Despite vast progress in maternal and newborn care in Cambodia over the years, a new study has found that the inequality gap between babies born to poor, rural families and their richer, urban counterparts has only widened since 2000.

The analysis – using data from the latest Cambodian Demographic and Health Surveys and published in the peer-reviewed PLOS ONE journal in March – found that while neonatal mortality in the country declined considerably over the years, inequality gaps based on the rich-poor and rural-urban divide have in fact increased.

In 2000, one in 26 infants born alive did not survive their first month; in 2014, the rate was one in 48. While mortality in Cambodia as of 2015 was still high compared to Southeast Asia as a region – with an average 1 in 77 live births – it had plummeted by nearly half since 1990.

The Kingdom’s success, however, was not evenly distributed within the country. The study found not only that babies born in rural households in 2014 were 2.39 times more likely to die within their first month than those born in urban households, it also found that this inequality gap had increased considerably since 2000. In 2000, the relative risk was estimated at 1.52.

In addition, babies born to poor families in 2014 were 3.84 times more likely to die within their first month compared to those at the top of the wealth distribution, a relative risk that had also increased over the years, researchers said.

“Despite progress made in reducing maternal and child mortality at the national level in recent years, some parts of the country are still lagging behind due to the cost of accessing health facilities, staff shortages and poor quality health services,” Unicef Cambodia Communications Specialist Bunly Meas said in an email yesterday.

“Neonatal mortality is closely related to the care services provided to the mother and baby during pregnancy and at birth . . . The distribution of health services, both by public and private facilities, is different from urban to rural areas.”

According to Chhuon Wathna, country health specialist at Plan International Cambodia, a lack of infrastructure and education are also impediments to women’s healthcare in rural areas.

“For those in rural areas, the access and utilisation of public health care is lower than those who are in urban areas . . . Transportation is a problem in many remote areas, where there are mountains or no main roads. Education is [also] important. People need to understand why [mothers] need to have skilled medical attendants for delivery,” he said.