahari (2011) argued that while there were significant changes in relation to the role and status of women in society and participation in labor market, there was still a lack of support services which enabled women to combine family commitments and work responsibilities.

Figure 2.1 illustrates the labor force participation rate by age group from 1980 to 2010. The most active force in labor market participation was those between 25 to 45 years. Thus, it was expected that the most active age group in labor market would also likely be the ‘sandwich generation’ who would likely be a overwhelmed with financial responsibilities for their own families as well as with the duty to take care of elderly parents, especially parents who were old and frail. In addition, data from the recent Census in 2010 showed a trend towards delayed entry into the labor force market among the younger generation, while there was also an indication of early exit from active employment among the working population in Malaysia as compared to data from Census in 2000, 1990 and 1980. Delayed entry into the labor force may reflect a continuity of support from parents into their children’s adulthood, which could translate to further a financial burden for the ‘sandwiched’ middle generation. Attwood & Croll (2006) argued that this was one way to reduce the odds and increase the likelihood of filial returns or repayment by the younger generation, given greater mobility, declining fertility, changing values and new social trends which weakened the possibility of old-support from children.

Figure 2.1
Figure 2.1

Labor force participation rates by age group, Malaysia (1980–2010).

Source: dosm, Labor Force Survey Report (various years).

As the population structure was altered with the increasing proportion of older people, the trend of labor force participation from 1980 till 2010 reflected that participation tended to decrease with age among those who are over 50 years. Hamid, Momtaz, Ibrahim, Yahaya & Abdullah (2013) asserted that continued employment was the most important form of social security in Malaysia, thus, decreased ability to generate economic income may cripple older persons’ livelihood with limited coverage from the post-employment social protection system that included Employees Provident Fund (epf) – a mandatory retirement savings plan, and the Social Security Organisation (socso). Yet, it was the family (or household) which provided most of the personal social services and support to each other. The employment status among elderly persons was further examined with data from 2004 Malaysian Population and Family Survey (mpfs) which showed that a high percentage of 28.2% elderly (60+) were still working, a scenario which could be attributed to having an ‘average health status’; however, the majority were working in agriculture and the fishery sector (46.8%), which may not have generated an adequate income to sustain the provision of old age support (npfdb 2005). This may have led to poverty, especially among the elderly who were alone or widowed with no spouse or children.

4 Demographic Background

Since the beginning of the twentieth century, demographic change in Malaysia can be divided into three stages (Mahari 2011). The first stage occurred from 1911 until 1927 (16 years), during which there were low birth rate and high death rates. The nation subsequently entered the second stage in 1928 to 1957 (29 years) with the birth rate reaching its peak of 46.2, whereas death rates decreased. The third stage began from 1958 until the present day, which is marked by relatively low birth and death rates.

4.1 Fertility, Life Expectancy and Mortality

Malaysia was in the third stage of demographic transition (Hamid 2012) where the two basic processes of demography, namely fertility and mortality, were beginning to show signs of converging with a declining birth rate and stabilising death rate. In general, the Total Fertility Rate (tfr) of Malaysia fell from almost 5 children per woman in 1970 to 2.3 children per woman in 2010 (Mahari 2011). As shown in Figure 2.2, there was a sharp decline in the tfr in the country. Between 1950 and 1965, the total fertility rate was 6.2, and it dropped to 5.2 in 1970, 3.6 in 1990 and further decreased to 2.7 in the period 2005–2010. It is projected that the tfr of the country will fall below the replacement level by 2050.

Figure 2.2
Figure 2.2

Crude birth rate, crude death rate, and total fertility rate in Malaysia, 1950–2100.

Source: World Population Prospects: The 2010 Revision (un 2011).

The declining rate of tfr was attributed to several factors. Tey (2007a) suggested that the changes in tfr between 1966 and 1985 were closely related to the sharp rise of the contraceptive prevalence rate from 8% to 50% following the National Planning Program in 1966. Projections foresaw a downward trend of fertility levels in the country over the next two decades. The pro-natalist policy of 1984 did not successfully reverse the trend.

Although there was a steady decline in fertility rate among Malaysians, differences in the rate of decrease among the various ethnic groups were detected. The demographic transition in Malaysia began before 1965. In 1960, the tfr was found to be highest among Indians with 7.2 children per woman followed by Chinese (6.5) and Malays (5.9). However, from 1965, the fertility rate began to decline in Malaysia whereby the tfr of the Malays was higher than that of Chinese and Indians. While the average number of children born to a Malay woman (or tfr) showed a gradual decline, it was still relatively higher than the national average from 1970 onwards (i.e. 5.2 in 1970 and 2.3 in 2010) (Figure 2.3). The tfr among Malays were reported at 5.0 in 1970, 3.4 in 2000 and 2.7 in 2010.

Figure 2.3
Figure 2.3

Fertility, mortality and total fertility rate in Malaysia, 1950–2100.

Sources: Population Profile, Malaysia (npfdb 1999); Vital Statistics Time Series, Malaysia, 1963–1998 (dosm 2011b); Vital Statistics, Malaysia, 2003 (dosm 2003a); Vital Statistics Malaysia, Special Edition, 2001 (dosm 2006).

The changing and diverse trend in fertility and mortality among the three major ethnic groups in Malaysia was closely related to various social, economic and cultural factors. Family planning was highlighted in a past study, which reflected on the lower use of an efficient method of contraception among the Malays. The Malaysian Population and Family Survey-4 found that a large proportion (70%) of women in the survey used contraception; the highest rate was among Chinese (almost 80%), while the Malays and Indians were more or less around 65.0%. In addition, the desire to have more children was found to be stronger among Malays compared to Chinese and Indians who did not seem to aspire to have many children. The relatively larger number of children among Malays was also supported by religious and cultural notion that children ware ‘gifts of god’ and a family with many children was a ‘prosperous’ family, irrespective of their economic conditions (Yaacob 2005).

The Department of Statistics, Malaysia (2006; 2010) recorded a growing population from 10.4 million in 1970 to 28.3 million in 2010, with an increasing trend in a sex ratio of 102 (males to 100 females) in 1970 to 106 (males to 100 females) in the latest 2010 census (see Table 2.2). Meanwhile, Malaysia experienced almost a three-fold increase in the population over the last four decades.

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Like many countries in Asia, life expectancy continuously increased among both males and females in Malaysia. In 1970, life expectancy at birth for males and females was 62 and 66 years respectively. After four decades, these figures (see Table 2.3) have soared to 70 and 75 years in 2000 and in the latest national census year 2010, the figures rose to 72 and 77 years respectively. The gap in life expectancy between sexes slightly widened; for the year 2000, it was 4.6 years while for year 2011, it was 5.1 years (dosm 2010).

T000003

In 2016, the national census reported that, of the 31.7 million Malaysians, 6.0% of the population were elderly (age 65 or above) and 7.8 million or 24.5% were children (age 0 to 14 years old). Meanwhile, the median age of the population increased from 15.5 years in 1970 to 20.6 years in 2000 and further up to 28.0 years in 2016, reflecting an age structure transition from a ‘very young’ to ‘mature’ type of population. Based on the 2010 national census, the median age of the head of family also rose from 43.2 years in 2000 to 46.1 years in 2010. The transition of these demographic indicators was in line with the shift of population structure towards an aging society in Malaysia (dosm 2010).

A similar trend was observed across the main ethnic groups in Malaysia from 1970 until 2011. Among males, the highest life expectancy at birth in 2011 was recorded by the Chinese at 74.5 years, followed by the Bumiputera (70.5 years) and the Indians (68.0 years). While among females, the highest was also recorded by Chinese (80.0 years), followed by Indians (76.8 years) and Bumiputera (75.4 years) (See Table 2.3). The differences across gender and ethnic groups may have been due to lifestyle and dietary difference or discrepancies in the knowledge, attitudes and practices (kap) in health but this is yet to be further investigated in Malaysia. More importantly, the demographic transition in Malaysia implied the feminisation of ageing and diversification across ethnic groups.

Malaysia achieved remarkable progress in social development with improvements in educational levels, health status and the standard of living. As a result of health development strategies aimed at improving the infrastructure and delivery of health system (Hamid, Rashid & Salleh 2006), the mortality rates reduced to a fairly low level. The Crude Death Rate (cdr) dropped from 5.3 persons per 1000 populations in 1980 to 4.4 in 2005. In terms of ethnic group comparison, while the general pattern of cdr rates for different ethnic groups was coherent with the national pattern, statistics from the dosm noted that the mortality rate was higher among Indians (7.0 in 1980, 5.2 in 2005) as compared to the Chinese (5.4 in 1980, 5.0 in 2005) and Malays (5.1 in 1980, 4.5 in 2005). The mortality rate difference may be attributed to the lifestyle and cultural practices of the ethnic Malays, Chinese and Indians in Malaysia (Hamid 2012).

In Malaysia, the trend of mortality rates among the elderly was on the decrease, an indication of a larger proportion of elderly in the coming decades. The continuous effort of the government on development and improvement of health care was evident. In the 2011 Malaysia budget, the government provided 5% of the government social sector development budget for public health care, which showed an increase of more than 47% compared to the previous budget. Due to the decreasing trend of mortality rates, there was an urgent need for the government to plan for and develop health programs to support more elderly people in the coming years.

