Reproductive Health in Cambodia
Reported, December 21, 2011
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 for 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 Rights 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 Kiri.
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.
The NGO Working Group has also highlighted the needs of people living with HIV/AIDS, Cambodia having one of the highest HIV prevalence rates 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).”
Equally 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.
Credits:
Ramona Vijeyarasa, RH Reality Check, Southeast Asia
More Information :
http://www.rhrealitycheck.org/blog/2009/07/22/accountability-and-reproductive-health-cambodia
