Persistent Inequities in Maternal Health Care in Cambodia: A Narrative Review of Coverage, Quality, and Access Across the Continuum of Care

Cambodia has achieved substantial reductions in maternal mortality over two decades, with near-universal facility delivery reaching 98.4% in 2021–22. However, aggregate improvements may obscure persistent inequities affecting poor, rural, and less-educated women. We conducted a narrative review synthesizing Cambodia Demographic and Health Survey data from 2000–2022, national policy documents, and peer reviewed literature on maternal health equity. We examined coverage patterns across the continuum of care, including antenatal, intrapartum, and postnatal services, and analyzed financial, geographic, and quality-related drivers of inequity.
CDHS 2021–22 data reveal substantial wealth-based gaps in adequate antenatal care, with 4+ visits reaching only 75.6% among the poorest quintile compared to 95.8% among the richest quintile, representing a 20.2 percentage point gap. Similarly, timely postnatal care within 2 days shows a 13.9 percentage point gap between the poorest and richest groups, at 76.1% versus 90.0% respectively. Facility delivery shows smaller gaps at 6.1 percentage points. Evidence indicates that indirect costs, geographic barriers, variable quality of care, and rapid private sector growth without adequate integration contribute to these inequities.
Cambodia's next phase of maternal health improvement must shift from aggregate coverage targets to equity focused strategies. Priority actions include strengthening antenatal and postnatal continuity in remote provinces, expanding financial protection beyond direct fees, improving quality and respectful care, and implementing disaggregated monitoring systems. Without targeted intervention, current inequities risk undermining Cambodia's impressive national gains.

maternal health equity; Cambodia; antenatal care; skilled birth attendance; postnatal care; health financing; Health Equity Funds; ID Poor

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