Cambodia

With 80 percent of its population living in rural areas, Cambodia has made remarkable progress in reducing poverty and improving peoples health in the past decades. Maternal mortality has decreased 58 percent since 1990, but sociocultural and economic factors still prevent women from accessing public health services. A policy of free access to care for lowincome groups is being tested and progressively extended. The 2008 Health Strategic Plan prioritized maternal health. The country has an acute shortage of health professionals and not enough cadres are being graduated. A Midwifery Council was established in 2006. A three-year direct-entry midwifery programme was introduced in 2008, and the curriculum for a four-year bachelors degree is being developed. While these initiatives are underway, several in-service training programmes have been implemented. Strengthening the competencies and numbers of midwifery faculty, and the educational materials, equipment and infrastructure is important to address the current shortage of midwives.

} country inDicAtors*
Total population (000); % urban Adolescent population (15-19 yrs) (000); % of total Number of women of reproductive age (age 15-49) (000); % of total Total fertility rate (children per woman) Crude birth rate (per 1,000 population) Births per year (000) % of all births registered Number of maternal deaths Neonatal mortality rate (per 1,000 live births) Stillbirth rate (per 1,000 births) Number of pregnant women tested for HIV Midwives are authorized to administer a core set of life-saving interventions Density of midwives, nurses and doctors per 1,000 population Estimated workforce shortage to attain 95% skilled birth attendance by 2015 Gross secondary school enrolment (male; female) % Literacy rate (age 15 and over) (male; female) % 15,053; 20 1,846; 12 4,177; 28 2.9 25 360 66 1100 30 19 153,884 Partial 1.0 736 44; 36 85; 71

} MiDWifery WorKforce1
Midwives (including nurse-midwives)2 Other health professionals with some midwifery competencies3 General practitioners with some midwifery competencies Obstetricians Community health workers with some midwifery training A live registry of licensed midwives exists 2,014 1,815
Unavailable Unavailable

No

} MiDWifery eDucAtion
Midwifery education programmes (direct entry; combined; sequential) Number of midwifery education institutions (total); number of private Duration of midwifery education programmes (in months) Number of student admissions (first year) Student admissions per total available student places (%) Number of students enrolled in all years (2009) Number of graduates (2009) Midwifery education programmes are accredited Yes; No; Yes 16; 5 36 to 48 Yes

} MDG inDicAtors
Maternal mortality ratio (per 100,000 live births) Proportion of births attended by skilled health personnel (%) Contraceptive prevalence rate (modern methods) (%) Adolescent birth rate (births per 1,000 women age 15-19) Antenatal care coverage (at least one visit; at least four visits) (%) Unmet need for family planning (%) Under-5 mortality rate (per 1,000 live births) 290 44 40 52 69; 27 25 90

} reGulAtion
Legislation exists recognizing midwifery as an autonomous profession Midwives hold a protected title A recognized definition of a professional midwife exists A government body regulates midwifery practice A licence is required to practise midwifery Midwives are authorized to prescribe life-saving medications No No Yes No No Yes

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T H E S TAT E OF T HE WORL DS MIDWIF E RY 2011

For more information, visit:

THAILAND

LAOS

trends in maternal mortality: 19902015

maternal deaths per 100,000 live births 800
690 640 470

CAMBODIA

Actual MMR trend Target 2015

600 400 200 0

CAMBODIA

350 290 173

Phnom Penh

VIET NAM

1990

1995

2000

2005

2010

2015

Where women give birth: urban vs. rural

100 90 80 70 60 50 40 30 20 10 0 Home (own or someone elses) Private/ NGO facility Public facility

MiDWifery BAroMeter
Midwives per 1,000 live births Birth complications per day; rural Lifetime risk of maternal death Intrapartum stillbirth rate (per 1,000 births) Neonatal mortality as % of under-5 mortality 6 160; 128 1 in 110 6

% of live births

Urban

2000

Rural

Urban

2005

Rural

Who attends births: urban vs. rural

34
100 90 80 70 60 50 40 30 20 10 0 Other/no one Midwife/nurse/ village midwife Doctor

A midwives association exists Number of midwifery professionals represented by an association Association(s) affiliated with ICM; ICN

Yes 1,915 Yes; No

} policies
A national maternal and newborn health plan exists that includes the midwifery workforce The plan is costed The national health workforce plan specifically addresses midwifery Compulsory notification of maternal deaths Systematic maternal death audits and reviews Confidential enquiry for maternal deaths Compulsory registration of all births All maternal and newborn health services are free (public sector) Yes Yes Yes Yes Yes No Yes No

% of live births

} professionAl AssociAtions

Urban

2000

Rural

Urban

2005

Rural

projected number of births, by age of mother

2000 number of births (thousands) 1500 1000 500 0

35-49 20-34 15-19

} serVices
Number of facilities providing essential childbirth care Number of Basic Emergency Obstetric and Newborn Care (EmONC) facilities Number of Comprehensive EmONC facilities Facilities per 1,000 births 1,087 19 25 3

20102015

20152020

20202025

20252030

Explanatory notes: *Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term Unavailable is used. In all other instances, is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.

www.stateoftheworldsmidwifery.com

PA RT 4: c ountry pr ofiles

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