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Journal Article Analyzes Cambodia’s Reductions in Maternal Mortality
Maternal mortality ratios are declining worldwide, including in Cambodia, where long-held home birth practices are finally giving way to facility births. URC Cambodia-based staff Jerker Liljestrand and Mean Reatanak Sambath explore the reasons for rising facility births and falling maternal mortality and recommend continuing improvement in an article in the June 12 issue of Reproductive Health Matters.
“Socio-economic Improvements and Health System Strengthening of Maternity Care Are Contributing to Maternal Mortality Reductions in Cambodia” offers a survey of non-health and health system changes since the start of the millennium that likely contributed to Cambodia’s improving maternal care. Under non-health changes, the URC experts point to stability and peace since 1997; economic growth and poverty reduction; improved primary education, especially for girls; road improvements; and new communication technologies that have ushered in easier access to information on health-related topics for both the public and health care professionals, better education, and a falling fertility rate and the attendant demographic bonus.
The health system has also undergone extensive changes. The country is thought to have had only 45 doctors after the Pol Pot regime, a situation reversed since 1979 with government leadership and support from many partners, including URC; two large national NGOs (the Reproductive Health Association of Cambodia and Reproductive and Child Health Alliance); and many international organizations, such as UNICEF. Liljestrand and Sambath describe the current maternal health system as largely public; public health care is favored in Cambodia for reproductive health services. Continuing improvement in the system is constrained by challenges in the areas of health financing, budgeting, quality of care, pre-service training, and human resources.
The authors detail changes in the health system that have likely contributed to the falling maternal mortality ratio. Skilled birth attendance rose from 32% in 2000 to 71% in 2010, while antenatal care coverage (at least one visit) rose from 38% of pregnant women to 89%. Contributing factors include:
- Health equity funds have made facility birthing care more available to the poor.
- Some development organizations are providing vouchers to pregnant women and remuneration to facilities if the facility provides a full package of services for ante- and post-natal care.
- The government gives an incentive to a health center ($15) or hospital ($10) for every live birth, motivating facility staff to provide round-the-clock service and midwives to give their phone numbers to pregnant women during antenatal care (to ensure the midwife will be at the health center when the woman arrives).
- The government has banned traditional birth attendants and discourages midwives from attending home births.
Other changes relate to a stronger midwifery, better emergency obstetric and newborn care and referrals, improved access to family planning, greater access to safe abortions, maternal death reviews/ reporting, and guidelines and training for maternal and newborn care.
Liljestrand and Sambath call for further improvements in the areas of infrastructure, referrals, unwanted pregnancy, postpartum hemorrhage, birth/ death registrations, postpartum and postnatal care, out-of-pocket payments, breast and cervical cancer, and sexual violence against women.
The article can be accessed with a subscription at http://www.rhm-elsevier.com/.
August 10, 2012