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Global Forum on Gender Statistics, Manila, Philippines, 11-13 October, 2010

This paper discusses the efforts made by the National Institute of Statistics in Cambodia to promote gender equality and integrate gender into health statistics. It highlights key gender issues in Cambodia, such as economic empowerment of women and promoting the health of women and girls. The paper also provides an analysis of health statistics related to women, including access to healthcare and maternal health.

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Global Forum on Gender Statistics, Manila, Philippines, 11-13 October, 2010

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  1. Global Forum on Gender Statistics,Manila, Philippines, 11-13 October, 2010 Integrating gender into tools for the production and Analysis of Health Statistics Mrs.Hang Lina Deputy Director General, NIS CAMBODIA ESA/STAT/AC.219/25

  2. Introduction • The National Institute of Statistics (NIS) has been closely working with a number of concerning line ministries (MOWA, MOH, MOE, MOA) and development partners (UNFPA, SIDA, and JICA) to promote gender equality and gender statistics in Cambodia. • A Gender Mainstreaming Action Group (GMAG) was formed in July 2006, supporting by UNFPA. A Gender Mainstreaming Action Plan (GMAP) had been produced for 2008-2010 and now is updating for 2009-2013. Training courses on Gender Mainstreaming into Statistics and Planning had been conducted for the senior officers of the Ministry of Planning and by provinces.

  3. Introduction • A Gender Statistics Working Group was established in February, 2007. A Gender booklet “Women and Men” in Cambodia (1st edition) had been published for 2008 and now is updating for 2010 (2nd edition) with the support from SIDA. Another publication namely “Gender in Cambodia” is an in-depth analysis based on 2008 Population Census results with the support from UNFPA.

  4. Introduction • The National Institute of Statistics has conducted two Censuses and several Surveys which serve as major sources of gender statistics for Cambodia. They are: • The Population Census (every ten years ,1998 and 2008) • The Socio-Economic Survey (every year from 1996) • The Demographic and Health Survey (every five years,2000,2005 and 2010). The Population census does not cover much on health though it provides mortality and cause of death indicators as well as population figures up to the village level disaggregated by sex, age group etc that are useful in estimating health indicators. The other two surveys,however, do provide health statistics.

  5. Introduction • NIS incorporate with MOH conduct Demographics and Health survey (DHS) since 2000, 2005. Then 2010 is on the way of collection data.

  6. Key Gender issues in Cambodia • Economic empowerment of women; • Enhancing women’s and girls’ education; • Legal protection of women and girls; • Promotion of health of women and girls; • Promotion of women in decision-making; and • Gender mainstreaming in national policies and programs

  7. Promotion of health of women • Women continue to report problems in accessing health care: • Women and men are accessing treatment for illness or injury, but women continue to report problem in accessing health care. No information is available on the problems faced by men in accessing health services. As of 2005, 91.5 percent of people who were ill sought at least one treatment, an increase over 88.6 percent reported in 2000. • While no data is available on the proportion of males reporting problems in accessing health services, the proportion of women reporting at least one problem in accessing health care decreased from 93 percent in 2000 to 88.5 percent in 2005.

  8. Promotion of health of women • However, the overall number of women reporting problem remains very high. Getting money for treatment remains the main problem (88.1 percent in 2000 and 74.1 percent in 2005), followed by concern that no provider or drugs are available, and not wanting to go to health services alone. • There are significant differences in utilization of public sector health services, 70 percent of health center and 58 percent of referral hospital clients are female. This gender bias is more pronounced in urban than in rural areas, and during reproductive years (15-49).

  9. Maternal Health • Antenatal Care: DHS 2005 • 69 percent of women received ANC from trained personnel (doctors, nurses, and midwives) at least once. • 61 percent of women received care during pregnancy from midwives; • 6 percent of women received care from a doctor, and • 2 percent of women went to a nurse. • 28 percent of women received no antenatal care for birth in the preceding five years against 55 percent in year 2000.

  10. Maternal Health (cont.) • Child Birth and Delivery: • A large majority of births (78 %) in the five years before the survey were delivered at home; • Only 22 percent being delivered in a health facility; • 50 % of children born in urban areas were delivered in a health facility. It was three time (17 %) of children born in rural areas. • The proportion of births delivered in a health facility is only 10 % for uneducated mothers, compared with 48 % for mothers with secondary and higher education.

  11. Maternal Health (cont.) • Assistance at Delivery: • In 2005 44 % of births are delivered with the assistance of a trained health professional (doctor, nurse, or midwife). Increase from 32% in 2000. • 55% of births are delivered with assistance of a traditional birth attendant

  12. Maternal Health (cont.) • Postnatal Care and Practices: • 30 % of women received no postnatal care; • 64 % of mothers received postnatal care within the first two days of delivery; • 32 % receiving care within four hours of delivery. • Urban women are more likely to receive postnatal care(74 %) than rural women during the first two days after delivery (62 %); • 37 % of women did not deliver in a health facility and did not receive a postnatal check-up.

  13. Child Health • Child’s size at birth : Birth weight is a major determinant of infant and child health and mortality. Children whose birth weight is less than 2.5 kg, or children reported to be “very small” or “smaller than average” are considered to have a higher than average risk of early childhood death. According to DHS 2005; • 85 % of births were considered by their mothers to be of average or larger than average size; • 11 % were perceived as smaller than average; • 4 % were considered very small.

