Cambodian women face a 1 in 50 chance of dying from maternal causes.

Despite five years worth of efforts to reduce Cambodia's high maternal death rates,

the results are still dismal due to lack of access to maternal health care services,

especially in the rural areas.

The Maternal Mortality Ratio (MMR) for Cambodia was unchanged at 4.72 deaths per

1,000 live births for six years, according to the 2005 Demographic and Health Surveys,

the most up-to-date and comprehensive survey of Cambodia's health issues.

The ratio means women in Cambodia have a lifetime risk of dying of 1 in 50 from maternal

causes.

"The number staying constant is not desirable," said John Naponick, team

leader of HSSP/ Reduction in Maternal Mortality Project. "It means no progress."

Naponick said the rate is very high compared to neighboring Vietnam.

The major cause of maternal deaths is that women continue to deliver babies at home

with assistance from untrained midwives using poor or no equipment, he said. This

increases the risks of hemorrhaging and infections that can lead to death.

The World Bank East Asia and Pacific economic and social performance report released

in November called the lack of progress in MMR the most "notable lagging indicator"

in Cambodia's progress in social sectors, compared to other indicators such as education,

poverty reduction and HIV prevalence.

The survey said maternal deaths account for 17 percent of all deaths to women aged

15-49, meaning that one in six Cambodian women die of pregnancy-related causes.

Tung Rathavy, deputy director of the National Maternal and Child Health Center (NMCHC)

and National Reproductive Health Program Manager, said the government and development

partners have been trying to upgrade health services, but the results are not yet

apparent. "We have already built 800 health care centers all over the country,

but it is not enough. We need to build at least another hundred," she said.

Millions of dollars have been put into training doctors, nurses and midwives. "The

result of the effort cannot be seen now, but in another five to ten years,"

she said.

Besides safety in delivery, pre-natal and post-natal care is also critically lacking.

The report said more than a quarter of women receive no pre-natal care. Those that

do receive it usually do not come until the later stages of pregnancy, not in the

recommended first three months. About 60 percent of women receive no post-natal care

within the critical first two days after giving birth. Rathavy said 90 percent of

the women surveyed said lack of money was the reason for not getting post-natal care.

"They come too late or they couldn't afford to come at all," said Rathavy.

Abortions also claiming female deaths

Naponick estimated that about 16 percent of maternal deaths are due to complications

from abortions.

His project - the Reduction in Maternal Mortality Project - provides technical training

in safe abortion procedures to service providers in the 12 most densely populated

provinces in the country. It is the only legal and nationwide foreign aid program

dealing with legal abortions.

The project is part of a $2.9 million agreement signed two years ago by United Kingdom

Department for International Development with the Ministry of Health to improve access

to lawful abortion. A new survey conducted by NMCHC, the National Institute of Public

Health and IPAS, a U.S based international NGO, found that only 22 percent of hospitals

and health facilities make elective abortions available. Services for second-trimester

abortions are more scarce.

Accessibility to abortion services for Cambodian teenagers is also limited. Sixty

percent of hospitals and health facilities that provide abortion services to adults

refuse patients under 18.

Prum Dara Chan, service manager for Marie Stopes Reproductive Healthcare clinic,

said that women who do seek medical help for abortion complications are usually women

who attempted to do an abortion themselves.

"These women usually have no knowledge on abortion. For example they took an

abortion pill obtained from the pharmacy. The pill itself is mostly fine, but the

problem is they don't know how much they should take or for how many months of pregnancy

the pill is effective," said Dara Chan.

The survey found shortcomings in the information provided about family planning.

"Counseling is important because some women didn't want to get pregnant, but

they don't know how to avoid it," said Naponick.