There is a policy in place and the legislation is progressive but it has not kept up with the advancements in medical abortion. A policy was developed to support the delivery of safe MA, however, it is inconsistent with international best practices.

For more than 12­week pregnancy, abortion is allowed only if the diagnosis shows that.

• The pregnancy is abnormal, growing unusually, or creates a risk to the woman’s life.
• After birth, the child can have a serious incurable disease.
• In the case of rape, the abortion can be irrelevant to the above criteria but must be requested by the woman if she is more than 18 years of age or by her parents or her tutors if she is under 18 years of age.

Options have trained 557 safe abortion providers to respond to the significant gap in safe abortion services.

NA

Misconceptions on the legality of abortion are not just evident among women (up to 80% believe abortion is illegal1), but among health workers too. Forty percent of government providers believe that the Cambodian Ministry of Health (MoH) does not permit elective abortion2. Furthermore, NGO and CBO partners working with the most marginalized and vulnerable women, including in the field of SRH and HIV/AIDS, are largely unaware of the United State’s Government’s (USG) lifting of the Mexico City Gag rule and continue to believe that they will contravene USAID policy if they refer women to safe abortion services. Anecdotal evidence shows that these women are secretly referred to backyard abortion providers who will incentivize the referral by as much as USD $5.00

Issues in accessing abortion are compounded by a silent, but largely accepted practice of government providers supplementing meager incomes by providing abortion services to women (who still believe the procedure to be illegal) either at their own private clinics or in their own homes. In 2005, the percentage of women reporting that they had an abortion either in their home or in someone else’s were 11.6% and 32.9% respectively3 suggesting that almost half of all abortions occurred away from a health facility and in potentially unsafe conditions4. Low provider wages are a good incentive to refer clients to private or underground abortion services which can command fees of up to USD $200 per abortion, meaning that a women’s likelihood of full reproductive health choice within government facilities is low.

• Population Services International (2010) Reproductive Health Among Women at Reproductive Age. Trac Population-Based Survey, second round, 2009.
• Hemmings, J et al. 2008. Abortion in Cambodia. Care seeking for abortion and family planning services. Reduction in Maternal Mortality Project, Options Consultancy service.
• Cambodian Demographic Health Survey, 200

Marie Stopes International Cambodia abortion providers operate out of 7 static clinics, and providers are trained to both the Cambodian Ministry of Health and international standards. Marie Stopes boasts a high rate of post-abortion family planning uptake in Cambodia. There are private abortion providers operating in Cambodia, both legally trained providers and illegal untrained providers.

Surgical Abortion – MVA

• Secondary Midwives
• Trained doctors (to Ministry of Health standards)

Cambodia has inadequate maternal health services which result in one of the highest rates of maternal mortality in South East Asia, at 472 deaths per 100, 000 live births, of which, abortion-related deaths contribute 13 – 29%5. More than 13 years after the legalization of abortion in Cambodia, safe, affordable, abortion services remain out of reach for the poorest, marginalized, and most vulnerable Cambodian women.

NA

In 2009, Options Consultancy Ltd began training government providers on CAC and PAC and worked with a number of international and national experts – including Marie Stopes – to set the agenda for the introduction of a combined Mifepristone (1 x 200mg) and Misoprostol (4 x 800mcg) MA regimen. In January 2010, the combination product Medabon was registered and licensed for use, and national protocols were developed making it legally available on-demand for women under 9 weeks gestation by trained providers.

• The information is available in national service delivery standards.
• Informal / illegal providers – if present who are they.
• Population urban/ rural: Demography of the country, with an analysis of availability of abortion services ratio to population.

The Cambodian Government has recently released a ‘fast track initiative road map for reducing maternal and newborn mortality’ which has a detailed section on how they will improve access to safe abortion services including improving availability, accessibility, quality, and utilization. There are still largely accepted systemic problems with the public health system that the government will have to address to make way for these improvements.

NA

Not available

NA

Awareness of the availability and legality of abortion is limited. Misconceptions on the legality of abortion is not just evident among women (up to 80% believe abortion is illegal6), but among health workers too. Forty percent of government providers believe that the Cambodian Ministry of Health (MoH) does not permit elective abortion7. Marie Stopes operates a dedicated hotline which serves primarily as a referral point to safe providers.

• Population Services International (2010) Reproductive HEalth Among Women at Reproductive Age. Trac Population Based Survey, second round, 2009.
• Hemmings, J et al. 2008. Abortion in Cambodia. Care seeking for abortion and family planning services. Reduction in Maternal Mortality Project, Options Consultancy service.