Gender and Health

While health outcomes and life expectancy in Cambodia are generally improving, Cambodia continues to have some of the weakest health indicators in the region. Overall life expectancy is increasing and current estimates show that women, on average, live 6.3years longer than men. Men are twice as likely as women to suffer from injuries, accidents or physical impairment, but women have very high risk of illness or death due to pregnancy and childbearing. Tuberculosis (TB) and HIV prevalence are roughly equal for men and women. Maternal mortality is unacceptably high at 472 deaths per 100,000 live births, representing 18 percent of female deaths between 1999 and 2005.

Twenty-one percent of all women were considered to be underweight in 2000 and this only decreased slightly to 20% in 2005. The poor nutritional status of women remains a serous concern. This is particularly urgent as stunting has increased over the last five years and poor female nutrition and stunting lead to poor productivity, increased risk of maternal morbidity and mortality, and increased risk of poor reproductive outcomes. Undernourished, short stature women are also more likely to deliver low birth weight babies, and such infants are at higher risk of morbidity and mortality. There are many health concerns which Cambodia should take into consideration such as HIV/AIDS, reproductive health sexual assaults, drug abuse and addiction, and so on.

I. Situation of Women Health in Cambodia
1.1. HIV/AIDS
HIV prevalence in the adult population aged 15 to 49 was estimated at 0.9% in 2006 based on data from the 2006 HSS and the 2005 CDHS. Previous estimations and forecasts, which were adjusted by using and improved methodology, show that HIV prevalence in the adult population has come down from 1.2% in 2003. HIV prevalence in young people is estimated using data from pregnant women aged 15-24 attending antenatal clinics, which is available from the HSS. The HIV prevalence among pregnant aged 15-24 attending antenatal clinics is estimated at 0.41% (HSS 2006).

The 2005 CDHS reports a HIV prevalence rate for women aged 15-24 of 0.2%. Prevalence was estimated to be 0.3% in young women and 0.36% in 2003 (HSS 2003). HIV prevalence among female sex workers was estimated at 12.7% in 2006 (HSS 2006), down from 21.4% in 2003.

a. Prevention
The 2007 update of the SRA 2007 acknowledges the success of prevention efforts in reversing the epidemic, resulting in declining HIV prevalence and incidence rates. However, the SRA 2007 update also point out that progress in scaling-up targeted prevention interventions has been less significant during the last two years and warns against complacency. Epidemiological and other risk assessment data indicate that it cannot be assumed that incidence will remain low and that there is a risk of a second-wave of HIV infections occurring in Cambodia. The main risk is related to the situation and behavior of female sex workers, their clients and sweethearts as a result of a high turnover of female sex workers and of recent changes in the structure of the sex industry. Behavior of MSM and IDU may also act as potential drivers of epidemic.

- Blood Safety
The NBTC reported that 97.3% of all blood units donated in 2007 ( 31,802 units ) were screened for HIV in blood banks that followed documented standard operating procedures and participated in an external quality assurance program. Despite this good result, blood safety still remains a concern due to the relatively limited number of voluntary blood donors (approximately 25% of all blood units) and the relatively limited use of blood components (approximately 70% of all blood use involves whole blood.

- Prevention of Mother to Child Transmission
In 2006, 311 HIV- infected pregnant women received antiretroviral to reduce the risk of mother to child transmission. In 2007, this number increased to 505. The PMTCT program of the NMCHC estimated the number of HIV infected pregnant women (the denominator) at 4,417 for 2006 and 4,509 for 2007. These estimates are based on Ministry of Health estimated concerning the number of expected pregnancies and a 1.1% HIV prevalence among pregnant women (HSS 2006).

