The role of social support and parity on contraceptive use in Cambodia

Cambodia's health infrastructure was all but destroyed during the Khmer Rouge regime and the Vietnamese occupation of the 1970s, rendering the country's family planning programs virtually inoperable for more than 20 years. 1–3 In 1994, an internationally supported, government-led effort to reinstate family planning campaigns was launched; 4 however, efforts were considerably hampered by the coun-try's poor infrastructure, leading to very low contraceptive prevalence rates and concomitantly high rates of fertility and maternal mortality. 5 Over the past decade, renewed efforts of government and nongovernmental agencies have contributed significantly to improved reproductive health outcomes. Between 2000 and 2005, the contraceptive prevalence rate (CPR) among all Cambodian women increased from 11% to 34%, and the total fertility rate (TFR) dropped from 4.0 to 3.4. 6 Despite these gains, shortcomings in family planning service delivery and acceptance in Cambodia remain. The most recent Cambodian Demographic and Health Survey (DHS) from 2005 reports that the CPR among currently married women is only 27%, and one in four married women have an unmet need for family planning. 6 As a result of the low use of family planning, Cambodia's TFR remains high relative to other Asian countries, and its maternal mortality ratio—estimated at 450–540 deaths per 100,000 live births—is among the highest in the region. 6–8 Moreover, Cambodia's CPR is the lowest in Southeast Asia—ranking 130th out of 177 countries around the world 8,9 —and its infant mortality rate (97 deaths per 1,000 live births) is above the regional average. 6 These measures are not only indicative of the risk to women and children, but have wider implications for the population as a whole. Women with a high number of births are less likely than others to complete their education , participate in the labor force and have high levels of income; 10,11 on the other hand, women who use contraceptives tend to have a better quality of life, higher social status and greater autonomy. 11–15 The health care costs associated with complications of pregnancy and childbirth can strain families with limited resources. 16,17 In countries where resources for health care are low, high fertility can further encumber fragile health systems. 16–20 Conversely, increased availability and use of family planning has been linked to improved economic and social development of families and broader communities. 11,16–20 The common determinants of contraceptive use (i.e., age, education, socioeconomic status) apply in the Cam-bodian context: 21–29 For example, …