Trends and Equity in Continuous Maternity Care Utilization in Cambodia, 2000–2021

Abstract

This study applied the effective coverage framework to analyse trends and equity in the utilization of maternity care in Cambodia from 2000 to 2021 using data from the Cambodia Demographic and Health Surveys. The findings revealed a significant increase in the proportion of women attending at least four antenatal care (ANC) visits, rising from 7.5% in 2000 to 78.2% in 2021. However, coverage of the WHO-recommended ANC components varied, with the lowest compliance observed in urine and blood tests (64.1%) while the highest in iron/syrup supplementation (92.6%). Despite this, fewer than half of the women received all recommended ANC services. Facility-based delivery increased dramatically from 8.5% in 2000 to 91.5% in 2021, and the cesarean section rate rose from 0.9% to 14.2% during the same period. Utilization of postnatal care remained relatively low, with only 51.7% of women having at least one postnatal visit by 2021. Furthermore, only 22.7% of women accessed quality-adjusted continuous maternity care by 2021. Significant disparities were observed that 27.8% of urban and 31.3% of the wealthiest women received quality-adjusted continuous maternity care, compared to 20.3% of rural and 14.2% of the poorest women. Women who were older, had higher levels of education, or were covered by social health insurance were more likely to access quality-adjusted continuous care. Persistent gaps in comprehensive care highlight the need for targeted efforts to reduce disparities and enhance care quality across all population segments.