UN calls for upgrade in midwifery services globally

June 23, 2011
ABC Radio Australia

Up to 3.6 million deaths could be avoided each year in 58 developing countries if midwifery services are upgraded, according to a United Nations report.

The State of the World's Midwifery 2011 report, released by the United Nations Population Fund and partner organisations, says that 350-thousand more midwives are still needed globally.

In Vietnam, five to seven women still die almost every day due to pregnancy or childbirth. In Cambodia, there is an average of six midwives for one thousand live births.

Presenter: Liam Cochrane

Speaker: Della Sherrat, UNFPA's international coordinator for skilled birth attendants in Laos.

Click here to listen to the audio program (Windows Media)

SHERRAT: Yes in fact Asia as a region has one of the most diverse regions in terms of midwifery needs. We have countries like where you're speaking from in Australia where of course you still have a shortage of midwives there, but many women have access to midwives and to services for midwifery services. Whereas in countries like Laos, only 20 per cent of women have access to any services at all, and Timor Leste equally the same and Bangladesh, and then in between that, there's a huge range. So huge diversities and huge differences across the whole of the Asia region.

COCHRANE: And can you spell it out for us, I mean what are the consequences of not having enough trained professionals to play this role?

In Cambodia, Women Fear Death at Childbirth

By Marwaan Macan-Markar

KRAING KAOK, Cambodia, Apr 2, 2011 (IPS) - Death haunts women in this Cambodian village at a moment of happiness - when they give birth.

"Today, nothing frightens Cambodian women more than having to give birth," says Mu Sochuea, former minister of women’s affairs. "It is costly, risky and not safe for the mothers and the babies."

Cambodia has acquired the notoriety of having among the highest maternal mortality rates in the region. Five women die every day during childbirth, according to U.N. reports.

Public health experts attribute the high death toll to lack of sufficient midwives, limited health care centres, the cost of health services, and a bias in remote rural areas towards untrained traditional birth attendants.

Hak Sam Ath still fights back tears as she recalls how Ouch Lay, her eldest daughter, died at a health clinic that serves this fishing and trading community on the banks of the Stung Slot River. "She had high blood pressure at the time she had checked into the health clinic for her delivery," said Sam Ath. "But this was overlooked and she died on the night she was to give birth."

Cambodia Prepares To Assess Its Development Goals

Cambodia is behind on saving mothers in childbirth and protecting the environment. (Photo: ASSOCIATED PRESS)

Men Kimseng, VOA Khmer
Washington, D.C Monday, 13 September 2010

“We have good figures on both prevention and treatment.”

When world leaders gather in New York next week to discuss the Millennium Development Goals of UN countries, they will find Cambodia well along on benchmarks for HIV and AIDS, but appears lagging in maternal mortality and other goals.

MDGs were pledged by 189 countries in 2000, creating targets for 2015. In that time, Cambodia has gained ground in the fight against HIV, AIDS and child mortality, officials said. But it is behind on saving mothers in childbirth and protecting the environment.

Tia Phalla, vice chairman of the National AIDS Authority, said Cambodia has reached a goal of 0.9 percent prevalence.

“We have good figures on both prevention and treatment,” he told VOA Khmer.

In child mortality, which was a prime concern in the past, Cambodia has made “remarkable progress” since 2000, Sherif Rushdy, the UNDP program adviser in charge of Cambodia's MDGs, said in an e-mail.

Infant mortality improved from 95 to 60 deaths per 1,000 live births between 2000 and 2008, while deaths for children under five years old fell from 124 to 83 death per 1,000 live births from 2000 to 2005, Rushdy wrote, quoting figures from the Ministry of Health.

Both rates were expected to “far exceed” Cambodia's 2015 goals, which may be revised further, Rushdy wrote.

But even with such improvement, Cambodia retains one of the highest child mortality rates in the region.

There is also concern it may not meet its goals in maternal mortality, and environmental protection, despite a sanguine report issued last week by the Center for Global Development. That report found Cambodia among countries that could achieve most of its 2015 targets, although it only looked into a small number of those.