4.2 Proportion of Older People and Children and Dependency Ratio

Malaysia experienced a gradual shift in the young-old balance over the last four decades. The 2010 national census reported that the total population of the country was 28.9 million of which 9.2 million were below 15 years old. While the total population soared from 10.4 million in 1970, the proportion of those below the age of 15 years (or young children) decreased to 31.7% in 2010 compared to 44.9% in 1970, 39.6% in 1980 and 35.4% in 2000. dosm (2012b) projected that the downward trend of the below-15 young population would continue, and it was estimated that it would be 19% of the total population by 2040.

On the contrary, the elderly population (aged 60 or over) increased steadily over the last few decades (See Figure 2.4). The latest Census in 2010 reported a total of 2.3 million or 8% of the total population were elderly (aged 60 or over) which soared from 0.5 million or 5.2% in 1970. Specifically, data from the dosm (2006, 2010) showed a steadily increasing share of population aged 60 or over, from 5.7% in 1950 to a rapid increase of 6.2% from the year 2000 onwards. The figure was projected to increase more than two-fold to 4.4 million or 10% of the total population by 2020 and by 2040, the percentage of older persons aged 65 and over was projected to soar to 11.4%. In other words, by 2020, one in ten Malaysians would be an older person aged 60 and over. In terms of gender differences, there was a larger proportion of male (52.2%) than female (47.8%) in the older population in 1970; however, after 1980, the pattern reversed where the females outnumbered the males with a gap of 1.2% in 1980, 5.4% in 1991, 4.6% in 2000 and 1.8% in 2010. In addition, it was projected that there would be 51.8% females and 48.2% males in the older population by 2020.

Figure 2.4
Figure 2.4

Rise of the older population, Malaysia (1970–2010).

Source: dosm2011, 2012b.

The dependency ratio is a rough indicator of the financial cost that the working population (15–64 years old) is facing to support the economically inactive population that include (1) children aged below 15 and (2) older persons aged 65 and over. Hamid (2012) noted that since the mid-1960s, the total dependency ratio for Malaysia fell due to the shrinking proportion of the young population. However, the country would experience an expansion of the aged population and contraction of the youth population as a result of declining fertility and mortality rate as well as increased longevity. In the 2000 Census, it was found that one older person was supported by 15 productive aged members of the population and in 2010, the number decreased to 14 (dosm2005, 2011).

Figure 2.5 shows the projected population support ratios of Malaysia based on the 2010 Census. It indicates that the total dependency ratio was projected to decline from 47.8 to 44.9 for the period of 2010 to 2040. This increased cost of the working population in Malaysia was further reflected in the decline in the young age dependency ratio from 40.4 to 28.3 and increase in old age dependency ratio from 7.4 to 16.6 during the same period. In other words, in 2010, one young person was supported by 2 persons of the productive age population but this was projected to be 1 young person to almost 4 working persons in 2040; while one older person was supported by 14 persons in the productive age population in 2010. The cost was projected to increase to 1 older person to 7 working persons in 2040. These figures reveal that the working age population would have to bear an increasing support from their dependents, in particular, the increasing number of those in the old age population. More importantly, the increasing number of family members surviving into old age means that the population would require more personal care. The demand for care would intensify with old age and deteriorating health status. However, given the smaller number of families which were available to share the responsibility, as well as the geographical distance, the question of whether or not the family was ready to provide this type of care remained to be answered.

Figure 2.5
Figure 2.5

Dependency ratio, Malaysia, 2010–2040.

Source: dosm 2012b.

4.3 Family/Household Composition and Size

4.3.1 Changes in Family Composition

Malaysia was a developing country, having started off with an agrarian economy before successfully transforming to a modern industrialised economy. The country achieved remarkable economic progress and modernisation since its independence in 1957. Over the last four decades, Malaysia experienced a significant change in family landscape in terms of composition, size, structure and functions, as a result of demographic transition and socio-cultural shift. Family structure also diversified from traditional two-parent families to include a significant proportion of single-parent, blended, step and dual-earners families (Doshi 2010; Strong, DeVault & Cohen 2011) and this had an impact on the functions of family and relationships between generations. The fundamental changes in the composition and structure of families among the Malay, Chinese and Indian communities differed, given their unique socio-cultural characteristics. The following summarises the key trends and characteristics of the families in Malaysia, with details in the sections that follow.

  1. (1)The significant proportion of nuclear household in Malaysia was steadily growing with a narrowing gap between urban and rural areas.
  2. (2)Increasing proportion of single-person/one generation households.
  3. (3)Increasing proportion of nuclear household with older persons.
  4. (4)Decreasing family and household size.

4.3.2 Shrinking Family Size and Prevalence of Nuclear Household

Demographic transition in Malaysia reflected the change from a large family size with short lifespans to a small family size and longer lifespans. Census data provided a clear indication that there was a continuous decline in family size. The average family size was reported to be at 5.2 in 1980 and it had dropped to 4.3 in 2010. Similarly, the average household size reported a downward trend where the average number of persons per private household in Malaysia was reported to have decreased from 5.2 (1980) to 4.2 (2010).

As indicated in Tables 2.4 and 2.5, the nuclear family which consisted of two parents and at least one unmarried child, remained the predominant family living arrangement in Malaysia. It also remained the most frequently reported type of household as compared to others that included extended households, single person households and living with relatives. According to the National Census and 2004 Malaysian Population Family Survey (mpfs), there was an increased percentage of nuclear household families in which 70% of the households form a nuclear family as compared to 65.4% in 2000. However, this figure has dropped to 62.8% in 2010. A similar descending trend was observed among extended family households where the total percentage dropped to 18.0% in 2010 from 27.8 in 2000. The percentage difference in nuclear households between rural and urban areas was more apparent between 1980 and 1994; while from 2000 onwards, the proportion of nuclear households was almost equal between the rural and urban stratums. While there was a decline in extended family households, past research asserted that there was relatively a high proportion of the elderly in Malaysia who continued to co-reside with their adult children and other family members (DaVanzo & Chan 1994; Chan & DaVanzo 1996; Ngin & DaVanzo 1999).

T000004
T000005

4.4 Growing Single Person and Older Person Household

While there was a decrease in the percentage of nuclear households to 62.5% in 2010, single person households have shown a slight increase in percentage. The proportion of single person households has grown to 8.7% in 2010 from 7.1% in 2000. Looking at the subset of households with older persons, about one-third of them were nuclear households while more than half tend to be extended households (Table 2.5). There was also an increase of nuclear households with older persons (37.6%) in 2000 compared to 1990 (30.6%); while the number of extended households with older persons decreased during the same period of time. This may be an indication that given their increased longevity, older people were more likely to live with their spouse in a nuclear household as compared to co-residing with adult children who were living at a distance or in a different city.

4.4.1 Diversified Family and Emergence of New Family Types

While statistics on divorce and marital dissolution, an indication of the stability of the family as an institution, indicate that the majority of Malaysian families tended to be stable, non-traditional families such as single parent, blended and step-families were on the rise in the current society. As shown in Figure 2.6, the divorce rate increased steadily from 0.58 cases per 1000 population in 2000 to 1.02 in 2005 and slipped slightly to 0.93 in 2008. Moreover, there was a disparity between the number of divorce cases among non-Muslims and those among the Muslim population. Among non-Muslims, the number of divorces increased rapidly by 2.7 times (9,020 cases) in 2012 from just 3,291 cases in 2004. In comparison, the number of divorces between Muslim couples increased more than twofold within 10 years in which the number of cases increased from 13,536 in 2000 to 20,529 in 2007 and further soared to 27,891 in 2009 and 33,239 in 2010. In addition, 20.7% of the 135,548 registered marriages resulted in divorce in the year 2010 alone (dosm2006, 2010).

Figure 2.6
Figure 2.6

Divorces in Malaysia, 2000–2008 (per 1000 population).

Source: dosm2006, 2010.

While the divorce rate steadily increased among both Muslim and non-Muslim couples, the rates of marriage tended to be higher between Muslims (M) than non-Muslims (NM) couples (2000: M=14.7%, NM=2.6%; 2003: M=15.2%; NM=5.6%; 2005: M=15.5%; NM=7.2%). Comparing the three dominant ethnic groups, Chinese Malaysians had the lowest divorce or separation rate (2.2%), followed by Indians (2.9%), and Malays (8.4%). In 1989, only 19.9% of divorced women in general remarried, but the rate was 78.7% for Malay women. It was widely perceived that these higher rates of divorce and remarriage in large part simply reflected the fact that divorce and remarriage tended to be far more socially acceptable among Malays than among the other ethnic groups (dosm2006, 2010).

The mpfs 2004 found that reasons for divorce included misunderstandings (41.6%), irresponsible husbands (11.6%) and in-law interference (8.9%). Other causes may have included poor parent-child relationships, failure to solve family issues, domestic violence and, lack of communication and commitment to the family (Doshi 2010). Following divorce, mothers typically received primary custody of the children. This could have had a significant impact on the father-child relationship and also the financial standing of the mother. Marital dissolution also led to other issues including severance of marital bonds, establishment of a new lifestyle, economic stressors, negotiation of custody arrangements, adjustments in parenting, and changes in social support systems. This phenomenon no doubt caused changes in the structure and dynamics among families in Malaysia such as the issues related to single mothers, the rise of women-headed households and, the adjustment of, and relationship between, divorced parents and their children (Doshi 2010).

