/countries/cambodia/antenatal-care-provided-in-a-health-clinic-in-cambodia.tmb-1200v.png?sfvrsn=6bb854d8_3 "Cambodia’s sustained progress in improving maternal, newborn and child health")
At the beginning of the 2000’s, Cambodia faced alarming maternal,
newborn and child health indicators. The maternal mortality ratio stood
at 437 per 100 000 live births, while newborn and child mortality rate
accounted for 37 and 124 per 1000 live births respectively. Limited
infrastructure, a shortage of skilled birth attendants and financial
constraints hindered progress. To tackle these challenges, the Cambodian
government, with support from WHO and key partners, embarked on a
transformative journey to strengthen maternal and newborn health
services and ensure equitable access to quality care.
Today,
skilled birth attendance is near universal, with 98.7% of births
attended by trained health professionals and 97.5% of women giving birth
in a health facility. Between 2014 and 2021-2022, neonatal and
under-five mortality rates declined by 54%, from 18 to 8 and from 35 to
16 per 1000 live births respectively, far exceeding the global average
reduction of 14% during 2015-2022. Cambodia achieved its Sustainable
Development Goal targets for reducing neonatal and under-five mortality
eight years ahead of schedule.
Strengthening health systems
Cambodia’s
investments in health systems and workforce capacity have been
instrumental in driving progress. Midwifery training programmes have
equipped health workers with essential skills to provide safe,
high-quality care, including routine antenatal care, essential
intrapartum care, postnatal care, and management of childbirth
complications. Deployment strategies have ensured that even remote
health centres are staffed with skilled birth attendants.
To
incentivize facility-based deliveries, the government introduced a
delivery incentive programme for health teams in 2007 and launched cash
transfer programmes for pregnant women and infants from poor families in
2019, targeting the critical first 1000 days of life. These initiatives
encourage families to seek comprehensive antenatal and postnatal care,
ensuring access to a full package of essential health services.
Financial mechanisms such as health equity funds, cash transfers and fee
exemptions have alleviated economic barriers, making institutional care
more accessible to vulnerable populations.
Improvements in
water, sanitation and hygiene infrastructure have also contributed
significantly to better health outcomes. An integrated routine primary
health care delivery system has been established across provinces and
districts, ensuring that essential services effectively reach
communities. Health promotion and behaviour change campaigns have played a
vital role in encouraging exclusive breastfeeding and antenatal
care-seeking behaviours.
/countries/cambodia/nurse-assisting-mother-with-breastfeeding-in-cambodia.jpg?sfvrsn=75e4eee7_5)
A nurse is assisting a mother breastfeeding in a referral provincial hospital in Cambodia. © WHO / Yoshi Shimizu
Strong leadership and strategic framework
A
key milestone in Cambodia’s progress has been the strong leadership of
the Ministry of Health, which has provided clear strategies for
advancing maternal and newborn health. Two main coordination platforms —
the Sub-Technical Working Group for Maternal and Child Health and the
Early Essential Newborn Care (EENC) Coordination Committee — were
established and have convened regularly to align efforts within the
Ministry and with health partners.
With technical support
from WHO and funding from the Korea Foundation for International
Healthcare (KOFIH), the EENC Coordination Committee plays a crucial role
in harmonizing national and sub-national efforts, monitoring progress
through regular reviews, mobilizing resources to scale up EENC
practices, and ensuring consistency in care delivery while addressing
service gaps.
Recognizing the need for a strategic and
systematic approach to newborn care, the committee led the development
and adoption of the Five-Year Action Plan for Newborn Care (2016–2020).
The plan emphasizes scaling up EENC and institutionalizing
evidence-based practices, integrating key life-saving and cost-effective
interventions — such as routine immediate care for all newborns under
“The First Embrace” approach, as well as measures to prevent and care
for small or sick newborns.
By 2023, EENC coaching was
implemented in 89.4% of health facilities (1187 out of 1328), surpassing
the 80% target. Kangaroo Mother Care for preterm and low birthweight
infants has been scaled up to two national hospitals and ten provincial
and district referral hospitals, while a national protocol for EENC in
Caesarean sections, introduced in 2019, has standardized care
nationwide.
“Maternal, newborn and child health are essential
components of investing in human capital. Providing quality care for
mothers and newborns brings immense benefits — not just for families,
but for entire communities and economies. Cambodia’s coordinated
approach to maternal and child health serves as an inspiring model for
the region and globally. It demonstrates what can be achieved with
strong national leadership, dedicated health workers and sustained
partnerships,” stated Dr Marianna Trias, WHO Representative to Cambodia.
Remaining challenges
Despite
significant achievements and high coverage of antenatal care and
facility-based deliveries by trained health personnel, challenges
persist. While maternal mortality has declined, it remains high at 154
deaths per 100 000 live births, primarily due to haemorrhage and
pregnancy-induced hypertension — both preventable causes. Greater
efforts are needed to get on track to achieve the 2030 target of 70
deaths per 100 000 live births. Similarly, child malnutrition continues
to impact long-term productivity, with 22% of children under five
stunted and 10% wasted for over a decade.
Disparities between
urban and rural areas and gaps in facility capacity to provide quality
essential services require targeted attention. Addressing unmet family
planning needs and expanding adolescent-friendly services are crucial,
particularly as rural adolescent girls aged 15–19 experience
significantly higher birth rates than their urban peers.
/countries/cambodia/infant-checkup-at-health-center-in-cambodia.jpg?sfvrsn=b641aeda_4)
Infant checkup at Banteay Srey Health Center, Cambodia. © WHO / Aforative Media
The way forward
Moving
forward, further reducing maternal and neonatal mortality requires a
stronger focus on enhancing the quality of care. Building on significant
improvements in coverage, efforts should prioritize improving the
quality of basic routine care during antenatal and intrapartum periods,
including emergency obstetric care, alongside establishing robust
referral systems for cases requiring higher-level care. Achieving this
will require both the strengthening of quality improvement mechanisms
with enhanced monitoring and the implementation of targeted improvement
actions.
The Fast-Track Initiative Roadmap for the Reduction of Maternal and Newborn Mortality (2025–2030)
aims to accelerate progress by scaling up interventions, sustaining
quality care and addressing service delivery gaps. To support its
implementation, WHO will assist in developing a comprehensive country
action plan and support the Coordination Committee for Strengthening
Quality of Care and Wellbeing of Women, Maternal, Newborn and Child
Health to ensure effective coordination and execution.
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