Tuesday, October 6, 2015

Breaking traditional barriers to improve maternal and child health in rural Cambodia

By Kong Vanny and Ariel Hofher

© UNICEF Cambodia/2015/Kong Vanny
Tong Soun (first right) with her 4-month-old baby in Kouk village, Ratanakiri province.

Under the shade of a large tree, Tong Soun carries her 4-month-old baby in a colourful shawl. They live in the remote village of Kouk, 620 kilometres from Phnom Penh in the distant north-eastern province of Ratanakiri.

Kouk village is located in the rural district of Ou Chum, where access to health services is extremely limited, especially for expecting mothers. Aside from limited services, many people in Ratanakiri maintain the belief that traditional birth attendants, who usually have not received formal medical training, are a better option than skilled midwives in a hospital or health centre.

In Ou Chum, only 30 per cent of women give birth in a health facility, compared to 49 per cent in Ratanakiri as a whole. This is significantly below the national average of 70 per cent.

Soun explains, “I learned about the danger of giving birth at home from the village health support group. I was concerned about giving birth safely, so I went to the health centre for regular check-ups.”

Volunteers at the village health support group gave Soun critical information on pregnancy and early childhood. The education Soun received is part of the Integrated Early Childhood Care and Development (I-ECCD) programme that the Cambodian government launched in Ou Chum district and the wider La Ak commune in 2014, with UNICEF’s support.

The I-ECCD programme is designed to increase knowledge among expecting mothers and caregivers on appropriate care during pregnancy, safe delivery and postnatal care; as well as demand for quality services. Critical brain development of a child occrs from pregnancy to age 3. It is influenced by the mother and child’s nutrition and health, as well as by proper stimulation and interaction between the parent and the child.

Health support group volunteers who educate mothers and caretakers on I-ECCD provide an invaluable bridge between the community and the healthcare system. This is because the volunteers are equipped with the necessary knowledge on birth registration, maternal, newborn and child health, immunization and nutrition (including breastfeeding and micro-nutrient supplementation). Also, the volunteers are can advise women on the importance of safe drinking water, improved sanitation and hygiene practices – both during pregnancy and after childbirth.

Soun explains, “The health centre staff advised me to give birth at the referral hospital because it was my first pregnancy. They said that the referral hospital had the right equipment for delivering in case I had an emergency.”

After participating in community parenting sessions, a component of I-ECCD, Soun chose to deliver her baby girl at the referral hospital in Banlung, the provincial capital.

Soun is joined under the tree by three of her friends. They are all from Kouk village and have babies between 5 and 9 months of age. All of these infants, were born safely at the local health centre or hospital. Souk and her friends say that they would not use traditional birth attendants in the future. Thanks to the I-ECCD programme, these women now understand that traditional birth attendants do not have the equipment needed for a safe delivery.

© UNICEF Cambodia/2015/Kong Vanny
Women from Kouk village who safely gave birth in health facilities in Ratanakiri province.

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