Progressive economic development in the country which provided increased opportunities for employment and education, specifically among women, combined with changing family values and high cost of living, led to the emergence of several new types of family in Malaysian society such as dual-career families, dink (Double Income, No Kids) families and commuter families. Dual career or dual earner families referred to families where both parents were actively engaged in full time employment and contribute to the economic well-being of the household. Within dual-career households, both parents were constantly challenged by the demanding roles of worker, parent and spouse. They also juggled issues on role conflict and role overload that included problems with child care arrangement, time management and balancing the demands of work and family life, emotional stress, and the need for support from the family and the workplace (Doshi 2010). Another significant implication of an increased female labor participation within Malaysian society was the emergence of “dink Syndrome/Lifestyle” (Double Income, No Kids), where some couples may have decided not to have children at all. “Househusbands” may have also increased and this would have implications for family relationships and the traditional gender roles and responsibilities of husbands and wives (Doshi 2010).

The phenomenon of the commuter family became a concern in Malaysian society since their living style was entirely different from the conventional family model in Malaysia. A Commuter family was defined as a weekend family whereby one of the married couple stayed far away from the nuclear family and they met regularly but only once a week, twice a month or once a month. The commuter lifestyle either on a voluntary or an obligatory basis was often related to increasing households with dual-career couples, financial and societal demands, career enhancement, deployment by employer and potentially higher incomes. This new type of family emerged as a direct result of shifting demographical trends and socio-cultural values that might have had long-term implications for family relationships across generations and care networks in Malaysia. The emergence of various unconventional family models challenged the traditional gender ideology of ‘father as primary breadwinner and mother as primary caregiver’ in a nuclear family; and thus, their impact on the fast ageing society of Malaysia had a considerable impact on the development of the social protection programme and policy (Doshi 2010).

4.4.2 Decreasing Two-generation and Increasing One-generation Families

The rapid development and urbanisation process in Malaysia accelerated the outmigration of the younger generation for education, employment and marriage leaving the older population remaining in the rural areas. As such it impacted on the decrease of two generations and increase in one generation families. mpfs-5 (NPFDB 2014) survey found more than 66% of households being nuclear family households as compared to only 20.8% of the population living in extended family households. Adding to that, the mean household size was four persons and 82% of households are headed by male (Doshi 2010).

Concurrently, this scenario brought the older generation to next stage of family life, the so- called empty nest. The term empty nest referred to the situation where the elderly person was living alone or living together only with their spouse after their children migrated elsewhere. A recent national survey shows that 9.0% of the elderly are living alone and 20.9% are living only with their spouse (Doshi 2010). These elderly ones may be experiencing the empty nest syndrome. This kind of situation must be given special attention as it may affect the emotional, health and economic stability of the elderly.

4.5 Marriage and Divorces

Demographic changes significantly affected the marriage trend in Malaysian society. Greater access to education and more opportunities in the labor force market delayed marriage and family formation among Malaysians. Some of the major trend and characteristics included:

  1. (1)Delayed marriage and child birth.
  2. (2)Growing single or unmarried population.
  3. (3)Diversified and emergence of new family types.

4.5.1 Delayed Marriage and Child Birth

There was a clear trend of men and women in Malaysia getting married at a later age, in particular, among women. Statistics showed that among women, the mean age at first marriage has increased from 23.5 years in 1980 to 25.1 years in 2000, and 25.7 years in the 2010 census; while among men, the mean age of first marriage also rose from 26.6 years in 1980 to 28.6 years in 2000 and 28.0 years in the latest 2010 census. A similar pattern was reported among Malays, Chinese and Indians (Doshi 2010).

Delay in marriage may be strongly associated with improvement in education attainment and employment opportunities. The achievement of women in education was remarkable with the increment of those in secondary education rising from 10% to 39.2% between 1970 and 2000; tertiary education reached 6.2% in 2000; and a reduction in the percentage of ‘never attended school’ from 51.0 to 22.8% was reported. The Malaysian Population and Family Survey-4, conducted in 2004 also revealed that age at first marriage increased with the educational level among women whereas women with no schooling showed the lowest age at first marriage (20.6 years) while those with tertiary education reported the highest age at first marriage (25.6 years). The effects of educational level tended to be more evident on marriage postponement among the Chinese as compared to Malays and Indians (npfdb 2005). Specifically, Tey (2007b) noted that in comparison to their Malay and Indian counterparts, Chinese women who were tertiary-educated tend to marry 5 years later, or more, than those who only received primary education; while this gap was much smaller among the Malays (1.3 years) and Indians (2.4 years) (npfdb 2005).

4.5.2 Rise of Single or Unmarried Population

Among the single or unmarried population, their percentage distribution across different age groups was also changing. The percentage of the population who were never married in the age groups of 15 to 19 and 20 to 24 was higher but moving toward a decreasing trend from 1980 to 2000 while those who were never married in the age groups of 30 to 34 and above was on the rise during the same period of time. Specifically, the proportion of never-married people aged 20–34 increased from 43.2% in 1991 to 48.1% in 2000. The figures of single females between the ages of 20 to 34 increased to 68.5% in 2000, compared to only 60.2% in 1991. This pattern was found to be consistent among males and females between the ages of 25 to 34 (dosm 2003a).

The 2004 mpf Survey (mpfs-4) also showed that the tendency to postpone marriage may be explained by the relatively high level of education in which more single females (34.7%) attained tertiary education qualifications than single males (25.7%) and, their economy stability where the majority are in employment whether as employees (79.5%), self-employed (15.9%), employers (2.6%) and unpaid family worker (1.9%). Only a minority (18%) indicated that they have ‘no intention to get married’ due to financial constraints (npfdb 2005). In terms of ethnic comparison, at ages 30 to 34, there were almost one third of Chinese women with tertiary education level who were still unmarried and the proportion of married Malay women was also higher compared with Chinese and Indians across most age groups. While it was recognised that the proportion of the population who were never married has doubled in the last decade, the changing values and expectation of the society together with rising education level, career opportunities and options in life contributed to the increase of the single, unmarried population in Malaysia. Those who remained unmarried in their 30s may be encouraged by economic independence, availability of other options than marriage from increased employment, career development and greater freedom in life. This emergence of ‘sink’ (Single Income, No Kid) lifestyle reflected a new trend in Malaysian society where both men and women in the working age group remained single without children.

5 Changes in Policy and Legislation

5.1 Five Phases of Policy Regimes along Demographic Change

Malaysia underwent a series of policy and legislative changes to promote economic growth and social development. Some of these policies directly or indirectly affected family structure and its function in protecting and caring for dependent family members. Lower fertility associated with rapid economic growth allowed the government to focus national investments in social development which include family planning, education, and health care programs (Robey 1991). In addition to lower fertility rates, economic developments also brought improvements in medical technology, public health and nutrition that led to increased well-being and increased life expectancy (Bongaarts & Sinding 2011; Robey 1991).

After its independence in 1957, the country implemented a total of ten national development plans which have guided the country’s developmental planning strategies and contributed to a significant reduction in the incidence of poverty, and to a more equitable distribution of income. Policies concerning children and the elderly were scattered and largely incorporated into various general policies until early 2000s. A diversity of family-related policies and legislation were also implemented in Malaysia to address the need for different laws which cater to the Muslim and non-Muslim population.

Drawing upon these contextual backgrounds, this section aims to provide explanations for care relations in Malaysia, focusing on national development strategies and the shift in relevant policies as well as their implications for population structure and care relations and support for young and old within the family and beyond.

5.1.1 Phase i: Population Growth in 1950s and Introduction of Family Planning Policy in the 1960s

Between the period from 1950 to 1955, Malaysia continued to have high fertility rates with a total fertility rate of 6.8 births per woman (Bach 1981). Family planning was not included in national development plans until the early 1960s (Tey 2007). The reason behind this lag was because during the 1950s, family planning was perceived negatively by the federal government. High fertility rates and rapid population growth following Independence were necessary to fast-track economic growth. Despite that, the government allowed the services to be carried out by private entities, comprising various Family Planning Associations at state level, whose services were mainly available in large urban areas and to those who could afford such services (Tey 2007).

With economic problems looming, the government became increasingly apprehensive of the impact of high population growth on the society, the economy and the health fabric of the country (Chong, Sia, Lim & Ooi 2011). In particular, as a result of the economic slump from falling rubber prices and increasing unemployment, the government was concerned about whether the standard of living could be maintained unless there were improvements in employment and economic production. By 1964, the government changed its approach and decided to adopt family planning as a policy based on the report on “The Population, Development and Welfare in Malaysia”.

When the First Malaysia Plan (1966–1975) came into effect in 1966, one of the specific targeted areas was population control and family planning (First Malaysia Plan 1966–1975). Parliament passed the Family Planning Act (Act No. 42) that led to the establishment of the National Population and Family Development Board (npfdb) to provide the required leadership in the coordination and implementation of a National Family Planning Programme (nfpp) (Yoon & Cha 1999). Family planning became a tool to curb population growth rate and increase the average annual per capita income. By the early 1970s, family planning services were extended to various parts of the country (with the exception of Sabah and Sarawak which came much later) through integration with the maternal and child health programs under the Ministry of Health (Tey 2007). Thus, the change in national policy towards the adoption of family planning marked the triumph of economics and health over politics and religious fundamentalism in a country with a multi-ethnic society and Islam as a main religion (Inhorn & Sargent 2006; Tey 2007). In relation to childcare, the earliest policy of the National Education Policy, was on matters related to children, which focused on promoting preschool education for children. This reflected the government’s initial efforts in human capital development through opportunities for education. This policy and legislative development have gradually led to a significant change in family size and population growth rates in the country.

