A NTENATAL C ARE

The health care that a mother receives during pregnancy and at the time of delivery is important for the survival and well-being of both the mother and the child. Antenatal care (ANC) from a trained provider is vital in monitoring the pregnancy and reducing morbidity risk for the mother and child during pregnancy and delivery. A well-designed and well-implemented ANC program facilitates detection and treatment of problems during pregnancy, such as anemia and infections, and provides an opportunity to disseminate health messages to women and their families. In the 2014 CDHS, women who had given birth in the five years preceding the survey were asked about the type of ANC provider, number of ANC visits, stage of pregnancy at the time of the first visit, and services and information provided during ANC. For women with two or more live births during the five-year period, data on antenatal care refer to the most recent birth only.

13.1.1 Source of Antenatal Care

Table 13.1 shows the percent distribution of women who had a birth in the five years preceding the survey by source of antenatal care received during pregnancy. Ninety-five percent of women received ANC from trained personnel (doctors, nurses, and midwives) at least once. Nearly 9 in 10 women (88 percent) received care during pregnancy from midwives, 6 percent received care from a doctor, and 1 percent received care from a nurse. Only 5 percent of women received no antenatal care for births in the preceding five years. The 2014 data show continued improvement in antenatal care since the 2010 CDHS, when 89 percent of women had received antenatal care from a trained health professional. In 2010, one-tenth of women received no antenatal care.

Younger women (less than age 35) were more likely than older women (age 35 and older) to receive antenatal care from trained personnel (96 percent versus 89 percent). Women were more likely to receive care from a health professional for first births (98 percent) than for births of order six and higher (72 percent). Urban and rural women differed slightly in their use of antenatal care services. Health professionals provided antenatal care for 99 percent of women in urban areas and 95 percent of women in rural areas. Five percent of women in rural areas received no antenatal care at all, as compared with 1 percent in urban areas.

T

138 • Maternal Health Table 13.1 Antenatal care

Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth and the percentage receiving antenatal care from a skilled provider for the most recent birth, according to background characteristics, Cambodia 2014

Antenatal care provider

volunteer Other No one Missing Mother’s age at birth Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.

1 Skilled provider includes doctor, nurse, and midwife.

Provincial differences in antenatal care coverage were significant. For example, while nearly all women in several provinces received antenatal care from a health professional, only about three-quarters of women in Kratie and Mondul Kiri/Ratanak Kiri received qualified antenatal care (73 percent and 76 percent, respectively).

The use of antenatal care services was strongly associated with a woman’s level of education.

Women with a secondary education or higher were more likely to receive antenatal care from trained

personnel (99 percent) than women with a primary education (95 percent) and women with no education (86 percent). Thirteen percent of uneducated women received no antenatal care at all, with the proportion decreasing to 4 percent among women with a primary school education and 1 percent among women with a secondary education or higher. The proportion of women who receive ANC from a skilled provider increases steadily with increasing wealth.

Antenatal care is more beneficial in preventing adverse pregnancy outcomes when it is sought early in the pregnancy and is continued throughout pregnancy. Health professionals recommend that the first antenatal visit occur within the first three months of the pregnancy and that visits continue on a monthly basis through week 28 of pregnancy and then every two weeks up to week 36 (or until birth). If the first antenatal visit is made during the third month of pregnancy and then visits occur as regularly as recommended, there will be a total of at least 12 to 13 antenatal visits. Table 13.2 shows that three-quarters of women (76 percent) make four or more antenatal care visits during their entire pregnancy. Table 13.2 includes antenatal care received from any type of provider listed in Table 13.1.

Four in five women (79 percent) make their first antenatal care visit before the fourth month of pregnancy.

The median duration of pregnancy at the first antenatal care visit is 2.5 months. This indicates that, overall, women in Cambodia start antenatal care during the first trimester of their pregnancy. Rural women tend to have fewer ANC visits and to start care later in pregnancy than urban women.

