PHNOM PENH (Cambodia Herald) - Things are looking up for Cambodian mothers. According to the United Nations Fund for Population Activities (UNFPA), Cambodia's maternal mortality rate plunged 70 percent between 1990 and 2010, the second steepest decline among members of the Association of Southeast Asian Nations (ASEAN). Vietnam was the only other ASEAN country to achieve a better result, with its maternal mortality rate tumbling 78 percent.
It turns out that among the ASEAN countries, Vietnam, Cambodia and Laos are all on track to achieve the United Nations Millennium Development Goals (MDG) target for maternal health. This aims to reduce the maternal death rate by 75 percent between 1990 and 2015. According to a UNFPA report released in New York last Wednesday, other ASEAN countries with high maternal mortality rates, namely Indonesia, Myanmar and the Philippines, are "making good progress" but are not yet on track to achieve the MDG target.
Vietnam was among only 10 countries to reduce its rate by more than 70 percent between 1990 and 2010. The nine others achieving even sharper reductions than the 76 percent decline in Vietnam were Estonia (95%), the Maldives (93%), Belarus (88%), Romania (84%), Bhutan (82%), Equatorial Guinea (81%), Iran (81%), Lithuania (78%) and Nepal (78%).
Another way to gauge if countries are on track with the MDG targets is to look at those which had 100 or more maternal deaths per 100,000 live births in 1990. Among the ASEAN countries, these included Cambodia (830 deaths) as well as Indonesia (600), Laos (1,600), Myanmar (520) and the Philippines (170). But only nine countries worldwide achieved average annual reductions of five percent or more between 1990 and 2010, and only two were in ASEAN. These were Cambodia (5.8%) and Laos (5.9%). The seven others were Eritrea (6.3%), Oman (6.2%), Egypt (6%), Timor-Leste (6%), Bangladesh (5.9%), China (5.9%) and Syria (5.9%).
The bad news for Cambodia is that maternal mortality was still stubbornly high at 250 deaths per 100,000 live births in 2010, well above the world average of 210. That may not be as bad as the average of 500 deaths per 100,000 in sub-Saharan Africa but it is well above the average rate of 150 deaths in Southeast Asia including Timor-Leste. Within ASEAN, only Laos has a higher death rate than Cambodia, with 470 deaths per 100,000 live births in 2010.
The other ASEAN countries with major maternal health problems had lower death rates than Cambodia, notably Indonesia (220%), Myanmar (200%) and the Philippines (99%). Strikingly, Vietnam managed to reduce its maternal mortality rate to only 59 percent in 2010 which is not much higher than Thailand (48%) or Malaysia (29%).
The upshot is that the lifetime risk for maternal death is 1 in 150 for Cambodia women. That may be half as risky as for Lao women (1 in 74) but is two thirds more risky than for women in Myanmar (1 in 250), which is poorer than Cambodia. It's also almost six times risky than for Vietnamese women (1 in 870).
UNFPA and other agencies deserve credit for helping to reduce the annual number of maternal deaths worldwide from more than 543,000 in 1990 to 287,000 in 2010, a decline of 47 percent. Yet the fact remains, as UNFPA itself acknowledges, that a woman somewhere on the planet dies of pregnancy-related complications every two minutes. The four most common causes are severe bleeding after childbirth, infections, high blood pressure during pregnancy and unsafe abortions.
Ninety-nine percent of maternal deaths occur in Cambodia and other developing countries, especially in Africa and Asia, notably India, Nigeria, the Democratic Republic of Congo, Pakistan, Sudan and Indonesia. Most of these deaths could be prevented with proven interventions.
"We know exactly what to do to prevent maternal deaths," says Babatunde Osotimehin, the executive director of UNFPA. He points to improving access to voluntary family planning, investing in health workers with midwifery skills and ensuring access to emergency obstetric care when complications arise. "These interventions have proven to save lives," Dr Osotimehin says. In the meantime, an estimated 790 women die from maternal health problems every year in Cambodia, amounting to more than two deaths every day.
