Maternal, newborn and child health services
© UNICEF Cambodia/Nicolas Axelrod
Giving birth in Cambodia remains a risky proposition for women and their babies. Inadequate and limited access to health care during pregnancy, childbirth and early childhood, combined with cultural practices that override modern medical alternatives, increase the risk of death for mothers and their children.
Every year, an estimated 1,700 women die during pregnancy, delivery and after birth, according to Cambodia’s 2008 Census. This leaves Cambodia with one of the highest maternal mortality ratios in the region. There has been no improvement over the last decade, partly due to the difficulty in obtaining good data to measure these deaths.
Women are dying because they lack basic emergency obstetric care and due to the limited availability of trained birth attendants. Though declining, there is still widespread use of traditional birth attendants as opposed to midwives and other trained health workers. Only 71 per cent of women in Cambodia had access to a skilled birth attendant in 2010 and just over half of births take place in a health facility, increasing a pregnant woman’s risks and decreasing her chances of accessing life-saving interventions during childbirth. Even when mothers can access health care, overall quality of care is deficient, magnifying the challenges women face in overcoming potential health problems during and after birth.
While infant mortality has decreased, the number of newborns who die each year remains unacceptably high, as an estimated 10,000 babies die during or shortly after delivery each year. Babies are dying due to complications at birth in addition to lack of postpartum care. Few women visit health facilities for routine yet potentially life-saving health check-ups for their babies because they lack the funds or are unaware of the benefits.
Unclean cord care based on cultural practices also leads to infection, which further contributes to newborn deaths.
Effective immunization combined with successful breastfeeding promotion and better infant and child care have contributed to Cambodia’s ability to reverse infant and child mortality. In Cambodia, immunization has kept polio at bay since 2000 and has dramatically diminished reported cases of measles, which dropped by more than 99 per cent between 1999 and 2006. The number of children aged 12 to 23 months who are fully immunized against six major communicable diseases grew from 40 per cent in 2000 to 79 per cent in 2010.
Meanwhile, expanded community-based integrated management of childhood illnesses – vital to decreasing child mortality – helps families and communities detect and track cases of pneumonia and diarrhoea for immediate and follow-up medical attention. Nearly 70 per cent of child deaths in Cambodia are due to diarrhoea, pneumonia or neonatal conditions. However, less than half of children with symptoms of acute respiratory infection, fever or diarrhoea see a health care provider.
The direct causes of maternal, newborn and child deaths are well known and largely preventable and treatable. However, coverage of some health interventions and practices remains low due to disconnect between knowledge, policies and action. Solutions do exist, but often do not reach those most in need. New programmes are revealing significant potential in helping to decrease maternal deaths while improving overall quality and access to health care for mothers and their children.
UNICEF collaborates with the government to accelerate improvements in health and nutrition for Cambodia’s infants and children in order to protect them against illness and death.
© UNICEF Cambodia/Nicolas Axelrod
What we do
- Work with the Ministry of Health to identify information needs, support data collection and analysis, identify policy options, and advocate for resources to scale-up maternal, newborn and child health interventions.
- Build the capacity of policy makers and health managers in data analysis and planning to support the expansion and sustainable implementation of high impact life-saving maternal, newborn and child health interventions. Special focus is placed on identifying and developing programmes to reach the unreached.
- Support frameworks that provide the necessary policy and financial conditions to overcome system-wide obstacles to improved maternal and child health services. Support emergency obstetric care, essential newborn care, and the Integrated Management of Childhood Illness system with priority on poor districts.
- Support improvements in antenatal, delivery and postpartum care, emphasizing the need for skilled birth attendance linked through referral systems to emergency obstetric and newborn care.
- Promote universal immunization coverage, case management of pneumonia and diarrhoea treatment with zinc. Contribute to improving the quality of preventative and clinical health services through training, coaching and supportive supervision for health providers.
- Support interventions at three levels – health system, health facility and community – to ensure families receive knowledge, skills, motivation and support to care for young children.
A growing number of women in Cambodia are seeking help from a skilled health attendant during delivery, up from 32 per cent in 2000 to 71 per cent in 2010. Attendance at antenatal care has also increased, from 38 per cent in 2000 to 89 per cent in 2010. Equally encouraging, improved obstetric care for women, early and exclusive breastfeeding, and life-saving immunizations have helped prevent newborn deaths. Comprehensive immunization against preventable diseases, together with better nutrition, has curbed the nation’s under-five mortality, from 124 to 54 deaths per 1,000 live births between 2000 and 2010, according to preliminary data from the 2010 Demographic and Health Survey.