Pert Vorn, a midwife working in rural Cambodia, remembers a time when women in villages throughout the country had no access to proper sexual or reproductive care.
Women would give birth on straw mats in their homes, assisted by a traditional birth attendant with no formal medical training.
According to Pert, “if there were complications, the only option for labouring mothers was to ride an elephant for hours through the jungle to reach the district hospital.”
Today, she sees how drastically reproductive health services have improved. But the global COVID-19 pandemic has made an already difficult job even harder.
To date, there is no scientific evidence about the increased susceptibility of pregnant women to COVID-19. There is also no evidence to support vertical mother-to-child transmission of COVID-19. Pregnant women should take the same preventive action to avoid infection recommended for all adults. Keep the health system functioning: Maintain sexual and reproductive health and rights (SRHR) information and services, protect health workers, and limit the spread of COVID-19.
Often traveling vast distances on motorcycles, midwives like Pert bring quality care to women and families in rural areas, providing services otherwise inaccessible to remote communities. But, with the onset of COVID-19, this small cadre of midwives must be more careful than ever, ensuring that they don’t contract the deadly virus, or transmit it, thereby imperiling the very people they are seeking to help. They are forced to walk a fine line, taking precautions to ensure prevention of contracting or spreading the virus while also maintaining the continuity of reproductive and maternal health services for those in remote communities. UNFPA Cambodia is providing technical assistance to the Ministry of Health to ensure that every woman access to quality integrated SRHR, including family planning, EmONC, and violence against women at health facilities during COVID-19 pandemic.
In Pert’s ethnic Bunong community in Mondulkiri province, it was difficult to convince people to turn from the traditional birthing practices which had been used for generations and adopt modern techniques. If these rural communities were infected with COVID-19, the community members would fear that midwife visits brought the disease in; this could drastically erode the trust that local midwives have spent years developing. To address this concern, the UNFPA technical brief on maternity services and ANC was approved and being implemented by the Ministry of Health at a sub-national level. This allows midwives and maternity care providers to deliver respectful and individualized maternity and antenatal care services that promote the safety of women, families, and health professionals during the COVID-19 pandemic.
Pert and her fellow midwives have found specific areas for improvement in times of emergency, particularly through the use of telecommunication connection technology. With such assistive technologies, midwives could better communicate with pregnant women in the remote villages, and monitor at-risk pregnancies to offer timely care.
COVID-19 has, in some ways, offered a revelation: whilst the past 25 years have gone a long way in achieving the goal of zero preventable maternal deaths in Cambodia, more can – and should – be done.
“Cambodia has made much progress and demonstrated high-level commitment to ensuring women’s rights are placed front and centre of its development journey,” says Daniel Alemu, UNFPA Cambodia Acting Representative “To achieve that, we must take this opportunity to build the health system’s resilience to ensure it is well equipped to respond to the needs of women at times of epidemics like COVID-19.” This also includes training midwives on an alternative delivery of maternity services such as remote contact of antenatal care and postnatal care.