  14. Child Health (cont.) • Immunization of Children : • 60 % of children age 12-23 months were fully vaccinated by 12 months of age; • 91 % of children had received BCG vaccination; • 70 % had been vaccinated against measles; • 90 % received the first doses of DPT and of polio and three- fourths received the third doses.

  15. Child Health (cont.) • Acute respiratory infection: ARI • 9 % of children under five years of age showed symptoms of ARI at some time in the two weeks preceding the survey(2005) • 11 % of children age 6-11 and 12-23 months had experiencedthe symptom of ARI in higher proportions than other age group. • Fever : • 35 % of children under five of age had a fever at some time in the two weeks preceding the survey • Children age 6-11 and 12-23 months are more commonly sick with fever (46 and 42 percent, respectively) then other children.

  16. Child Health (cont.) • Diarrhea : • 20 % of all children under five had diarrhea while 3 percent had diarrhea with blood; • As with ARI and fever, young children age 6-11 and 12-23 months are more prone to diarrhea than children in the other age group (32 % and 28 %, respectively) • Diarrhea is slightly more common among rural children (20 %) than urban children (16 %)

  17. Nutrition of children and women • Nutrition status of children : • 37 % of children under five are stunted; • 13 % are severely stunted; • 7 % are wasted; and • 36 % are underweight. More rural children are stunted (38 %) than urban children (31 % ).

  18. Nutrition of children and women (cont.) • Initiation of breastfeeding : • Breastfeeding is nearly universal in Cambodia, with 97% of children born in the five years preceding the survey having been breastfed at some time. • About one in three children is breastfed within one hour of birth (35 percent) and 68 percent within one day of birth. 56 percent of children were given a pre-lacteal feed, that is something other than breast milk during the first three days of life. • Contrary to WHO’s recommendations less than half of Cambodian children age 4-5 months is exclusively breastfed.

  19. Nutrition of children and women (cont.) • Prevalence of anemia in children : • Anemia is a critical public health problem in Cambodia, where more than half (62 percent) of Cambodian children 6-59 months old are anemic, with 29 percent mildly anemic, 32 percent moderately anemic, and 1 percent severely anemic.

  20. Nutrition of children and women (cont.) • Nutritional Status of Women : • Two indicators of nutritional status for women (age 15-49) are height and body mass index BMI; • The data analysis on BMI is based on 7,799 women, while the height analysis is based on 8,370 women age 15-49. • Overall, 8 percent of women are shorter than 145 cm. • 20 percent of women were found to be underweight (BMI less than 18.5), while 10 percent were overweight or obese.

  21. Nutrition of children and women (cont.) • Foods consumed by mother: • The staple diet of mothers of young children in Cambodia consists of foods made from grains (99 percent), and meat, fish, shellfish, poultry, and eggs (94 percent). • Three out of four women consume fruits and vegetables rich in vitamin A. • Smaller proportion of mothers consume milk or other milk products (6 percent) and foods made from beans, peas, or nuts (10 percent). • 31 percent of mothers consume foods made with oil, fat or butter or sugary foods.

  22. Nutrition of children and women (cont.) • Prevalence of Anemia in women : • 47 percent of women age 15-49 arehaving anemia. Among them, 35 percent mildly anemic, 10 percent moderately anemic and just 1 percent severely anemic. • Women with high parity, with little or no education, are pregnant, and living in poor households havehigher prevalence of anemia. • Anemia is also higher among rural than urban women.

  23. Maternal Mortality • Maternal death is defined as any death that occurred during pregnancy, childbirth, or within two months after the birth or termination of a pregnancy. • DHS 2005: Maternal Mortality Ratio ( MMR) was 472 per 100,000 live births • Population Census 2008: MMR was 461 per 100,000 live birth.

  24. Infant and Child Mortality • Infant mortality: the probability of dying between birth and the first birthday; • Child mortality: the probability of dying between the first and fifth birthday; • Under-five mortality: the probability of dying between birth and the fifth birthday; DHS 2005 Census 2008 • IMR 66 per 1,000 live births 60 per 1,000 live births • Under- five MR 83 per 1,000 live births

  25. Causes of death among infants and children • The most commonly reported causesof death are: • Baby being premature; • Fever; • Illness of the respiratory system; • Dengue hemorrhagic fever; • Accidents; and • Tetanus type convulsions

  26. Cause of death among males age-groups 5-59 and 60+, Cambodia 2008 Census

  27. Cause of death among females age-groups 5-59, and 60+ and 15-49, Cambodia 2008 Census

  28. Disability • The five types of disability identified for the 2008 census purpose are as follows: • In Seeing • In Speech • In Hearing • In moving • Mental

  29. Disability (cont.) • According to 2008 Population census, there are 192,538 disabled persons in Cambodia (or 1.44 percent of country’s population), of which; • 56.3 percent are males and • 43.7 percent are females • Among the disabled in the country only 61,151 (31.76 percent) persons are congenitally disabled.

  30. Distribution of Disabled Population by type of Disability, Cambodia 2008

  31. CONCLUSIONS • Decennial population and housing censuses and periodic surveys which are serving as major tools for the production and analysis of health statistics in Cambodia do integrate gender to a great extent. • However there is a need for a satisfactory civil registration system in the country which would provide on a continuous basis, statistics on births, deaths, causes of death, health, marriage divorce etc . This would go a long way in monitoring public health with particular reference to gender • More hospitals or public health centers especially in the rural areas for women and children is yet another area that requires attention. .

  32. Thank you for your attention

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