Efforts To Reduce Maternal Mortality Rate in the Remote O’Svay Commune, Stung Treng Province
Following the death of a young mother during childbirth in O’Svay Commune, Thalaborivath District, Stung Treng Province in 2005, the Commune Committee for Women and Children (CCWC) has dedicated a vast amount of their limited time and resources to ensuring that pregnant women are receiving the support they need.
The CCWC, chaired by the Commune Chief, Mr Man Lee Hoa, has focused on improving access to health care, the quality of education and improving the way the commune monitors the health of pregnant wo-men. The testimonies of new mothers provides compelling evidence that the work being done by the CCWC to reduce the rate of maternal mortality is having a profoundly positive impact on the lives of many of O’Svay’s families.
With many of the commune’s villages on islands in the Sekong River, for the majority of O’Svay’s residents the local health centre is at least a twenty minutes motorboat journey away. For the more vulnerable families in the commune, like widowed mother of five, Ms Chev Mok, this journey to the health centre is simply unaffordable. In December 2008, Ms Mok went into labour with her fifth child in the company of a traditional birth attendant (TBA). After giving birth she began bleeding excessively.
By providing Ms Mok with a boat, paid for with the commune’s limited administration budget, Mr Hoa was able to get her to the health centre in time to receive a life saving blood transfusion. The CCWC’s initiative to provide women in danger during labour with emergency transport to the health centre, in this case saved the life of a single mother of five. In the last four years, O’Svay Commune’s CCWC has funded emergency transport to the health centre for three women. During this period the commune has reported no cases of maternal mortality.
As part of a scheme aimed at reducing the number of women needing emergency transport to the health centre, during, or immediately after birth, the local health centre, in conjunction with O’Svay Commune’s CCWC, has set up a monthly outreach program for pregnant women in the commune involving regular monitoring of the mother and unborn baby’s health. The Commune’s Women and Children Focal Point (CWCFP) in O’Svay, Ms Siv Samoun regularly attends these outreach session to offer her support to the health centre staff and the pregnant women. ‘All 45 pregnant women in the commune are now attending these check-ups’, Ms Samoun says with a smile on her face, ‘if there are any problems with a pregnant woman she is immediately referred to the health centre and strongly advised to give birth there as well’. The health centre’s outreach program has not only improved the monitoring of pregnant women in O’Svay Commune, but has also meant that the majority of high risk births are now taking place at the health centre where mother and baby have a much greater chance of survival.
One of the most important initiatives introduced by O’Svay’s CCWC to reduce maternal mortality cases has been to run educational sessions on reproductive health for women of childbearing age. After holding their first successful session in 2006, the CCWC now holds annual educational sessions for all women in the commune between the ages of 15 and 45. These sessions, facilitated by Ms Samoun, are held with the support of health centre staff. The sessions focus on how women should look after themselves and their unborn baby whilst pregnant. Expectant mothers are strongly advised to use the health centre’s monthly outreach program when pregnant and to give birth at the local health centre, rather than at home with a TBA. As a result of this educational program the majority of women in O’Svay Commune who can afford to travel to the local health centre or provincial hospital to give birth are doing so. However, those women who cannot afford the travel costs are still opting to give birth at home with the assistance of skilled TBAs. Financial support is only offered by the CCWC in emergency situations, due to the limited funds available. By educating all women of childbearing age on the importance of using the health services provided, the CCWC have greatly reduced the number of women putting themselves at risk by opting to ignore these services.
The CCWC in O’Svay Commune are working hard to ensure that all pregnant women understand the importance of using the health centre services on offer. After falling pregnant, women are visited by either their TBA or village health volunteer and this vital message is reiterated. Mr Seoung Savang, the health center representative in the CCWC argues that this is very important as TBAs and village health volunteers are usually neighbors and often friends with the pregnant women. ‘Pregnant women are more likely to respond to information when they are told it by someone they know and trust’ Mr Savang explains. After discovering that she was pregnant with twins, Ms Kim Mon a resident in O’Svay followed the advice of her village health volunteer and gave birth at the health centre. During the birth Ms Kimoun hemorrhaged. Although her son, who was born first, survived, his sister was not so lucky and she died inside the womb. ‘Without the immediate care and attention of the health centre staff’, Ms Kim Mon says quietly, ‘Chetra (her son, pictured left with his mother) and I might not have survived either’. Both the educational sessions held by the CCWC and the home visits by health centre outreach workers play a vital role in increasing the number of pregnant women using the health services on offer and as a result reducing the number of maternal mortality cases in the commune.
As part of the attempt to reduce the cases of maternal mortality in the commune, the CCWC in O’Svay commune and the local health centre have, in the last few years, been striving to improve their working relationship. Collaboration between the CCWC and health centre staff in the implementation of the initiatives aimed at preventing maternal mortality has played an important role in building the relationship and encouraging enhanced communication between the two parties. Mr Hoa explains that on a day to day basis, through their reports to village chiefs, village health volunteers and TBAs provide the link between the CCWC and the health service provider. This link not only allows for effective collaboration and successful outreach projects, but enables both the CCWC and health centre to effectively monitor all pregnant women in the commune.
In recent years, the CCWC in O’Svay Commune has worked hard to implement initiatives aimed at reducing the number of maternal mortality cases they have to deal with. Although they no specific budget to put towards maternal mortality, Commune Chief Mr Hoa, explains that they have been using the CCWC’s administration budget including the $200 they receive from UNICEF and small sums of money from other donors. Through the implentation of initiatives like those in O’Svay Commune, CCWCs across Cambodia work to significantly reducing the maternal mortality rate in the country.
(Source: D&D Bulletin, the publication of the Commune Council Support Project, Volum 8 No.7, July-September 2009)