By Pauline Yongeun Ahn
Ms. Hul Savy (36 years old, pictured with her two month old baby)
delivered her fifth baby at home in Intra Chey island
in Beoung Char Commune, 33 km away from Kratie town
© UNICEF Cambodia/2016/Ahn
Kratie province, Cambodia: Regular health checks during pregnancy and soon after birth are essential to the health and wellbeing of mothers and babies. But many women in Cambodia continue to face obstacles that can have devastating effects. In remote villages and towns, women struggle to care for their young children and earn enough money to survive. Pregnancy adds another layer of burden to this struggle.
Many poor women find it impossible to pay for transport to a health centre, and the long distances they have to travel mean they do not have regular antenatal and postnatal check ups.
Seeing the level of need in hard-to-reach villages, UNICEF has launched outreach services in Kratie province in northeastern Cambodia, and now supports health centre staff to travel around the province taking health care to the people.
For the women of Intra Chey Island in Kratie province, UNICEF’s outreach programme is bridging the gap between them and life-saving health services.
Intra Chey Island is in Beoung Char commune, Sambo district. It takes one hour by road and a further two hours by boat from Kratie town. The US$110 cost of the return boat ride far exceeds a whole month’s salary for an average household, with most people here making a living through subsistence farming or fishing.
Mother of five, Savy Hul, 36, was one of the first people to benefit from the new outreach activities when she attended an outreach session with her baby for vaccinations, deworming and vitamin A supplementation. Outreach also covers health education, birth spacing, iron and folic acid distribution, screening and referral for malnutrition and many other important health care needs.
Most women who live in Intra Chey, including Savy, deliver their babies at home, often attended by neighbours and traditional birth attendants, or at times alone.
“After having my fourth baby, I wanted to stop having children and used birth control. Soon after taking contraceptive pills, I started bleeding and had to stop the pills,” Savy said. “That was when I found out I was pregnant with my fifth child.”
This is often the case for mothers in Intra Chey, as they have limited knowledge of birth spacing.
“I saved up money to go and see a midwife for antenatal care in the private clinics of Kratie (the provincial town) and even in Stung Treng province, which is actually closer to my home,” Savy said. “I had planned in advance to have my baby in the hospital, but unfortunately when my water broke the river levels and current were too high and I did not dare cross the river,” she said.
“The labour happened very quickly, and I delivered by myself. I was scared, but I knew what to expect after delivering four babies already,” she added.
Birth preparedness is an all-inclusive plan for mothers during the continuum of care, required from pregnancy through to delivery. It includes saving up for the cost of antenatal care, delivery and postnatal care, coordinating child care and other household responsibilities for when the mother is away from home, and arranging transport to the health centre. But this is a fruitless venture for these women, as merely accessing the health facilities is a major obstacle.
UNICEF’s support for health centre staff to do outreach activities is certainly a life-saving intervention, but more action needs to be taken by provincial health departments and commune councils. They need to map all pregnant women in hard-to-reach villages like Intra Chey, and bolster their commitment to dispatching special mobile clinic teams to ensure everyone has access to these critical health services.
Access to care saved the life of Phin Yim, 38, when she developed a dangerous condition in the late stages of her pregnancy.
Phin is the mother of five children and lives in Chbar Island, Kok Knair commune. One night, Phin realized her body was swelling, and as the pain and discomfort grew, she asked the village chief to support her to be transferred to the health centre.
The swelling in Phin’s body was a sign of pre-eclampsia, a malfunctioning of the placenta that can obstruct oxygen and nutrient flow to the baby and restrict foetal growth. As the symptoms were coupled with high blood pressure, her condition could have been fatal.
Ms. Yim Phin (38 years old, pictured with her baby), a mother of five children in Chbar island, Kok Knair commune,
was fortunately spared her life by UNICEF’s village emergency referral support
© UNICEF Cambodia/2016/Ahn
Under the UNICEF-supported Village Emergency Referral Scheme, funded by the Korean International Cooperation Agency, Phin was able to travel to the health centre free of charge and have the cost of her meals covered while in hospital.
“I stayed in the hospital for five days,” Phin said. “If I did not receive support, I would have had to borrow money from my relatives.
“My husband left me when I was five months pregnant, so it has been difficult for me to sustain myself and my five children,” she added. “Now I have to live in my uncle’s house and borrow money until I have a daily job to pay him back.”
For women like Phin, deprivation is multi-dimensional, and making sure she receives the health care she needs requires interventions from all angles. Local authorities need to develop a robust system that links mothers like Phin, living in pockets of multiple deprivation, to essential health services.
Women living in Chbar Island, Kok Knair commune, juggle the responsibilities of working and taking care of their families, often neglecting their own health. Seeking appropriate health care is generally not a priority.
Han Sok Kheat, 37, is the mother of seven children, who also lives in Chbar Island. When Kheat was about to deliver her seventh baby, she had to choose between going to the health centre and staying home to watch over her six children and her rice field, the sole source of income for her family. The midwife recommended she stay in hospital for one week, as her baby was going to be born pre-term, but Kheat stayed home and delivered with the help of a traditional birth attendant and her aunt.
Ms. Han Sok Kheat (37 years old, pictured with her baby),
a mother of seven children in Chbar island, Kok Knair commune, took an over the counter fever medicine
and found that her baby’s feet were deformed
© UNICEF Cambodia/2016/Ahn
Even though local authorities do sporadic health promotion and behaviour change campaigns, there is a real need for them to increase support to healthcare, to advocate in communities and to share the burdens associated with pregnancy and delivery.