Cambodia

The history of Cambodia since the 1970s has been marred by unrest, including bombings and invasions by the United States during the Vietnam War, extremely high civilian deaths during the Pol Pot regime, 10 years of Vietnamese occupation, and regular outbreaks of civil war. This meant many years of little or no economic development, and much of the population still lives in poverty. However, since 2004 the economy has grown about 10 percent per year, and the per-capita Gross Domestic Product in 2008 is estimated at $2,000, up from $1,800 in 2006. However, inflation is also high: consumer price inflation was estimated at 20.2 percent in 2008.

Population is estimated at about 14.5 million, with 36.6 percent under the age of 14 (an extremely high percentage, typical of a nonindustrialized country) and 3.6 percent over the age of 65. The population growth rate is about 1.8 percent, with a birth rate of 25.68 per 1,000 population and a total fertility rate (an estimate of the number of children which each woman has) of 4.7. Life expectancy is low for both men and women, about 60 and 64 years, respectively: one reason is a high rate of infectious diseases including human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), food and waterborne diseases, and insect-borne diseases. The population is predominantly Buddhist (95 percent) and literacy is substantially higher for males (84.7 percent) than for women (64.1 percent).

Per capita health care expenditures were estimated to be $32, of which most (85 percent) was private rather than governmental. About 12 percent of Cambodia's Gross Domestic Product is spent on health care, and about 5 percent of the financing for health care comes from external sources. Standards of maternal and infant health care are much lower than in most countries of the world: for instance, less than 70 percent of children receive timely immunizations against measles, diphtheria, and tetanus, and tetanus immunization rates for expectant mothers are below 50 percent. Only 32 percent of births are attended by skilled health personnel and only 10 percent take place in health facilities; 44 percent of women receive at least one prenatal care visit, and 9 percent receive four or more. The maternal mortality ratios is 450 per 100,000 live births, the stillbirth rate is 37 per 1,000, and the neonatal mortality rate in 40 per 1,000.

Only 19 percent of women use modern methods of contraception, and although abortion has been legal in Cambodia since 1997, due to many barriers to providers a substantial number of women either seek to terminate their own pregnancies or seek the procedure from unsafe service providers. A randomized study in 2008 found that in 2005, [Page 156]over 30,000 Cambodian women were treated in health care facilities for complications of miscarriage or abortion, and 40 percent of these disclosed or showed strong evidence of prior termination attempts as well. The researchers projected a ratio of abortion/miscarriage complications to live births in Cambodia as 93 per 1,000.