UNICEF Cambodia September 2010 Maternal Health Cambodia UNICEF Cambodia September 2010

Cambodia Millennium Development Goals: Overall Summary of Progress While progress made with reducing the country's HIV prevalence - significant disparities remain 'masked and hidden' within this apparent progress that need to be addressed to prevent a 'second wave'. E.g. rates remain high among key (vulnerable & often marginalized) populations; more women are proportionately affected, diagnosis (and treatment initiation) is often too late; loss to follow-up remains unacceptably high. (scored in terms of % distance travelled from baseline to target)

Is health in Cambodia getting better? Yes 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 Based on the reported cases, what we have learned from the DHS and census and what we know from countries with similar situations, the main causes of MMR are... 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 The MDG4 has been met in the richest quintile, but has a long way to go in the poorest one Sources: Cambodia DHS, 2005

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