Dear Editor,

Regarding your article “Govt warns of MDG failure in maternal care” (June 10, 2010), the minister of women’s affairs is set to tell a global conference on maternal health that Cambodia is not on track to meet its Millennium Development Goal of lowering its maternal death rate to 140 deaths for every 100,000 live births by 2015.

The minister says she will call for more action on the part of “global leaders and donors to address the problem” during the conference Women Deliver 2010 in Washington.

I appreciate the minister’s efforts to reduce Cambodia’s MMR [maternal mortality ratio], which is still among the highest in the region at 472 deaths per 100,000 live births, according to a 2005 Cambodian Demographic Heath Survey (CDHS).

In my observation, in recent years the government and its aid assistance partners have contributed to address several main factors of MMR such as building better roads to allow villagers to reach the main health centres in rural areas, improving public health facilities, including equipment, electricity supplies and building the capacity of midwife staff. In March 2009, Prime Minster Hun Sen also committed to increase the number of midwifery students and raise the government’s financial incentive for midwives assisting births to 60,000 riels (US$14.20).

These contributions will help to reduce MMR, but I think the government is still going to find it difficult to achieve its MDG in this area.

However, I am optimistic that MMR can be reduced to a level that approaches the MDG if the government commits to addressing two key factors: to control public and private clinics that perform abortions and punish those clinics that perform abortions either illegally or in an unsafe manner.

Unsafe abortions are a key reason in maternal deaths, resulting in 20 percent to 29 percent of all fatalities.

Another crucial need is to change the methods of traditional birth attendants, who have long helped pregnant women to deliver their children at home (55 percent of babies are delivered with the help of a traditional birth attendant, according to the CDHS).

This creates a high-risk environment and contributes to maternal deaths, although no national data is available to measure the number of these incidents.

But according to a study by URC/USAID on traditional birth attendants in Angkor Chum Operational District, Siem Reap province, from 2005 to September 2009 that was published on April 19, 2010, two key elements stand out.

Firstly, most traditional birth attendants in Angkor Chum stopped delivering children in homes, and instead assisted women after they were sent to referral hospitals that are supported by public health facilities. By doing so, the MMR was significantly reduced. In 2006, eight women died under the care of a traditional birth attendant alone, while none died at health facilities. In 2009, only two deaths were reported: one of a woman under the care of a traditional birth attendant and another in a public health centre.

Secondly, during the past five years, Angkor Chum officials have cracked down on nearly all illegal private clinics that provided abortions, as well itinerant healers and unlicenced pharmacists operating in district villages.

As a result, nearly all patients now seek treatment at public health facilities, raising the incomes of legitimate healthcare providers by five times.

These successes in Angkor Chum should push the government to consider applying these measures in Cambodia’s other districts.

I strongly believed that the government has enough time to reduce MMR to achieve its MDGs by 2015 if it starts practicing these two keys innovations from now on.

Tong Soprach

Phnom Penh

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