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Lowering the bar on deaths in pregnancy

Lowering the bar on deaths in pregnancy

A new mother weighs her baby during a checkup at the Treal Health Centre in Kampong Thom province in May.

Health Ministry seeks easier target, cites economic crisis, funding woes.

THE Ministry of Health has requested permission to significantly scale back its target for reducing the number of women who die during childbirth, government officials and development partners have told the Post.

Recent estimates place the maternal mortality rate at 461 deaths per 100,000 live births, a figure the UN routinely describes as “unacceptably high”. To meet the existing Millennium Development Goal (MDG) for maternal health, Cambodia would need to cut the rate by nearly 70 percent — to 140 deaths per 100,000 live births by 2015.

Development partners said Thursday that the Health Ministry had likely requested that the target be raised from 140 to 250 deaths per 100,000 live births. The UN Population Fund’s Cambodia office first cited the target in an interview Thursday morning, then backed away from it, saying in an email that it was a “rumour … heard via multiple other sources” that “cannot be verified”. But Dr Niklas Danielsson, a medical officer for child and adolescent health at the World Health Organisation’s Cambodia office, said he had heard that the target was accurate.

Government officials would not confirm the proposed target, but they acknowledged that the request for a revision had been submitted.

Sao Sovan Ratanak, deputy director of the ministry’s Planning Department, said the “global financial crisis” had put the existing target out of reach.

“The reason [for the proposed change] is the global financial crisis,” he said. “Some of the funds may be cut, so the ministry is afraid that we will not be able to reach the goal.” He added that the ministry has no intention of changing any other goals.

Theng Pagnathun, director of the Planning Investment Department at the Ministry of Planning, said the request had been submitted earlier this month as part of an ongoing revision of the National Strategic Development Plan, an initiative designed to help Cambodia meet its goals. He said it would be approved or rejected during a November meeting of officials from the Ministry of Health, the Ministry of Economy and Finance, the Cambodian Rehabilitation and Development Board and the Supreme National Economic Council.

Proposal raises questions
News of the proposed change – and the Health Ministry’s stated rationale for it – drew a mixed response from NGOs and development partners, some of whom questioned what it would accomplish.

Chan Theary, executive director of the Reproductive and Child Health Alliance, said she strongly disagreed with the move. “For me, keep it the same and see how much you can achieve,” she said. “And if you cannot achieve it, find out the reason why and what you need to focus on.”

Others said the stated reason for trying to change the target was dubious. “I am not a health expert, but I do not think that the ‘global financial crisis’ has much to do with not reaching the targets for maternal mortality,” said Sherif Rushdy, a consultant who recently conducted an assessment of the MDG effort for the UN Development Programme. “At the most, the high food prices of 2008 may have exacerbated the nutritional situation of women and pregnant women,” he said.

Danielsson said the effect of the “global financial crisis” on maternal health was “very difficult to measure”, but UNFPA Cambodia Representative Alice Levisay said the change might be “necessary given current realities and new data”. She said the crisis had made it “more difficult to make all of the necessary improvements” to areas affecting maternal health including education, infrastructure and access to health care.

Beyond the crisis, experts cited a range of reasons for the stubbornly high maternal mortality ratio, including the shortage and weak capacity of midwives; the fact that 57 percent of pregnant women are anemic; the high number of at-home deliveries; the lack of access to safe abortion and the widespread lack of access to emergency obstetric care, which Danielsson said was “maybe the most important”.

Given the barriers, Danielsson said reaching even the adjusted target, assuming it is approved, would not be a sure thing. “I think it is possible, but it’s not going to be easy,” he said.

Rushdy said progress would “require a substantial improvement” in quality and access to health services as well as “educating the population about the importance of women’s health and the health options available to them”.

He added: “Maternal mortality is a good indicator of the quality, reach, strength of and access to the health sector in general.”


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