13.1.2 Components of Antenatal Care

Apart from receiving basic care, every pregnant woman should be monitored for complications.

For that reason, pregnant women should receive information on pregnancy complications or danger signs and be screened for complications at all antenatal care visits. The 2014 CDHS asked respondents a number of questions about the care they received during pregnancy for their most recent live birth in the past five years. Table 13.3 presents information on the percentage of women who took iron tablets and intestinal parasite drugs during pregnancy and on the content of ANC services, including the percentage of women who were informed of the symptoms of pregnancy complications.

Nearly all women (96 percent) took iron tablets or syrup during pregnancy, and 72 percent took intestinal parasite drugs. Eighty-two percent of mothers who received antenatal care reported that they were informed about the signs of pregnancy-related complications during their visits. Blood pressure measurements were part of antenatal care for 96 percent of mothers, and 95 percent were weighed as part of their antenatal care. Urine and blood samples were taken from 49 percent and 77 percent of women, respectively.

Table 13.2 Number of antenatal care visits and timing of first visit

Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by number of antenatal care (ANC) visits for the most recent live birth, and by the timing of the first visit, and among women with ANC, median months pregnant at first visit, according to residence, Cambodia 2014

140 • Maternal Health

Table 13.3 Components of antenatal care

Among women age 15-49 with a live birth in the five years preceding the survey, the percentage who took iron tablets or syrup and drugs for intestinal parasites during the pregnancy of the most recent birth, and among women receiving antenatal care (ANC) for the most recent live birth in the five years preceding the survey, the percentage receiving specific antenatal services, according to background characteristics, Cambodia 2014

Among women with a live birth in the past five years, the percentage who

during the pregnancy of their last birth: Among women who received antenatal care for their most recent birth in the past five years, the percentage with selected services

Background

Urban-rural differences existed for various components of antenatal care. Urban women and rural women were equally likely to have been informed about signs of pregnancy complications, to have been weighed, and to have their blood pressure measured; however, urban women were more likely than rural women to have blood and urine taken for testing. Women in rural areas were more likely than those in urban areas to take intestinal parasite drugs, but rural and urban were equally likely to take iron tablets or syrup during pregnancy. Antenatal care content was also greatly related to education and wealth. Women with a secondary education or higher and women in the highest wealth quintile were more likely to have received most services than other women.

13.1.3 Tetanus Toxoid Vaccinations

Tetanus toxoid (TT) injections are given to women during pregnancy to prevent deaths from neonatal tetanus. Neonatal tetanus can result when sterile procedures are not followed in cutting the umbilical cord after delivery. In the 2014 CDHS, information was collected on the number of doses of TT vaccine the mother received for her most recent birth during the five-year period prior to the survey. In addition, questions were included to ascertain whether mothers received tetanus injections prior to the last birth as a means of determining whether that birth was fully protected from neonatal tetanus.

Table 13.4 shows the percentage of women with a live birth in the five years preceding the survey who reported receiving TT injections during the pregnancy for the last live birth. Also shown is whether the last birth was fully protected against neonatal tetanus. An infant is considered to be fully protected if the mother had two tetanus toxoid injections during the pregnancy or if she had the requisite number of injections prior to the pregnancy (see footnote in Table 13.4). According to the 2014 CDHS results, 89 percent of last-born children during the five-year period before the survey were fully protected against neonatal tetanus.

This figure is slightly higher than that observed in the 2010 CDHS (85 percent). There were provincial differences in the percentage of last-born children who were fully protected against neonatal tetanus. For example, 98 percent of births in Kampong Chhnang were fully protected, as compared with 72 percent of births in Mondul Kiri/Ratanak Kiri. The proportion of births protected against tetanus is higher in urban than rural areas and increases with increasing mother’s education and wealth.

For approximately three in five births in the past five years (62 percent), the mother received two or more tetanus toxoid injections. This figure is similar to that reported in 2010, when 61 percent of women received two or more doses of tetanus toxoid vaccine.