5.1.2 Phase 2: Fertility Transition and New Economic Policy in the 1970s

The nfpp has effectively changed fertility levels in the population through its programs on family planning and limiting child births. Between 1970 and 1979, Malaysia’s tfr had declined to 5.2 births per woman (Bach 1981). Ethnic differences in the acceptance of the nfpp were consequential in the diverging fertility trends among the main ethnic groups in Peninsular Malaysia (Abu Bakar, Tan, Tey & Rohani 1985; Yoon & Cha 1999). As the average annual population growth rate declined from 3.2 (1960–1965) to 2.4 (1970–1975) (DaVanzo & Starbird 1991), population growth was no longer featured in policies.

Under the Second Malaysian Plan (1971–1975), there was greater emphasis on rapid economic growth through greater opportunities for education, employment and higher income for those in disadvantaged groups. The New Economic Policy (nep), drawn up after the May 1969 ethnic riots, combined all development planning with intensified implementation of poverty reduction programs to offset economic imbalance and create social unity. Improvements in economic indicators have led to fertility decline across all ethnic groups, with the Chinese and Indians having a much accelerated decline compared to the Malays (Bach 1981). Through the nep, there was also a growing Malay middle class from the greater opportunities for urban migration, employment, education and affirmative action on quotas for business participation (Leete 1996). The policy’s underlying motive of economic growth through income redistribution and affirmative action was noted as a reason for the variations in fertility decline among the ethnic groups due to differential opportunities afforded in education and employment.

5.1.3 Phase 3: Pro-natalist Policy for Population Growth and Increase in Productivity in the 1980s

The period of the 1980s saw enormous economic and social changes due to economic liberalisation and industrialisation in response to recessionary pressure at the beginning of the decade. Under the newly-elected Prime Minister, Dr. Mahathir Mohamad in 1981, the government introduced the Look East Policy, which resulted in privatisation and an aggressive industrial policy with a heavy emphasis on industrialisation in the national development strategies. The formulation of the Industrial Master Plan in 1985 has transformed Malaysia’s industrial landscape into one that is capital intensive, high-tech and knowledge-based (epu 1986). As a result, labor shortages began to emerge with industrialisation and the foreign labor market burgeoned (Ariff 1998). In the Mid-Term Review of the Fourth Malaysia Plan (1981–1985), a pro-natalist policy was developed and family planning was de-emphasised and Information Education and Communication (iec) activities were discontinued. This was also supported by resurgence of Islamic fundamentalism in the 1970s. Thus, Malaysia was able to maintain fertility levels at a medium range compared to other Southeast Asian countries (Gubhaju & Moriki-Durand 2003; Sanderson & Tan 1995; Tey 2007).

The Fourth Malaysia Plan (1980–1985) not only promoted the agenda on women and included integration programs of women in development, but also included expanded programs for medical and health services to promote family development, women and child well-being, from infancy until they leave school. In relation to childcare services, the provision of maternity and child health services was expanded to previously underserved urban and rural centres as well as specific areas such as estates and mines (Fourth Malaysian Plan 19811985, 254). A review of the National Population Policy (npp) in 1984 led to a major shift from family planning to family and human resource development, to achieve an ultimate population of 70 million by 2100 and to raise the quality of the population through education and human resource development. The nfpp was renamed the National Population and Family Development (npfd) Programme with an expansion of programs on reproductive health, gender issues, marriage, parenting and counselling (Mahari 2011). The npfd Board developed strategies and programs on family welfare in order to achieve a target population of 70 million by 2100, guided by more family-focused principles of the npp: Attainment of a quality education, the role of woman in development, family support of the elderly, encouraging family and community and the government to support vulnerable/disadvantage groups and programs for child protection and survival.

In 1989, the National Policy on Women was introduced to enhance the role of women and warrant their integration into the development process including promotion of health services to women and children (Kahar & Mohd Zin 2011). In the same year, important legislation related to family development such as the Child Care Centre Act 1984 (ccca 1984) was introduced to regulate the quality of child care services for children below the age of four, and Early Childhood Care and Development training were provided to service providers and parents. The Islamic Family Law (Federal Territories) Act 1984 contains the provisions for the rights of a Muslim child to be provided with maintenance by the parents until the age of 18 or until the completion of higher education/training. The Act also stipulates matters pertaining to the custody and welfare of children, including children who are born out of wedlock. Thus, in terms of family and child care, Muslim and non-Muslim women are governed separately by various laws such as the Islamic Family Law Act for Muslims and The Law Reform (Marriage and Divorce) Act 1976 and Married Women and Children (Maintenance) Act 1968 for non-Muslims. The implementation of diverse family- and child-related policies and legalisation is unique in the Malaysian context; nonetheless, an absence of child-focused and family-focused policy affects their smooth implementation in terms of upholding and supporting child care and family well-being (Kahar & Mohd Zin 2011). In terms of childcare, the Care Centres Act 1993 governs the registration, control and inspection of the day and residential care centres which provide care for four or more persons over an extended period of time. Together with the ccca 1984, these two Acts are crucial for the provision of child care services and quality control of child centres by both private and public sectors.

Policies implemented at the beginning of 1990 carried impacts on fertility rates and shortened childbearing spans for women and have contributed, through better education, and later marriage, and the country’s vision, towards nation building and development of quality human resources. This lead to the introduction of the National Social Welfare Policy in 1990 with a focus on policies that promote the concept of a stable and ‘caring society’ for the well-being of people. The National Social Welfare Policy (1990) also addressed the need of older persons for care within the family and community, a commitment that was further emphasised in the National Policy for the Elderly (1995) (Ambigga et al. 2011).

5.1.4 Phase 4: Increased Emphasis on Social Development from 1996

The rapid economic progression that followed aggressive national industrialisation strategies in the 1990s has raised concern on the impact of economic growth on the individual, family and community development. The Seventh Malaysia Plan (1996–2000) reflected a significant paradigm shift in the national development plan with a greater precedence of social over economic development. With an increased budget allocation for a social agenda, the national development plan aimed for a more balanced development to create a resilient society with strong family values, greater self-discipline and an appreciation for culture (Seventh Malaysia Plan, 5). As proposed in the Vision 2020 plan (1990), national strategies were shifted to a stronger emphasis on economic resilience and quality of life with positive social and spiritual values (Seventh Malaysia Plan, 4), strengthening the nation’s focus on developing quality human resources through the solidification of the family institution. In addition, this renewed emphasis also included efforts on promoting relationships between family members and across generations though the National Development Plan (ndp), replacing the nep in 1991, for more integrated and holistic human resources development.

While there is still no child-focused policy in Malaysia, family-friend social policies for child care and family support are embedded in various general policies and legislation. For example, the Education Act 1996 represents a strong government commitment to childcare, upholding the rights of every child of school age to free education for a period of eleven years. Under the Islamic Family law, the establishment of the Family Support Unit is the most recent policy introduced by the government in order to address the issues of maintenance, including children’s educational support, (Kahar & Mohd Zin 2011), in addition to the Baitul Mal scheme which provides financial disbursement to the divorced, as well as economically deprived Muslim women whose ex-husbands could not afford to pay for their maintenance. It has been argued that the care and financial support for children under the Islamic Family Law Act 1984 was more advanced than the civil courts, which governed the welfare of non-Muslim children (Kahar & Mohd Zin 2011).

The Child Act 2001 (CA 2001) was enacted when Malaysia realised that many of its statutes did not conform to the United Nations Convention on the Rights of a Child (uncrc). The CA 2001 is very comprehensive and covers all areas of law relating to children, from ill-treatment, neglect, abandonment or exposure of children to moral danger, child prostitution or begging to children left without reasonable supervision. In 2006, both the ccca 1984 and cca 1993 were amended to monitor the operation and quality control of childcare centres, including those at workplace and community centres. Compulsory Certification on Registration of Child Care Centre was issued to all qualified service providers. Following public concerns regarding children’s safety, quality of care and training of child minders, the Department of Social Welfare was given more authority in monitoring the administration of centres with support from the Health Department, Fire and Safety Department and the Local Authority. The provision of childcare services, often privately owned, is often viewed by authorities as a business enterprise where the permit has to be renewed on a yearly basis rather than on the basis of the best interests of the child. Thus, this may have implications for children safety and the quality of child care services. Nonetheless, the National Permata Policy for early childhood care and education in rural areas and areas with lower socio-economic income groups has been implemented at government kindergartens and nurseries for children under 4 years old. This reflects the government’s efforts and serious intent in the creation of policies and implementation of laws on childcare in Malaysia.

Major policies addressing the needs of older persons were also introduced from the 1990s namely the National Policy for the Elderly (1995) which was later revised in 2011. In 2003, the National Social Policy was used to consolidate all social development policies and strengthen other action plans in previous social policies (Kahar & Mohd Zin 2011). The government, through the Ministry of Health, also developed the National Plan of Action for the Health Care of Older Persons in 1997.

