Accountability and Reproductive Health in Cambodia

Ramona Vijeyarasa

NGO reports indicate that Cambodia, like many other countries, is falling short on its commitments to universal access to reproductive health services.

In mid-May, the Government of Cambodia was put to a test of
accountability as it reports to the Committee on Economic, Social and Cultural
Rights in Geneva. This was a great opportunity to give attention to
the situation of social and economic rights in a country where discussions
about education, health and housing rights are frequently clouded by the
attention given to the war crimes tribunal. The Covenant on Economic, Social
and Cultural Rights has been enforced in Cambodia for over 17 years.
As a result of this commitment, the Government of Cambodia is bound to take
steps to achieve the full
realization of the right to the highest attainable standard of health
all Cambodians. 

The Government has already noted women’s reproductive health needs
in its report to the Committee. Its national population policy aims to ensure
that all Cambodian people have access to comprehensive use of reproductive
health service in 2015, with the goal of supporting couples and individuals to
decide the number and spacing of their children and have the information and
services to do so. 

However, the reports previously submitted by a number of NGOs to the
Committee revealed the extent of the current government’s shortfall in
achieving its international obligations, particularly with regard to maternal
health as well as access to health care by indigenous communities. 

A report by the Center for Economic and Social
highlighted the inadequate resources
dedicated by the Government to economic and social rights. The Government’s
expenditure on health and education is particularly low compared to the
country’s GDP. Compared to other countries in the region, Cambodians are more
likely to pay out-of-pocket for their health care. In fact, the World Bank has reported that Cambodia
has the highest private health expenditure as a percentage of GDP of all
low-income countries. The report also highlights the
vast regional disparities in availability of reproductive health services in Cambodia.
Women giving birth in the capital Phnom
Penh are over six times more likely to be assisted by
a skilled birth attendant than women in the regions of mondol Kiri and Rattanak

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The health disparities for indigenous people are also a pressing issue
highlighted by several NGOs. The NGO Working Group argues that money, transportation,
language, discrimination, low levels of education and traditional
beliefs/obligations act as barriers and are impeding access to health services
and information. The Indigenous Community Support
Organization, one of several organizations reporting on the rights of
indigenous peoples, has similarly reflected on the obstacle to accessible
services created by language and cultural barriers, citing the lack of
indigenous minority staff in public health services as a significant problem. 

Maternal health has also received coverage among the NGO reports,
unsurprising given that the World Health Organization reporting a Maternal Mortality Rate of 540 per 100,000 live births in
Cambodia, though data varies with the Cambodian and Demographic Health Survey
indicating an MMR of 437 in 1998 and 472
in 2005
. Regardless, the estimates are
alarming and can be addressed with greater prioritization of maternal health.
The NGO Working Group has offered several recommendations including addressing
basic needs for reproductive and child health services, supplies and
infrastructure with particular emphasis on community-based health care,
increasing the skill of birth attendants and emergency medical obstetrics care
services and providing free maternal health services to all poor and
marginalized women. 

Working Group
has also highlighted the needs of
people living with HIV/AIDS, Cambodia
having one of the highest
HIV prevalence rate
s in Asia, falling second to Thailand.
They have specifically noted the need for expansion and strengthening of Antiretroviral Therapy (ART) programs,
increased coverage of the Prevention of
Mother-To-Child Transmission (PMTCT) services, including better access to
Voluntary Confidential Counseling and Testing (VCCT) services for pregnant women and, overall, an increase in the number of
HIV positive pregnant women who received antiretroviral drugs to reduce
mother-to-child transmission. They have also called for improvements in
programs targeting specific at-risk groups, "such as brothel sex workers, women
working in entertainment establishments, Men Who Have Sex with Men (MSM) and
Injecting Drug User (IDU)." 

concerning, however, are the issues that have been given inadequate attention
in the government and NGO reports. Wide-scale gender inequality
persists in the country, with UNFPA reporting
high rates of gender-based violence, with limited services for survivors and
limited strategies for finding perpetuators of violence, rape and indecent
assaults that disproportionately affect young women and girls. UNFPA and others
like the Global
Health Council
report alarming evidence of gang rape, resulting in
unintended pregnancies, HIV and other STIs as a result. Other groups whose
health needs appear to be neglected in these reports are migrant workers and
those living in urban slums. 

It is clear
the inadequacy of reproductive health care is much more complex than a question
of improved physical access and increased government investment. At least,
however, the Cambodians, through the NGOs participating in the process, have an
opportunity to seek some accountability for the shortfall, and a new platform
to lobby for change.

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