Fighting against maternal and neonatal mortality

Midwives and doulas, two key professions for reducing maternal and neonatal mortality in the province of Kampong Speu in Cambodia

Midwives and doulas, two key professions for reducing maternal and neonatal mortality in the province of Kampong Speu in Cambodia
I now know a lot of things about reproductive health and I can pass on my knowledge to my community to try and get rid of false beliefs and bad practices. I love working as a doula because it helps me and it helps my village a lot.

Testimony from Yim Pim (Volunteer village doula in the village of Putrea)

Location of Project Kampong Speu, Cambodia
Name of Association Regional Program for Midwife Capacity Building Enfants & Développement
www.enfantsetdeveloppement.org
facebook.com/Enfantsetdeveloppement
Project Partners
(financial and operational)
  • Ministry of Health
  • Provincial Health Department
  • District Health Operational Districts
  • The EU is giving financial support for the first year.

Program description

Issues / local context

Kampong Speu is the poorest province in Cambodia where there is only very limited access to medical care, especially obstetric and neonatal care. The referral hospital to accommodate pregnancies with complications is more than 100 km from the remotest village. Health services lack staff and equipment. Midwifery skills are not up to the needs and their availability and their relationships with patients from the villages cannot ensure high quality monitoring of pregnancies.

Due to this lack of access, facilities and knowledge, village women still do not use health services very frequently. Less than half of all deliveries are carried out by competent persons. There is also a very low level of education in the villages and many beliefs and practices that are harmful to mothers and their babies still persist.

In 2010, the maternal mortality rate in the province of Kampong Speu was 206 per 100,000 births and the neonatal mortality rate was 31 per 1,000 live births, with significant disparities between urban and rural areas.

To achieve the Millennium Development Goals 4 and 5, the Ministry of Health has implemented a plan to improve emergency obstetric and neonatal care, based on improving and extending the skills in certain health centers so that they become referral facilities for emergency care. However, a large number of training courses will still be required to reach this level of care.

Key figures

  • 106 midwives from 37 health centers will be trained
  • 133 village doulas will be trained and monitored so they can operate in 184 villages.
  • In all, more than 10,000 pregnant women will benefit from support and improved services for the three years of the project.
  • At the end of the project, it is expected that more than 80% of village women will give birth in health centers.

Project goals

This project aims to reduce maternal and neonatal mortality by stepping up care services, especially in obstetric and neonatal emergencies, and provide better resources for communities. It is based on two complementary actions: training midwives to improve the quality of services in hospitals and health centers, and training village doulas to inform and support women during pregnancy and the first months of their babies’ lives.

The project will build a sustainable network of collaboration between midwives and doulas. It will also work with the government to ensure recognition for doula training.

The doula system was launched in Cambodia in 2010 by Enfants & Développement. Doulas provide women with information and support for their sexual and reproductive health, while educating them about their rights. They accompany them during their pregnancy and the first months of their child’s life. Without providing strictly medical care, they act as the interface between pregnant women and the public health services - particularly midwives.