5.1.5 Phase 5: Approaching Replacement Level 2007 and Onwards

As the fertility rate is approaching replacement level, the government’s view on fertility has changed from ‘too high’ in 1996 to ‘satisfactory’ in 2007. Thus, the population policy on fertility was reviewed and revised from one that sought to lower it, to one with no intervention, but with the emphasis on raising the quality of the population through education and human resource development.

The 1995 National Policy for the Elderly, which was revised in 2011 based on Madrid International Plan of Action on Ageing (mipaa), was set to re-examine strategies for incorporating the reintegration of older persons into society, in order to promote healthy, active and productive ageing. These were pressing issues as Malaysia is approaching the fertility replacement level and transforming into an aging society at a much faster rate than expected, including increased life expectancy, a soaring population of older people, estimated to reach 15% by 2030 from 8% at present, under-utilisation of human resources, care and support for dwindling extended families, inadequate social protection, and the high cost of long term care. The introduction of the policy has led to several changes:

  1. Raising the mandatory retirement age to 60 in both the public and private sector.
  2. Tax relief up to RM5,000 to those who are providing care for the elderly which includes day care costs, a salary for maids who are specifically hired for the care of elderly and the cost of daily needs for encouraging family care.
  3. 100% tax rebate on costs to retrain older persons.
  4. Financial assistance for older people amounting to RM300 to assist the elderly poor to remain in their families or communities.
  5. The first University of the Third Age (U3A) in Malaysia was set up, affiliated to the Institute of Gerontology to encourage learning for leisure among the elderly.
  6. Through We Care Services, the Central Welfare Council of Peninsular Malaysia and Department of Social Welfare provide free transportation as a medium of accessibility to older person with disabilities to hospitals/clinics for health treatment and services.
  7. Rumah Seri Kenangan (home for the elderly), Pusat Activiti Warga Emas (senior activity centres) and home help services for elderly persons living alone, and partnerships with ngos were set up to provide care and protection for the elderly who are in need and to encourage active aging.

In addition, the need for effective, coordinated and comprehensive health care for the elderly population led to the development of the National Health Policy for Older Persons in 2008. These governmental efforts were translated into services provided at Health Centres that included health promotion and education, health assessment, medical examinations, home visits and home nursing and rehabilitation, and at the hospitals, services include acute medical care, long term care, discharge plans, psycho geriatric care, counselling and clinical pharmacy. In addition, recognising the importance of the family as social and production units, and its important role in nurturing the future generation and the care of older people, a National Family Policy was introduced in 2010. It was used as the blueprint for family services and encompasses housing, education, health and community development. It advocated the concept of ‘Family Well-being’ based on family values, to impart positive values from generation to generation, and thus the importance of family solidarity development.

In terms of child care, many family policies were reviewed and revised to accommodate the emerging needs of changing Malaysian society. After 2011, maternity leave, addressed in the Employment Act 1955, increased from 60 days’ leave to 90 days for civil servants, with other institutions and multinational companies beginning to follow the 90 days of leave. Paternity leave for civil servants increased from 3 days to 7 days in 2003. Under the Children Act 2011, Cash Allowances were provided for the following: (1) civil servants with a household income of less than RM5,000; (2) parents with a household income of not more than RM900 who sent their children to private childcare centres registered under the Social Welfare Department; and (3) tax relief of RM1,000 per child under the Income Tax Act 1967.

Several main social security programs were developed over the years which offered protection for old age support and ensure income security in old age, but much of the focus was on the national provident fund which managed a mandatory retirement savings scheme for private sector workers. The two main programs are the Employees Provident Fund (epf), established in 1951 and governed by the Employee’s Provident Fund Act 1991, which is a mandated defined contribution plan for private and non-pensionable public sector employees with a full withdrawal at age 55, and the Public Service Pension which was a pension payment for civil servants which was calculated based on the last drawn salary and number of years in service. It was perceived as a good scheme as compared to epf because it buffered against inflation risks as it was adjusted in tandem with the civil service pay review. Other schemes which were given less attention include the Older Persons Assistance Scheme which started in the 1980s. This was a means-tested social assistance to support the poor elderly aged 60 years or over to sustain their livelihood in the community. In 2008, the government escalated their efforts through an active campaign to locate those in need of aid and this boosted the number of recipient by 7 times in 2010 compared to 2005.

Other schemes for specific populations included the Armed Forces Fund for military personnel below the rank of commissioned offers; the Private Retirement Scheme (prs) which was a voluntary long term investment plan to boost retirement savings and was complimentary to saving with the epf; the Malaysia Retirement Savings Scheme in 2010 targeting self-employed individuals and workers in informal sectors with fixed incomes including housewives; and the Merdeka Savings Bond which was a risk-free, highly liquid, 3-year tenure bond issued by the Bank Negara Malaysia to boost retirement savings.

6 Changes in Care Relations

6.1 Child Care

In the last quarter of a century, Malaysia experienced rapid changes economically and socially. There was an emerging trend of contemporary social changes such as the rise of dual-worker households, sandwich families and commuter families, growing numbers, and higher rates, of family breakdown in the current society as well as economic problems (Ortega, Abdullah & Roslan 2014; Roslan, Li & Ahmad 2013) and (Roslan et al. 2013). Added to that, the increasing in education and labor force participation of women, and the dual earner couple emerged as the norm rather than the exception, and in the Malaysian context, women form a substantial force in the labor market. Thus, this new social economic transition had a significant impact on childcare.

6.1.1 Role of Family and Kin

One of the main functions of the family was to provide care for the young. The central and crucial role of family in the care of young children was prominent in traditional society. In Malaysia, child rearing that included instilling cultural values and norms to children was often not perceived as the sole responsibility of family, but was shared with other kin members (Yaacob 2014). Traditionally, children were primarily cared by the mother, but grandmothers and other familial or non-familial members may also be involved. The most recent national survey indicated that the care of young children was also provided by other family members, namely grandparents (60.4%), other relatives (22.5%), and older siblings (17.1%) (npfdb 2014). For example, young children were being looked after by grandparents or an unmarried aunt when the parents were working. In line with this, Chinese parents were found to rely more on extended family members and grandparents for child-care and this may have also provided a better sense of security and assurance to parents that their babies were well cared for (Roopnarine, Lu & Mohammad 1989) while Malay parents tended to rely on other kin members for childcare.

Previously, a review of early childhood care and family policies in Malaysia by Kamerman (2002) highlighted a study by the National Planning and Development Board in 1998 on “Childcare and Parenting Styles among Working Parents”. The study reported that working parents were profoundly dependent on alternative childcare services even though they would have preferred to provide the care themselves (14.6%) or to have family members play a role in co-parenting while they work (30.6%). Among family members, grandparents play an important role as care providers (60.4%) followed by other relatives (22.5%) and older siblings (17.1%). The survey also noted that working parents were also obtained care from neighbours and friends which accounted for another 15% of childcare services.

These changing demographic trends re-established intergenerational links and encouraged a more integral grandparental role to family functioning and intergenerational solidarity (Bengtson & Oyama 2007). More importantly, the unique role and contribution of grandparents and the fact that elderly parents played an increasingly significant role in downward support to their children and grandchildren in Asian societies, was recognised. (Butts, Thang, Yeo & Jefferson 2012; Tsai, Motamed, Elia & Rougemont 2011) Therefore, the potential importance and contribution of intergenerational relationships for the development of family and grandparents became increasingly recognised.

6.1.2 Role of State

There were three main ministries namely the Ministry of Women, Family and Community Development (mwfcd), the Ministry of Education (moe) and the Ministry of Health (moh) that were responsible for social welfare, health and education in childcare. They played an important key role in providing social welfare services, education and primary healthcare to children and families in order to ensure that family and community perspectives are incorporated in the formulation of policies and plans as well as in the implementation of programs.

In addition, the Malaysian government placed a strong emphasis on Early Childhood Care and Education (ecce) and formulated the National Policy for Early Childhood Education (Boon 2010). Under this policy, programs were introduced to meet the various needs of the vital early years of children until the age of six. These programs provided a solid foundation for healthy growth and development which expose them to activities in nation building and enhance their readiness for primary school education (Boon 2010). There were several initiatives to make early childhood programs more accessible and available, especially for less fortunate children and those in less urban areas. Early childcare and education (ecce) in Malaysia was divided into two age groups, which were 0–4 years and 4–6 years old. The first group (0–4 years), came under the Ministry of Women, Family and Community Development (mwfcd) which coordinated national programs on the growth and development of children (“Early Childhood Care & Education (ecce) in Malaysia at a Glance (for newborns to 6–year olds),”). Through its Department of Social Welfare, mwfcdmaintained registration of all childcare centers (also known as taska) in the country. Pre-school education for the second group (4–6 years) came under three ministries/agencies namely the Ministry of Education, the Ministry of Rural and Regional Development, and the National Unity Department and were offered through two types of institutions, namely childcare centres or nurseries or taska, and preschools or kindergartens or tadika.

In 2006, the Permata Early Childhood Education and Care programme with the theme ‘Every Child a Jewel’ was initiated to provide integrated quality care and early education services based on the needs of the local community to children below five years old. This program was implemented in childcare centres of the Community Development Department of the Ministry of Rural Development all over the country, childcare centres of the National Unity Department, and some institutions which were community-based childcare centres. It adopts the community-based integrated approach practised by Pen Green Corby, United Kingdom under the SureStart Programme. Under this approach, the centres offer childcare services, outreach programs, parenting courses, counselling, and healthcare services to help the local community develop a healthy lifestyle. Facilities included a community resource centre and library; and some may offer the services of a speech therapist and nutritionist. The founding principles of Permataecec Centres were: “Every child is a jewel for the country; Every child is precious; Every child is a part of the human capital of the country; Every child needs the best education; and Education must start from young/birth.”

