Introduction

At UNFPA Cambodia, we believe that everyone should have access to good sexual and reproductive health information and services. Supporting individuals with knowledge enables them to make informed decisions about their sexual and reproductive health. We are committed to ensuring that couples can choose when to have children, determine the number and spacing of their children, and that individuals can protect themselves from sexually transmitted infections. Our focus is on providing women, girls, adolescents, and youth with comprehensive sexual and reproductive health services and information.

Human Rights-Based Family Planning

Every woman and girl has the right to decide when and how many children she will have. However, 12% of married women have an unmet need for family planning, including 5% who want to delay or space out births and 7% who do not want any more children.

UNFPA Cambodia supports human rights-based family planning by:

• Strengthening pre-service curricula and in-service capacity building of health service providers at the grassroots level.
• Ensuring a regular supply of family planning commodities through Third-Party Procurement for the public sector.
• Promoting public awareness through media, social interventions, comprehensive sexuality education, and community outreach.
• Providing technical assistance for developing protocols and policies alighned with international norms and standards.

As a result, The use of modern contraception increased from 39% in 2014 to 45% in 2021 (CDHS 2021-22). However, the unmet need for family planning among sexually active unmarried women aged 15-49 is at 59.7% and is stagnant at 11.5% among currently married women. (CDHS 2021-22).

Midwifery

The training of midwives is crucial to providing quality sexual reproductive and maternal health care services and information. According to the World Health Organization (WHO), half of all perinatal deaths could be prevented with the provision of skilled care during birth. Yet, some people in rural Cambodia still deliver their children under the assistance of traditional birth attendants, who have not received any medical training, due to limited accessibility to service delivery points due to different challenges such as social norms and financial barriers.

UNFPA Cambodia works in partnership with various agencies to

• Improve reproductive and maternal health services and information.
• Promote community best practices and participation.
• Build the capacity of midwives in asic and Comprehensive Emergency Obstetric and Newborn Care
• Equip midwives with up-to-date knowledge and skills 

Maternal health

Providing maternal and newborn health services for all women saves lives. The maternal mortality ratio in Cambodia remains higher than the regional average (74 women dying per 100,000), with 218 women dying per 100,000 live births. To address this, UNFPA provides technical assistance for:

• Emergency Obstetrics and Newborn Care (EmONC).
• Building the capacity of the Skilled Birth Attendance and Midwifery programme.

These initiatives improve the availability of EmONC to save women and newborn lives should critical conditions arise. UNFPA also promotes and enhances women's, girls’, adolescents and youth’s rights to sexual reproductive and maternal health. UNFPA places particular emphasis on ensuring that the furthest left behind have access to quality sexual reproductive and maternal services and information including safe deliveries and family planning.

Cambodia has made significant progress in reducing the maternal mortality ratio from 472 (2005) to 154 per 100,000 live births (CDHS 2021/22).

High Antenatal Care Coverage:

• 99% of women aged 15–49 who had a live birth in the two years preceding the survey received antenatal care (ANC) from a skilled provider during their most recent birth.
• 86% of these women had at least four ANC visits, meeting the World Health Organization's recommendation for minimum ANC contacts.

However, teen pregnancy, education gaps, and the costs of services still act as barriers to maternity care for many women and girls.

Leaving No One Behind

To reach those most at risk of being left behind, the UNFPA SRHR Output targets key populations particularly in remote rural provinces in the Northeast with indigenous populations. Our effort include:

• Service delivery and community outreach to female entertainment workers, adolescents and youth, persons with disabilities, LGBTQIA+ individuals, migrants and other women at risk.
• Scaling up digital innovations to increase access to information and services.
• Prioritising seven remote rural provinces where indigenous populations live and socio-economic indicators are low, based on an analysis of nearly 30 indicators from Cambodia Demographic and Health Survey (CDHS) data.
• Advocating for female entertainment workers to register with the National Social Security Fund (NSSF) to access free healthcare services, including SRHR.
• Targeting adolescents and youth in eight provinces through the rollout and implementation of Adolescent and Youth Friendly Health Services (AYFHS).
• Ensuring at-risk women in seven UNFPA Cambodia target provinces are covered by the Health Equity Fund and Family Package (1000-day financial support) of the Royal Government of Cambodia.
• Advocating for the inclusion of migrants, especially female migrant workers, in Ministry of Health policies and strategies.

Through the SRHR Output, UNFPA will continue advocacy and policy work to ensure other key populations are not left behind, and UNFPA Cambodia prioritises programmes and recognition in the National Strategy for Reproductive and Sexual Health and Rights. To ensure the continuity of those services in humanitarian settings, we:

• Collaborate with the Ministry of Health and other stakeholders.
• Roll out the Minimum Initial Service Package (MISP) to health facilities prone to seasonal flooding in target provinces.
• Explore South-South Technical Collaboration (SSCT) with neighbouring countries and the National Maternal and Child Health Center (NMCHC) to address issues such as infertility.

Digital Platforms for SRHR

Ensuring access to learning and services during the pandemic as well as for remote locations, a national digital sexual and reproductive healthcare platform for e-learning and tele-medicines for Sexual, Reproductive and Maternal Health (SRMH) professionals and women and girls were established with UNFPA support and with the leadership of the NMCHC/MoH in partnership with midwives’ professional association, council, MoH’s Human Resources Development Department and health partners. 

E-learning platform: 
The e-learning platform, https://elearning.nmchc.moh.gov.kh/ which is recognized by the Cambodian Midwives Council as online platform for Midwives’ Continuing Professional Development was developed and initiated by UNFPA, in collaboration with  health partners in early 2020 in response to COVID-19 pandemic. This platform currently covers 10 different topics:  

• Family planning
• Health education for continuum of care on maternal and child health
• Intrapartum care focusing on initial assessment.
• Adolescent and Youth Friendly Sexual and Reproductive Health Service 
• Healthcare for GBV/VAW survivors
• Telemedicine for SRH services
• Infection and prevention control (IPC) at health facilities
• Water, sanitation, and hygiene (WASH) in health facilities
• Infant and young child feeding counselling (IYCF), and
• Nutrition

Telemedicine: 
Ensuring that no one is left behind, telemedicine services are critical for ensuring and expanding the access to SRHR services and information during and post-pandemic. This platform was developed with technical assistance from UNFPA, and helps address the current gaps of SRHR services in three essential services:

• Family Planning counselling
• Antenatal Care (ANC)
• Postnatal Care (PNC)

Telemedicine platform fosters closer relationships between clients and providers, improving the continuum of care, particularly for clients living far from the facilities