1.2. Drug
Drug use has rapidly become a source of concern in Cambodia, and the government, UN agencies and NGOs are responding to contain its spread and mitigate its adverse impact, especially as related to HIV transmission. In 2004, an estimate of the number of illicit drug users was developed by UNAIDS using the Delphi technique. Women in the entertainment sector, including workers in the sex industry, karaoke parlors, massage parlors, clubs and beer houses, are often exposed to and subsequently become addicted to drugs (2007 workshop CPWD). This is reinforced by PSI’s recent findings during its second round HIV/AIDS tracking survey which found that 83% of women working in karaoke parlors reported having tried drugs and 7% reported having used injected drugs (PSI 2007). The impact of drug use during pregnancy can include spontaneous abortion, birth defects and developmental difficulties. Drug related damage to cognitive function and impulse control can lead to violent behavior and crime (UNDCP 1995).

1.3. Abortions
Abortion is increasing, and unsafe abortion is a key contributor to maternal mortality. As of 2005, 8% of Cambodia women 15-49 reported having had one or more abortions in their lifetime. This is an increase from 5% in 2000. Women are more likely to resort to abortion as they get older and less than 1% of women 15-19 reported having an abortion, while 15% of women over aged 34 reported having an abortion. Abortion also increases with the number of living children. Abortion rates vary significantly by location with more urban women having abortions than rural women, and the number of women reporting multiple abortions increased from 29% in 2000 (of all women reporting abortions) to 44% in 2005 (CDHS 2005).

Unwanted pregnancies can be prevented through increased availability and access to family planning services including emergency contraception and female controlled methods (female condoms), and abortion-related maternal mortality reduced through ensured availability and access to comprehensive and post-abortion care services in accordance with and in compliance with Cambodia law.

II. Women and Health Care in Cambodia
In Cambodia, five women die every day because of inadequate health care during childbirth. The government is trying to improve health services but it is proving a long slow process. Lvea village, in north-western Cambodia, is a collection of wooden stilt-houses along a dirt track, hectic with dogs, piglets and chickens. Most of the women here have been told to have their babies in the local health centre. So when one woman, Low't, went into labor recently with her ninth child, she made her way there too.

Eighty per cent of Cambodia's population living in rural areas and the public health system is weak. In recent years, the government has made it a priority to strengthen its network of trained midwives. They now attend more than half of all births - a significant increase. Many local clinics function better, even if they're still poorly equipped. But midwives are paid very little - and can be distracted by running private businesses too. In Lvea village, the women were cautious about criticizing the midwives who tried but failed to save Lout’s life.

III. Mass Media Screening
WMC has produced multi media approaches and innovation high quality radio, television and video productions that related to gender and health by broadcasting to provide educations about women health care today. It always produces many spot that educate to women in Cambodia how to take care of their health when they got disease. For instance, the maternal health care when they are pregnant, they need to go to see the doctor. The group works of WMC always go to do the fieldwork to collect any data of women health care and educate them about the women issue.

- The National Strategic ( CMDG )
Goal 5: Improve Maternal Health- The proportion of births attended by skilled health personnel has remained very low throughout the last decade at round 32 percent. Using of modern contraceptives remains at modest rate of approximately 20 percent. Progress on maternal mortality has been limited.

The main challenges are the lack of trained health personnel, the high cost of health care and low education levels among pregnant women. In order to meet Goal 5, an effective response would need to improve access to health care and family planning service increase the number of trained health personnel provide information campaigns and better target and manage health expenditures.

IV. Conclusion
While data on HIV knowledge and behavior is still relatively limited, trends in condom use have been monitored for several years. Data presented here show that condom use in commercial sex settings is generally very high. However, condom use among women involved in non-commercial higher-risk sexual relations and their partners (e.g. relationships between sweethearts and other regular, but non-faithful partners) remains very low. The situation of women working in environments and professions at risk of sexual and other forms of exploitation needs more attention and in-depth study in order to prevent abuse and manipulation.

In this situation the women care are not encourage because it doesn’t have enough material and expert doctors in the rural hospital that lack of health care for women when they got disease or ill. Sometime they don’t have enough money to pay for the fee. But now most of women have known a lot how to take care themselves and our government have build more hospital near their house that make them easy to examine their health on time.

Written by: Nhim Soknea, Pannasastra University of Cambodia, PUC