WUNRN
CAMBODIA - WOMEN FEAR DEATH IN
CHILDBIRTH
By Marwaan Macan-Markar
KRAING KAOK, Cambodia, Apr 2, 2011 (IPS) - Death haunts
women in this Cambodian village at a moment of happiness - when they give
birth.
"Today, nothing frightens Cambodian women more than having to give
birth," says Mu Sochuea, former minister of women’s affairs. "It is
costly, risky and not safe for the mothers and the babies."
Cambodia has acquired the notoriety of having among the
highest maternal mortality rates in the region. Five women die every day during
childbirth, according to U.N. reports.
Public health experts attribute the high death toll to lack
of sufficient midwives, limited health care centres, the cost of health
services, and a bias in remote rural areas towards untrained traditional birth
attendants.
Hak Sam Ath still fights back tears as she recalls how Ouch
Lay, her eldest daughter, died at a health clinic that serves this fishing and
trading community on the banks of the Stung Slot River. "She had high
blood pressure at the time she had checked into the health clinic for her delivery,"
said Sam Ath. "But this was overlooked and she died on the night she was
to give birth."
The death of mothers like 28-year-old Lay, over one year ago
in this village some 60 kilometres southeast of Phnom Penh, confirms why a
common saying in the local Khmer language about the dangers of childbirth still
resonates in this country of some 14 million people. "The expression
‘crossing the river’ is used in Khmer to describe the moment when a woman is to
give birth," says Sochuea, now an opposition parliamentarian. "It
illustrates the risk and the danger of crossing a river, a totally uncertain
experience, which is how childbirth is viewed by many here."
The country’s maternal mortality rates reflect this fear.
There are 461 maternal mortality cases per 100,000 living births here, which is
"among the highest in the region and which has not changed much since
1997," noted a report released Mar. 28 on the country’s progress towards
achieving the U.N. Millennium Development Goals (MDGs) - a set of global targets
to reduce poverty, ensure basic education, achieve gender equity, and overcome
major health challenges.
Such frequent maternal mortality has condemned Cambodia to
fall well short of meeting the fifth of eight MDGs by 2015, which specifically
calls on countries to improve maternal health by reducing maternal mortality
ratios. Cambodia is also trailing to meet the first MDG: slashing the number of
people living in extreme poverty and hunger.
"It is highly unlikely that the original [Cambodian
MDG] target of 140 deaths per 100,000 live births can be reached,"
revealed the ‘Cambodian Millennium Development Goals (CMDG) Update 2010’, the
report that was jointly produced by the government and U.N. agencies. "The
target for 2015 has therefore recently been adjusted to a more realistic level
of 250, which still represents a major challenge."
To meet such a challenge in a country still struggling to
rise to its feet after the 1991 peace accords - which ended two decades of
deadly conflict, genocide and occupation - the U.N. has courted a prominent
ally: Bun Ray Hun Sen, the wife of Cambodian Prime Minster Hun Sen. The former
nurse was recognised in late February as the national champion for U.N.
Secretary- General Ban Ki-moon’s Action Plan for Women’s and Children’s Health.
"We are tackling the maternal mortality issue at an
extremely high level," Douglas Broderick, the U.N. resident coordinator
here, told IPS. "We will be working with the first lady to raise the
profile of the maternal mortality challenge in the country."
Limited numbers of midwives and skilled birth attendants in
the hospitals and health centres has contributed to maternal mortality, with
the rural rice- growing areas - home to nearly 85 percent of the population -
being the worst hit. Nearly 40 percent of births in Cambodia are
"unattended by skilled birth attendants, who could save women’s lives in
case of emergencies," according to the World Health Organisation (WHO).
"Maternal mortality in rural areas is three times
higher than in the urban areas," says Chea Thy, the national health
advisor at the Cambodia office of Plan International, a British child rights
agency. "Some health centres don’t have qualified midwives."
Midwives are paid approximately 10 dollars for assisting in
a birth and the profession is struggling to attract larger and committed
numbers to meet the health ministry’s national health plans. The government has
set its sights on opening 1,600 health centres across the country, with each
having up to two midwives. This would mark a sizeable increase from the less
than 1,000 health centres that currently dot Cambodia.
The high cost of health services in a country where over a
third of the population live in poverty is also fingered as an explanation of
why maternal care is so poor.
"The average payment for a four to six day stay at a
hospital is 130,000 riels (about 27 dollars)," Henk Bekedam, director of
health sector development at the WHO’s regional office, told IPS. "That
includes mothers going for delivery, a patient who has broken a leg, or
somebody hospitalised for diarrhoea."