6.1.3 Role of Local Governments, Communities, and Other Not-for Profit Providers

In 1982, a study was jointly conducted by the Ministry of Social Welfare and the United Nation Children’s Fund (unicef) which indicated the need to enhance the quality of childcare among childcare providers especially in the aspects of food handling, environment, mental development and training for childcare providers. As a result, the Childcare Centre Act 1984 was passed to maintain required minimum standards in childcare centres across the country. Besides its aim of providing care and education to preschool children, the Act included directives on registration; monitoring and inspection of the childcare centres; and protecting the interests and safety of the children against any form of abuse or neglect.

Thereafter, the Childcare Centre Act 1984 was reviewed and updated by Parliament giving rise to the Childcare Centres (Amendment) Act 2007. Government-supported community childcare centres, subsidized workplace childcare centres and a Quality Improvement Accreditation System (qias) were also implemented. The Association of Registered Childcare Providers Malaysia (arcpm) was one of the non-profit organizations that worked towards ensuring that the children received quality care by professional childcare providers and/or their parents. In Malaysia, a legislative-approved childcare centre was defined as any premise where four children or more from a household were received to be looked after for a fee with childcare services ranging from a half-day to full day basis. The objectives of the childcare centre are (i) to assist working parents so that their children get good care while they were at work, (ii) enhancing the standards of living of the family, (iii) to provide opportunities for people who love children to work in the childcare centres and (iv) encouraging involvement of society in the caring and nursing of the children. The childcare centres fell into four categories:

  1. Government-owned childcare centres
  2. Workplace childcare centres
  3. Institution-based childcare centres with 10 children or more
  4. Home-based childcare centres with fewer than 10 children

Under the Childcare Centre Act, all childcare centres needed to be registered with the Department of Social Welfare (dsw), more popularly known as Jabatan Kebajikan Masyarakat Malaysia (jkm), under the Ministry of Women, Family and Community Development (mwfcd). mwfcd was responsible for the approval and establishment of childcare centres in the country whilst the Department of Social Welfare served as the main regulator and coordinator of ecce programs. In the plantation sector, childcare centres were provided under the Standard Act, Minimum Housing and Workers Facilitation 1990 and monitored by the Ministry of Human Resources. The Association of Registered Childcare Providers Malaysia (arcpm) was a registered national association that plays roles in implementing programs and providing consultancy & training services to childcare providers, organizations and individuals who worked with children.

6.1.4 Day Care Services by Profit and Not-for Profit Providers

During the 1950s, child care services were limited to those provided by the churches (Chiam 2008). Fortunately, the extended family could still be relied upon at that time to supplement the role of parents in providing childcare. Nevertheless, significant rural-urban migration led to the breakdown of extended families and coupled with the unprecedented entry of women into the labor market, the care of children was beyond what the family could cope with. For these reasons, child care services were made available by the late 1970s (Chiam 2008).

As Malaysia was increasingly moving towards becoming a developed nation by 2020 and look to boost its female workforce participation, the establishment of high-quality child care centres became an imperative. Awareness of the demand for childcare kept increasing as most parents, especially those from urban areas, are both active in the work force. However, the National Family and Population Board’s survey in 1999 reported that affordability became a significant factor for parents to want to use childcare services.

Therefore, in the Ninth Malaysian Plan 2006–2010, the Malaysian government initiated community childcare centres in urban and rural areas with the objective of providing quality childcare services that was more accessible and affordable to the local community especially for targeted groups. The centres used a curriculum set by mwfcd which was based on the active participation of the local community, parents, children, governmental agencies as well as private organizations.

Besides that, workplace childcare centres were another alternative that provide child rearing services. In line with the National Plan of Action for Children for the establishment of child care centres to be set up at, or near business premises, which operated during the usual work hours of the employer towards providing care for children aged 0–4 years, as specified in the Child Care Centre Act 1984, mwfcd encouraged employers to set up childcare at the workplace. For instance, the government provided incentives in the form of a RM 80,000 grant for the establishing of childcare centres within government offices. In addition to encouraging working mothers to utilise these centres, a subsidy of RM180 per month was given to government servants with monthly salaries below RM2000 who sent their children to these centres. mwfcd also encouraged the private sector to provide childcare facilities at the workplace for their employees. Incentives included a 10% tax exemption on the cost of building the childcare centres for a period of 10 years.

Despite the local community and government providing several schemes and incentives to encourage participation of mothers in labor force, the rate of workforce participation among Malaysia women (aged 15–64) remained well below that of other countries in Southeast Asia, ranging between 44–47% for the last three decades. The low rate of Malaysian women’s participation in the workforce was mainly due to inflexible working arrangements, family commitments and child rearing responsibilities (mwfcd 2014). As such, work-family balance became a common issue related to early resignations among women workers (npfdb 2014). The recent 5th Malaysian Families Survey (mfs-5) highlighted childcare problems as the highest reason for leaving the workforce among Malaysia women, accounting for 32.4%. . As such, the cost of childcare could be one of the reasons for women to stop working. In Malaysia, a local study found that on average the cost of childcare ranges from RM350 up to RM1,200 per month excluding necessities such as clothes, diapers and food or formula milk which might cost up to RM3,000 per month. The fees for childcare centres commonly depend on the location, type of childcare service, age of child, the length of time that the services were required, whether these were used on a full day or half day basis. Another option for childcare was through employing a live in domestic helper a so called “bibik” which may have costed up to RM22,400 per year including fees for domestic workers’ agency that ranged between RM8000 and RM18,000 (Baby Centre 2015).

6.2 Elderly Care

6.2.1 Role of Family and Kin

The family was considered the main institution for the livelihood and care of older persons. This was based on with its traditional role of directly caring for their aged relatives. In line with Asian values of filial piety and religious values of respecting and caring for older parents, society’s younger members, out of their sense of duty and filial piety, care for elderly family members (Alavi, Sail, Idris, Samah & Omar 2011; Hossain 2014). Institutionalisation was frowned upon because it implies irresponsible and ungrateful children dumping their parents in the old folks or nursing homes (Kua 2007).

Family members, especially adult children, remained the main support for the elderly in Malaysian society (Ong & Hamid 2010; Teh, Ng, Tey & Siti-Norlasiah 2013). A local study on living arrangement preference among elderly parents noted that almost all the respondents refused to stay at nursing homes, regardless of ethnicity (Alavi et al. 2011). The study reported that Malay and Indian parents indicated that since they had taken care of their children, when the parents were fragile and unhealthy would be the time for the children to reciprocate such care. A nearby accommodation was perceived to be helpful for provision of personal, emotional and physical support, especially in times of crisis. In addition to care provision from children/family, support from ones’ spouse is another source of care among older persons, although this tends to differ across ethnic groups (Hamid 2012). The majority of elderly Malays and Indians had support from their children, whereas elderly Chinese got support from their partners. In fact, many elderly Chinese reported having at least one child living abroad compared to Malays or Indians (Hamid & Yahaya 2008). Given the smaller number of children among the Chinese, this scenario would translate as the unavailability of children as family caregivers.

The family provided a variety of assistance and care to its aged members to ensure their socio-economic wellbeing. Economic wellbeing included providing food, clothing, shelter; and financial assistance. On average, family caregivers spent up to RM900 per month to purchase medical supplies, dietary supplements as well as disposable items for elderly parents; while social wellbeing includes family care, housekeeping, socio-emotional support, and personal care. This range of care, which was provided round the clock, forms a part of everyday family interaction and is addressed by the caregiver on an individual basis. Nonetheless, the extended family structure, which made such care giving possible is gradually disintegrating and changing towards the nuclear family system. This transformation was due to the modernisation process, rapid development, urbanisation, and rural-urban migration.

In Malaysia, the changes in care provision for the elderly may have been attributed to the intertwining of three major factors, namely demographic, economic and epidemiological shifts. First, demographic shifts affected family size and composition. Fertility decline and smaller family sizes diminished the pool of children and with that, the potential source of social and financial support for elderly parents. Family size was also shrinking as families transform from the extended into the nuclear form to fit current economic conditions and modern lifestyles. At the same time, high co-residence between older persons and their children remained the norm (Sulaiman & Masud 2012). Longer life expectancy and the high cost of housing also changed family composition to become multi-generational (Antonucci, Birditt, Sherman & Trinh 2011; Izuhara & Forrest 2013). The family adapted to changing social circumstances to increase its survival, for example, through structural adaptation as in ‘beanpole families’ which had more surviving family members but with smaller numbers from each generation (Aziz & Yusooff 2012), and functional adaptation by ‘women in the middle’ (Jones & Leete 2002), who continued to provide protection and care to older members despite shifting social conditions.

