Continuum of care for maternal and newborn health in Cambodia: Where are the gaps and why?

Cambodia still suffers from high neonatal mortality and maternal mortality despite the recent progress. Continuum of care, referring to continuity of care throughout pregnancy, birth and post delivery – i.e. antenatal care (ANC), skilled birth attendance (SBA), and postnatal care (PNC) has become the key strategy of programmes for improving health of mothers and newborns. Successful service delivery to improve continuum of care relies on a better understanding where the gaps are in seeking care along the continuum and what factors contribute to these gaps. We analyzed the 2010 Cambodia Demographic and Health survey (CDHS) data to address these questions.

Every three out of five women received ANC, SBA and PNC within 48 hours for their most recent birth, which is remarkable for a nation that 30 percent of the population lives below the poverty line. However, still a large proportion of women dropped out from the pathway of continuum. After receiving ANC, 11% of women had SBA but no PNC, 8% had PNC but no SBA and 13% received neither. Poor women particularly suffered from low access to care and health insurance did not seem helpful. Regional variation is substantial-ranging from 14% to 96% of women in 19 provinces receiving all three services. Quality of antenatal care affects women's use of subsequent skilled birth attendance and postnatal care. The findings of this study could provide key inputs for identifying program and policy priorities in Cambodia in order to reduce maternal mortality and neonatal mortality.