Determinants of utilisation of intrapartum obstetric care services in Cambodia, and gaps in coverage

Abstract

Background. Facility delivery and skilled birth attendance are two of the most effective strategies for decreasing maternal mortality. The objectives of this study were to further define utilisation of these services in Cambodia and to uncover socio-economic or location-specific coverage gaps that may exist.

Methods. We performed a cross-sectional analysis of the 2005 Cambodia Demographic Health Survey (CDHS) to determine prevalence, and determinants, of service utilisation.

Results. Out of 6069 women aged 15–49 years, 77% delivered at home, three-fourths without a skilled birth attendant. Poverty, lower education and rural residence were associated with the highest likelihood of poor utilisation of services.

Discussion. While there has been an overall increase in facility deliveries and skilled birth attendance since 2000, improvements have been spread unevenly across the population, benefiting mostly urban, wealthier and better educated women. While recent financing initiatives and health system developments appear to have further increased service utilisation since 2005, the extent of their reach to the most vulnerable populations, and their ultimate impact on maternal mortality reduction, remain to be elucidated.

Conclusion. Further expanding successful initiatives, particularly among vulnerable populations, is essential. Longitudinal evaluation of ongoing strategies and their impact remains critical.

Keywords:

• Cambodia
• maternal mortality
• birth attendance
• facility delivery
• health care disparity
• Demographic Health Survey

Acknowledgements

The 2005 Cambodia Demographic and Health Survey (CDHS 2005) represents the continuing commitment and efforts in Cambodia to obtain data on population and health. Our study was made possible by the work carried out by MEASURE-DHS, which itself was sponsored by USAID/ADB using a grant from DFID, UNFPA, UNICEF and CDC/GAP. Within Cambodia, the National Institute of Public Health, Directorate General for Health, Ministry of Health and the National Institute of Statistics of the Ministry of Planning were the project implementation agencies. No sources of funding were used for the purpose of our own study.