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 (pictured), 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."