Maternal Health

Cambodia

UNICEF Cambodia September 2010

Cambodia Millennium Development Goals: Overall Summary of Progress

CMDG9: DE MINING/UXO CMDG7: ENVIRONMENT 66 33 CMDG1: POVERTY/HUNGER 100 90 80 30 20 10 0 70 60 45 50 40 41 41 CMDG2: BASIC EDUCATION CMDG3: GENDER EQUALITY 37 CMDG6: HIV/AIDS OTHER 66 CMDG5: MATERNAL HEALTH

(scored in terms of % distance travelled from baseline to target)

83 CMDG4: CHILD MORTALITY

 Yes

Is health in Cambodia getting better?

 Child Mortality is falling  Newborn mortality is falling  Life expectancy is rising  Fertility is falling  ............but

Between 2000-2008 there is not recorded improvement in maternal mortality in Cambodia

Why?

 Maternal mortality reduction requires a strong health system, with good interaction among various levels  Societal values: Is women’s health important enough?

A fundamental challenge

 85% of all births are “uneventful”  But 15% of women in pregnancy and delivery develop a potentially life threatening complication  Few of these complications can be predicted

With MMR of 461 in Cambodia....

- An estimated 1,700 – 2,000 women die maternal deaths in Cambodia every year, or five women every day!

- These are young, productive women, leaving families and children. Families often disintegrate after maternal death, and their children have high mortality - Most of maternal death can be prevented

Causes of Maternal Mortality in Cambodia

Other 12% Abortion 6% Uterus rupture 4% Haemorrhage 54% Infection 6% Eclampsia 18%

Almost all of the above causes are either preventable or treatable, but solutions are not available to all those in need…

Opportunities in Cambodia

- Midwifery education is expanding - Abortion is legal - Government and partners are committed: the Minister of Health has launched a Fast Track Initiative Road Map (FTIRM) to accelerate interventions for reduction of maternal mortality - $15 incentive for professionally assisted deliveries & health equity funds for the poor - Increased facility births: 11% in 2002 and 40% in 2008 - Community involvement , and increasingly that of local government (transport contracts for obstetric emergencies)

What is needed?

- Further strengthening of the health system: incentivized human resources, drugs and supplies, improved 24-hour availability of Emergency Obstetrics and Newborn care, stronger referral systems - Improve quality of services - Remove financial barriers to care, especially for the poor - Higher contraceptive prevalence to avoid unwanted pregnancies - Improve family and community practices during pregnancy, delivery and postpartum period

Child mortality by poverty status

140 127 129 120 100 101 109 114 98 80 92 78 60 66 64 60 40 39 43 34 20 12 0 1st quintile 2nd quintile 3rd quintile 4th quintile 5th quintile

Sources: Cambodia DHS, 2005

Infant mortality Under-5 mortality Postneonatal mortality The MDG4 has been met in the richest quintile, but has a long way to go in the poorest one

UNICEF Contribution

• • • • Strengthen knowledge and evidence base for policy and action: studies, operational research/pilots, good practices Support capacity development of health managers at all levels to effectively plan, implement and monitor quality maternal, newborn and child health and nutrition services Support improvement of quality of care – training of health staff, post training follow-up, coaching and supervision Support empowerment of communities to adopt healthy practices, seek timely and appropriate health care and claim their rights to health and nutrition – media campaigns and interpersonal communication