Second, economic growth and urbanisation also curbed family size and family networks, introducing economic values that negated interdependence and collective responsibility (Lee, Ong & Smith 1973), and brought modern pressures on the individual and family. Families invested in the higher education of their children to improve the family’s economic conditions and allowed the younger generation to pursue career mobility to urban areas at the expense of extended family ties. Increased educational opportunities and greater participation of women in the formal labor force also meant a steady decline in the pool of daughters as traditional carers in the family system, and therefore, increased the demand for the provision of institutional support for the elderly (Chee & Barraclough 2007).

Third, demographic and epidemiological shifts also affected the capacity of informal carers to provide care for older family members. Longer life expectancy and high disability due to co-morbid conditions among older Malaysians pushed family members to their limit and stepped up the demand for formal long-term care services that could manage the changing health circumstances of older persons. Added to that, increased life expectancy also contributed to the emergence of the ‘sandwich family’ in today’s society. In ‘sandwich families,’ adult children of working age not only had to provide care and support to their children but also to elderly parents. The pressure of providing care and support to both young and old generations was more apparent especially among time-poor, young dual-earner couples when economic resources were limited (Ambigga et al. 2011). In addition, the old-age dependency ratio which reflected the burden of working adults to support the elderly increased from 14 adults:1 elderly to 11 adults:1 elderly (MPFS-4 2010). The escalating cost of social protection and demands for aged care services came to the attention of the government, necessitating greater collaboration across sectors for long-term sustainability.

6.2.2 Role of State

The government, through the collaboration and participation from the stakeholders such as the Ministry of Women, the Family and Community Development (mwfcd), the Ministry of Health (MoH), the Ministry of Urban Wellbeing, and the Housing and Local Government (muwhlg), was a major provider of public-funded services and regulates major functions such as social and welfare services, public healthcare facilities and services, affordable housing and urban planning. The mwfcd was a government ministry that plans and implements social policies and oversees the direction of government ministries and agencies in achieving the goals of gender equality, family development and a caring society. The mwfcd, through the Department of Social Welfare, provided institutional (residential care) and non-institutional services (financial assistance, activity centres) for older persons. In addition, the muwhlg provided for affordable housing schemes, regulates various areas pertaining to physical planning and housing, and guides local government agencies in delivering municipal services, recreational and socio-economic facilities.

There were 14 government-funded old folks’ homes, known as Rumah Seri Kenangan (rsk) and Rumah Warga Tua (rwt) which provided shelter and protection for 2553 residents. Eleven of the rsks are in Peninsular Malaysia and Sarawak1 whereas there were three rwts in Sabah. The residents of these homes had to fulfil the admission criteria which included being Malaysian citizens of age 60 and older who lacked the means to support themselves. They were also required to be free of mental illness and any contagious diseases. The lack of family support was generally the basis of the decision to stay or be admitted to the old folks’ homes. This was because older persons who were poor but having family members to take care of them were supported through the financial assistance schemes for the elderly (Bantuan Orang Tua) of RM300 per month.2 The Department of Social Welfare also operated two homes for the chronically ill (Rumah Ehsan) and two social rehabilitation centres for beggars and the destitute (Desa Bina Diri) which were not age-specific.

Other than providing primary, secondary and tertiary healthcare, the moh was also actively involved in monitoring the National Health Policy for Older Persons (2008) and more recently, in the development of the new Private Aged Health Facilities and Services Bill. The new bill was presented to the lower house (Dewan Rakyat) and was yet to be passed by the Senate of the Parliament. Until the new law was gazetted, the present regulatory mechanism separates private healthcare facilities and nursing homes which are licensed by the Ministry of Health, whereas the old folks’ homes were to be registered with the Department of Social Welfare.

Other government agencies and departments such as the Civil Service Department, Armed Forces Fund Board, Employee Provident Fund, Social Security Organization dealt with government- or employment-related social security programs and schemes. The government also provided some tax relief for Malaysian citizens, through the Inland Revenue Board of Malaysia, for the medical expenses of parents, limited to RM5,000 for both parents or RM1,500 for one parent, and the purchase of basic supporting equipment for parents up to RM6,000, which was borne by adult children. Inasmuch as population ageing entered the political discourse in Malaysia, gender issues was central in the social security system with regards to health, financial support and welfare. With the longer life expectancy of women and the cumulative disadvantages over their lifespan, the addition of the demographic dimension piqued the issue of the quality of life and the needs for social protection and long-term care for a growing segment of the population.

Malaysia’s social security system was made up of an assortment of programs and schemes under public health, welfare, employment, and education systems, in addition to rural and urban development plans in poverty eradication. As such, there were gaps in the social security programs that provide basic protection through contributory and non-contributory schemes. The system caters for healthcare and essential needed for livelihood in old age, but did not necessarily address the need for long-term care. In addition, financial assistance was not substitutable for long-term care and there was still a strong focus on the family to provide support and care, regardless of whether it was going to be provided by the family network or paid formal services.

The institutional arrangement of social security programs/schemes and care services was presently being reviewed. The government also strengthened its regulatory mechanisms for the emerging aged care industry through a new act that consolidates the regulation of private nursing homes and care centres for the elderly under a single body. Over the long term, these programs and schemes would not be sustainable in view of the rapidly ageing population that was expected to become double and triple in magnitude in the next few decades. Thus, there was a need to expand the social protection floor and long-term care for the elderly and to use innovative approaches that enable the distribution of the care burden and cost-sharing of care across individuals and family, the community/voluntary sector, the market and the government.

6.2.3 Role of Local Governments, Communities, and Other Not-for-profit Players

Local governments in Malaysia generally fell under the purview of the state government but the federal ministries, namely the Ministry of Urban Wellbeing, Housing and Local Government and the Ministry of Federal Territories and Urban Wellbeing, oversight in formulating, executing and monitoring all laws related to local government. There were three types of local government with a range of responsibilities reflecting their size and capacity: city councils (in the Federal Territory of Kuala Lumpur and in Sabah and Sarawak), municipal councils, and district councils. The scope of their authority was related to urban planning, the development of basic facilities and infrastructure, monitoring development, public health, waste management, business licensing, maintenance of peace and landscape, and promoting the local economy. The local authorities derived their income from taxes, non-tax revenue and federal or state government allocations. However, due to the centralized federalism or the significant intervention of the federal ministries, the local governments’ functions were diluted by other levels of government (Berman 2017).

The community was represented by a spectrum of civil society actors on ageing in Malaysia. Based on a recent engagement of the Malaysian Institute of Ageing with the third sector on the 12th of October 2017, it was found that there were many individual actors with important roles with regard to ageing and the elderly. We identified a core role of the actors but their actual activities may not necessarily be limited to these roles. The roles included:

  1. Research institutions in various academic institutions
  2. Professional bodies
  3. Retiree associations Disorder / Disease / Health support
  4. Senior citizen clubs
  5. Advocacy / welfare groups
  6. Learning / education groups
  7. Faith-based groups
  8. International groups

The discussion and deliberation of issues among the civil society organizations highlighted several issues regarding the existing structure and modus operandi of civil society organizations. Some of these issues were: (a) not many of older adults’ groups were registered or collaborate with each other, even the registered groups might be inactive regarding older adults’ engagement, (b) the third sector on aging was not active in terms of enumerating their resources or sharing their experiences to develop intra- or inter-sectional collaborations, (c) the main focus for quality of care and regulatory compliance was still on residential facilities and services, and day care or mobile care were presently beyond legal reach. Service providers need to join their voice for the rapidly developing aged care industry, (d) there was a large gap between public funding, autonomous capacity and service coverage, and (e) there was a lack of understanding of the issues which led to failure to respond to the new opportunities for civil society growth. These issues signalled the need for the aggregation and coordination of civil society organizations at the national level to promote collaboration and more efficient responses to the needs of older population.

6.2.4 Elder Care Services by Profit and Not-for-profit Providers

Families seeking support to care for the elderly requiring long-term health and daily physical assistance had to rely on the services by the for-profit and not-for-profit providers. The for-profit sector played a major role in supplying full-time domestic workers, residential and non-residential aged care services that included nursing or personal care for the more dependent elderly. The not-for profit sector was better known for their role in providing financial assistance, companionship and helped with some household chores, learning and social activities as well as accommodation with some level of personal care for the elderly who were poor and lack family support. Other support services provided included awareness and advocacy, as well as the development of financial products for retirement (Malaysian Digest 2017).

6.2.5 Full-time Domestic Workers

Time-poor adult children tended to hire a live-in domestic worker to act as a primary caregiver to their elderly parents. In general, these full-time ‘foreign maids’ worked around the clock to feed, washed, dressed and accompanied the elderly; the more dedicated ones were able to perform more technical tasks including wound dressing, suction of phlegm and basic physiotherapy or rehabilitation exercises. It became quite common to see patients of all races in the geriatric ward being accompanied by a female domestic worker from neighbouring countries such as Indonesia, Myanmar and Cambodia. Nevertheless, not all families could cope with the exorbitant fees of hiring foreign domestic workers (Malaysian Digest 2017).

The cost of hiring a live-in foreign domestic worker was approximately RM18000 per annum. With the additional agency fees ranging from RM 12000 to RM18000 in the first year, the total cost for employers could come up to RM36000 (or approx. usd9000) (“Implement the New Maid Hiring Policy Quickly” 2017). In addition, employers also had to bear additional charges including an annual levy of RM600 along with another RM100 for their maids’ annual medical examination. Yet, in the absence of more affordable alternatives including community-based day care centres and mobile care services, the hiring of a live-in foreign domestic maid offered a quick fix for the recurrent and highly intensive care needs of households with not just very old members, but also with very young children. The guilt and stigma of sending parents to old folks’ homes or nursing facilities (Malaysian Digest 2017) may have also contributed to the employment of live-in foreign domestic workers becoming a common approach for well-to-do families.