“We need to deepen our study on these issues,” said Hou Taing Eng, secretary of state for the Ministry of Planning.

Meanwhile, the administration of US President Barack Obama in July unveiled its own strategic plan to help developing countries meet their goals, including investing in health and education, economic growth and well-governed institutions; empowering women and girls; and watching development outcomes and accountability.

“We applaud President Obama's MDG plan,” Gregory Adams, the director of aid effectiveness for Oxfam America, said in a statement. “We urge the president at the September summit to make an appeal to the world's leaders that achieving the MDGs is a winnable fight, but one that cannot be done in isolation. It is a global effort, and as a global community we need a policy and funding to win it.”

The US provided $68.5 million to Cambodia through USAID in 2010, “part of the broader program of US assistance in Cambodia,” according to the US Embassy in Phnom Penh.

The US aid package focused on health care and education in rural areas, reduction of HIV and AIDS, good governance and rule of law, as well as food security and climate change, the Embassy said in a statement.

Cambodia still has a high poverty rate—about 30 percent of its population live below the poverty line—and there is room for improvement, development experts say.

“We believe that resources provided by development partners to Cambodia should be used more effectively and transparently,” Seang Soleak, a spokesman for Oxfam America's Cambodia office, said. “We have seen that assistance has so far not effectively tackled grave issues affecting the poor, especially those in rural areas.”

Cambodia women in health battle

Cambodian villagers are encouraged to give birth in the local health centre
Most Cambodians live in rural areas, where the health system is not strong

Sunday, 31 May 2009
By Jill McGivering
BBC News, Cambodia

In Cambodia , five women die every day because of inadequate health care during childbirth - making it a leading cause of death among women of child-bearing age.

The government is trying to improve health services but it is proving a long slow process.

Lvea village, in north-western Cambodia, is a collection of wooden stilt-houses along a dirt track, hectic with dogs, piglets and chickens.

Most of the women here have been told to have their babies in the local health centre.

So when one woman, Low't, went into labour recently with her ninth child, she made her way there too.

Sad but common story

Her neighbour, Ron, told me what happened:

"The delivery went well - but afterwards Low't started to feel faint. She was losing blood.

"The health centre didn't have the right medicine - so they went eight kilometres (5 miles) by trailer to a larger one.

"The midwife there couldn't stop the bleeding either, and sent them to the hospital in the nearest town.

"They were still travelling, heading downriver by boat, when Low't died."

It's a sad but common story.

Eighty per cent of Cambodia 's population live in rural areas and the public health system is weak.

In recent years, the government has made it a priority to strengthen its network of trained midwives.

They now attend more than half of all births - a significant increase.

Many local clinics function better, even if they're still poorly equipped.

But midwives are paid very little - and can be distracted by running private businesses too.

In Lvea village, the women were cautious about criticising the midwives who tried but failed to save Low't's life.

But one woman made this plea to her government: "Please supply good quality medicine to the health centre so that it can help us."

Progress is being made.

But for women like Low't, it's simply too little, too late.

US Urges Better Care for Women

By Kong Sothanarith, VOA Khmer
Original report from Phnom Penh
28 May 2009

The US called on Cambodia to take measures to better provide health to women, an average five of whom die each day while giving birth.

The high maternal mortality rate goes with a high infant mortality rate, and the US called for serious action from the government and NGOs to help women.

“The Government of the United States of America takes great interest in women’s health and the Embassy commends all health organizations in Cambodia that are working to further women’s health in the country,” the embassy said in a statement, marking International Day of Action for Women’s Health.

“We believe that combining women’s empowerment with access to health services strengthens the individual and the family,” the embassy said.

Cambodia’s maternal mortality rates rank among the highest in Southeast Asia, resulting in about 2,000 deaths each year, the embassy said.

But midwives trained in recent years had helped reduce the rate.

“We take the today’s ‘call to action’ seriously and look forward to working with our partners in the Royal Government and in the NGO sector to continue helping women and their families in Cambodia,” the embassy said.