By Irwin Loy
Chan Theary, executive director of the Reproductive and Child Health Alliance, an NGO that supports a remote health centre in Cambodia. Credit:Irwin Loy/IPS
PHNOM PENH, June 19, 2010 (IPS) - For Chan Theary, a remote, mountainous stretch of land in western Cambodia encapsulates the uphill struggle this South-east Asian nation faces in reducing the alarming number of women who die during pregnancy.
Thma Da commune, which sits along the border with Thailand in Pursat province, is a sparsely populated area that lies roughly 200 kilometres from the closest hospital.
There is a single midwife stationed in a makeshift health centre. That means there is only one person who is trained to treat pregnant women for the roughly 4,000 people scattered throughout the entire commune over difficult, muddy roads.
"It’s hardly accessible," said Chan, executive director of the Reproductive and Child Health Alliance (RACHA), a non-government organisation that supports the health centre.
"It takes so long to get to. If you imagine pregnant women when they go during the rainy season when the storms are very strong, it’s so difficult."
Cambodia is burdened with one of the highest maternal mortality ratios, or MMR, in the region. In 2008 the figure stood at 461 per 100,000 live births.
The numbers mean that, on average, five women in the country die on a daily basis from what are essentially preventable causes – post-partum hemorrhages, eclampsia, and infections.
The frustration for those who work in the field here is the fact the MMR has not decreased in the last decade. And with five years to go until 2015, it appears unlikely Cambodia will meet one of its key Millennium Development Goals (MDGs) for maternal health – to cut the nationwide MMR to 140.
That is despite the fact the country has shown improvement in some of the building blocks crucial to curbing maternal health.
One of the eight MDGs – aimed at significantly reducing, if not totally eradicating, poverty – which all United Nations member states must meet by 2015 is to reduce the maternal mortality ratio by three quarters from the 1990 levels.
According to the U.N. at least 529,000 women die from complications in childbirth every year – the vast majority of them in developing countries.
Alice Levisay, the country representative for the U.N. Population Fund, says Cambodian authorities have been committed to solving the maternal health problems.
"There have been significant increases in deliveries by skilled providers, deliveries in facilities and in antenatal care in the last few years," Levisay said.
Within the last decade, for example, the proportion of women who have their babies delivered by skilled health personnel has almost doubled form 32 percent in 2000 to 63 percent in 2009, she said.
More women now receive two or more antenatal check-ups from these trained professionals during their pregnancies – from 30 percent in 2000 to 83 percent last year.
And Cambodia now has at least one midwife for every health centre in the country, thanks to a recent focus on training and an incentive scheme that rewards midwives with cash payments for each delivery.
Though experts here say these are significant accomplishments, there still remains a wide gap between current standards and quality care.
Thma Da commune highlights both sides.
The health centre in Thma Da, for example, lacks running water during the dry season and until recently, electricity – brought in only after RACHA funded the installation of solar panels.
The centre's midwife herself is inexperienced, and makes so little money, Chan said, that she sells cakes on the side, taking her away from her duties and ensuring the health centre is not fully staffed all the time. Crucial medicine, as well, that can help treat deadly post-partum hemorrhages, is in short supply.
"It is not even basic care," Chan added. "We cannot say that, okay, the service there is really high quality. It’s not.
"That’s why, if you look at this situation, it is hard to say now that maternal health has been improved."
Authorities here have acknowledged the tremendous difficulties the country faces in reducing maternal deaths.
"With a maternal mortality ratio of 461, Cambodia ranks among the highest in the region, and we are not likely to reach our goal," said Ing Kantha Phavi, the Minister of Women’s Affairs, during the Women Deliver global conference on maternal health held earlier this month in Washington. "What is worse is that we know how to prevent these needless deaths."
Still, experts here say there is some cause for optimism – provided that the proper investments are in place.
A study published earlier this year in the British medical journal ‘The Lancet’ suggested that Cambodia’s MMR has actually fallen over the last decade. It used what the researchers believe are more precise estimates to peg Cambodia’s MMR at 266.
If accurate, the findings would suggest that Cambodia is much closer to its elusive goals on maternal health, though Susan Jack, a medical officer with the World Health Organisation’s country office in Cambodia, noted that both figures are unacceptably high.
"Every effort needs to be made to prevent these largely preventable deaths through better access to good quality care," said Jack. "This remains the paramount challenge for Cambodia."
For now, health experts here are anticipating the results of this year’s demographic health survey – the last countrywide health census scheduled before 2015.
RACHA’s Chan said many, including her, are optimistic the recent gains made on the ground will finally culminate in showing a statistical reduction in maternal deaths.
"There is an expectation the MMR will be reduced because of all the efforts," said Chan. "We hope so, too."
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