A study on immigrants in Malaysia (Munoz Moreno, Del Carpio, Testaverde, Moroz, Carmen, Smith, et al. 2015) highlighted significant challenges in Malaysia’s approach to migration including fragmentation, lack of coordination, and the inability to meet market needs. The on-going system of hiring foreign maids through a middle party was also seriously vulnerable to abuse by unscrupulous agencies. For instance, the current recruitment fee for Indonesian maids was set by the government at RM7800; however, agents were known to mark up the price to as high as RM12000 and to charge an additional fee of RM5000 to replace a maid who absconded or was deemed unsuitable for the job. It was also reported that agency fees skyrocketed due to growing demands, amidst the dire shortage in the supply of domestic workers. Ill-treatment of domestic workers and human trafficking caused countries, such as Indonesia and the Philippines, to suspend the supply of domestic workers into Malaysia. The countries supplying the domestic workers, particularly Indonesia, insisted on sending upskilled domestic helpers who had specific skills and are provided with better wages, which fed into the cost of hiring domestic workers by households.

The announcement of a government policy which allowed foreign domestic workers to be hired directly without necessarily using agency services in the 2018 Budget brought some relief to households. Nonetheless, for this strategy to work, there must be more coordinated implementation of policies between the government agencies and the private sector and a stronger legal framework to protects the rights of the employers and the employees, instead of merely tinkering with the procedures. The role of the not-for profit sector in the domestic worker arena was exemplified in the establishment of The Malaysian Association of Foreign Maid Agencies (Persatuan Agensi Pembantu Rumah Asing Malaysia or papa) as a platform to address employers’ and public grievances towards its members, comprising of agencies licensed under the Department of Manpower, Ministry of Human Resources Malaysia and registered with the Malaysian Immigration Department. Another not-for-profit group, the Malaysian Maid Employers Association (Persatuan Kebajikan Amah Malaysia or mama) was formed in 2011 to look after the interests and the rights of the employers and the welfare of the maids. Aside from providing awareness and training, mama also aimed to be of assistance to the government of the supplier and receiving countries in providing an amicable solution on the issue of maids.

6.2.6 Residential Aged Care by the Non-for-profit and For-profit Sectors

Shelters for the vulnerable elderly run by missionary groups were among the earliest form of residential aged care to exist followed by those operated by the federal government. As a case in point, the Penang Silver Jubilee Home for the Aged was established in 1935. The Central Welfare Council of Malaya (Majlis Pusat Kebajikan Malaya) was established in 1946, after World War ii to attend to those afflicted by the war, and has been providing shelter and support for the elderly since the 1950s. The Central Welfare Council’s report in 2013 provided a description of the history of the association and the types of elderly services provided by it. Rumah Sejahtera, or residential homes for the elderly, began in 1954 under the resettlement scheme to address the Malayan Emergency, to cater for elderly peasants, many of whom had no kin relations.

Another type of residence provided by the Central Welfare Council is Pondok Sejahtera, which was initiated in 1973 to respond to the elderly Malay peasants who refused to move to new resettlement areas in order to continue their religious studies in the rural areas. The pondok establishments in Malaysia, like the pesantren in Indonesia, represent the traditional Islamic educational institutions that began in the 18th century in rural areas on the north of Peninsular Malaysia. This set up was also part of the non-formal of adult learning within the community in pursuing religious education and become a new residential option amenable to the needs for a sociable and supportive environment among the Muslim elderly (Merriam & Mohamad 2000).

These residential set ups of old folks’ homes and traditional learning institutions (pondok) created distinct models of institutional care that were fundamentally welfare-orientated. Homes for the elderly that were operated by the not-for-profit sector remain under the purview of the Department of Social Welfare, at the federal level, whereas the Islamic religious institutions belonged under the jurisdictions of the Islamic Religious Councils of each state. The pondok system was presently running in the absence of laws and regulations to govern the establishment, or the rights to operate such institutions from either the federal or state governments sides. These conditions, in turn, could have led to problems in ownership, accidents or negligence within the system (Merriam & Mohamad 2000).

In more recent decades, residential aged care also became a demand that was capitalised upon by business. The first nursing home run by the private sector was established in 1983. Nursing homes were mainly concentrated in the urban areas and affordable to those with high income. According to newspaper reports and government documents, there were a growing number of nursing homes. These homes were mainly located on the west coast of Peninsular Malaysia and in urban centres in Sabah and Sarawak. However, there were numerous small-sized homes with 10 beds or less mainly located in bungalows and other private premises. All the nursing homes offered full-time nursing care for people with various needs, including disabled people and older adults. As the quality of the services provided by the nursing homes was not consistent, they cannot be considered as formal facilities for long-term care. Although the detailed services provided by different homes differ, the basic facilities remain the same. From the numerous operating residential aged facilities in Malaysia, there were only 17 nursing homes that were licensed by the Ministry of Health facilities for the elderly or mixed population (Ong, Phillips & Hamid 2009).

As was demonstrated above, the demand regarding establishing nursing homes for older adults was increasing. Furthermore, subsidies for the aged population resulted in an increase in government debt, thus there was an urgency for the governments to find more adequate solutions. Hence, developing senior living business concepts based on the Economic Transformation Program were encouraged by governments. Moreover, as Malaysia about to reach 2020 soon, more innovative, affordable private sector provided solutions with higher quality were the pressing issue. Additionally, due to an increase in chronic and lifestyle disease rates, the aging population in both developed and developing countries, and a growth in the number of middle class citizens with adequate incomes to spend on services in developing areas, the demand for healthcare was rising fast. Therefore, more private sector-based facilities were required to address the needs of the Malaysian aging population.

As part of the Government’s Economic Transformation Programs to propel the growth of the nation’s private pension industry, the Private Retirement Scheme (prs) was initiated in 2012 to improve retirement savings. With the approval by the Securities Commission Malaysia, this scheme was established as the third pillar of a voluntary saving scheme under Malaysia’s multi-pillar pension framework, protecting members’ interests and educating the public on retirement planning. Other initiatives by the private sector included, concessions in service fees and preferential treatment (e.g., special lanes, parking, resting areas) for retirees/ senior citizens.

Malaysia had the right conditions for senior living concepts due to its own aging population and the introduction of the “Malaysia My Second Home” programme. Retirees from other countries were encouraged to live in Malaysia because of the low cost of living and the climate of the country.

It should be taken into consideration although the demand of the aging population was significantly increasing, the adequacy and adoptability of other countries’ models should be evaluated carefully. And developers willing to provide services and care in terms of retirement homes or nursing homes for older adults had to consider the Malaysian culture and the stigma related to sending an older adult to live in a nursing home. Moreover, considering the type of services and the target service users was essential. More often, older adults from the highest income bracket were capable of maintaining their own homes and getting services delivered to them in their own premises whereas the middle income would be more inclined to choose residential care to optimise costs.

In terms of non-residential care for the elderly, the not-for profit sector also provided day care, rehabilitation centres, home help, and caregiver support groups. The Central Welfare Council of Malaysia and the National Council of Senior Citizen’s Organizations in Malaysia, through their associations’ members, provided senior activity centres and clubs to promote active ageing among the older population. Besides that, lifelong learning initiatives in the community was also initiated by the Universiti Putra Malaysia in 2007 and expanded through collaborations with the Department of Social Welfare, Civil Service Department and the community colleges. While civil society support for the elderly has been strong, the capacity of the sector must be further developed to expand the scope and reach of services in the community.

7 Conclusion

Within the context of care relations in Malaysia, it is interesting to note that the family existed as a microcosm, within which changes in human relationships and arrangements for care, were reflective and responsive to the larger cultural, demographic, economic, social and political developments. The temporal aspects, depicting continuities and changes in the different development timelines, were also discussed. The section on history and culture demonstrated that at the centre of ethnic pluralism, instigated by British colonisation, was an amalgam of family practices that were based on cultural notions of good childhood and parenthood. The religious institution also had an influence on the family in terms of fertility and family planning, family size, gender roles and expectations as well as the rights and responsibilities between parent and children. The discussion on socio-economic conditions illustrated that despite improvements in economic indicator, the growth in the economy favoured smaller, alternative family forms and promoted female labor participation that created the demands for universal social pensions, affordable child care services and availability of child care at workplace. There were also increasing economic pressures on dual career families as the nation braces itself through several economic crises and struggles under the circumstances characterised by the middle income trap. The primacy of economic growth in national development plans affected fertility levels, with some differences across ethnic groups, and opened the first demographic window for the population to increase its productivity. In spite of the paradigm shift in policies for welfare to social development approach, families remained an important pillar in the protection and care of children and older persons. The paradigm change should also be related to intensification in the government’s investments in human capital, through education and training, in order to reap the benefits of the demographic dividend.

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1

There were two old folks’ homes, or Rumah Seri Kenangan in the state of Sarawak located in Kuching and in Sibu. The facilities were undergoing reconstructions and residents were temporarily relocated to other nearby welfare institutions while the project was being completed.

2

The amount of financial assistance was raised to RM350 in the 2018 Budget.

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