Cambodia Demographic And Health Survey 2014 - The DHS Program

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Cambodia
Demographic and
Health Survey 2014
C
am bodia 2014
D
em ographic and H
ealth Survey
Cambodia
Demographic and Health Survey
2014
National Institute of Statistics
Ministry of Planning
Phnom Penh, Cambodia
Directorate General for Health
Ministry of Health
Phnom Penh, Cambodia
The DHS Program
ICF International
Rockville, Maryland, USA
September 2015
The analysis of the Cambodia Demographic and Health Survey 2014 was achieved through the joint
efforts of:
Sok Kosal, NIS/MoP
Chhay Satia, NIS/MoP
They Kheam, NIS/MoP
Phan Chinda, NIS/MoP
Loun Mondol, DGH/MoH
Lam Phirun, DGH/MoH
Rathavuth Hong, ICF International
Bernard Barrère, ICF International
Anne Cross, ICF International
Sunita Kishor, ICF International
See Appendix D for a list of contributors to the implementation of the CDHS.
The 2014 Cambodia Demographic and Health Survey (2014 CDHS) is part of The DHS Program, a worldwide
project which assists countries in the collection of data to monitor and evaluate population, health, and nutrition
programs. Funding was provided by the Royal Government of Cambodia (RGC), the United States Agency for
International Development (USAID), the Australian Department of Foreign Affairs and Trade (AustraliaDFAT), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the
Japan International Cooperation Agency (JICA), the Korean International Cooperation Agency (KOICA), and
the Health Sector Support Program—Second Phase (HSSP-2).
Additional information about the survey can be obtained from the National Institute of Statistics; 386 Monivong
Boulevard, Sangkat Beong Keng Kang 1, Chamkar Mon, Phnom Penh, Cambodia; Telephone: (855) 23-213650;
E-mail: ssythan@hotmail.com; Internet: www.nis.gov.kh and the Directorate General for Health, Ministry of
Health 80 Samdech Penn Nouth Boulevard (289), Sangkat Boeungkak 2, Tuol Kork, Phnom Penh, Cambodia;
Telephone: (855) 23-885970/23-884909; E-mail: webmaster@moh.gov.kh; Internet: www.moh.gov.kh.
Additional information about The DHS Program can be obtained from ICF International, 530 Gaither Road,
Suite 500, Rockville, MD 20850 USA; Telephone: 301-572-0200, Fax: 301-572-0999, E-mail:
info@DHSprogram.com, Internet: www.DHSprogram.com.
Suggested citation:
National Institute of Statistics, Directorate General for Health, and ICF International, 2015. Cambodia
Demographic and Health Survey 2014. Phnom Penh, Cambodia, and Rockville, Maryland, USA: National
Institute of Statistics, Directorate General for Health, and ICF International.
Cover photo of Angkor Wat temple ©2014 J.H. Tan.
Contents • iii
CONTENTS
TABLES AND FIGURES ........................................................................................................................... ix
FOREWORD ............................................................................................................................................ xvii
ACKNOWLEDGMENTS ......................................................................................................................... xix
MAP OF CAMBODIA ............................................................................................................................... xx
1 INTRODUCTION ........................................................................................................................... 1
1.1 Geodemography, History, and Economy ............................................................................. 1
1.1.1 Geodemography ..................................................................................................... 1
1.1.2 History ................................................................................................................... 2
1.1.3 Economy ................................................................................................................ 2
1.2 Health Status and Policy ...................................................................................................... 2
1.3 Objective and Survey Organization ..................................................................................... 4
1.4 Sample Design ..................................................................................................................... 4
1.5 Questionnaires ..................................................................................................................... 5
1.6 Training and Fieldwork ....................................................................................................... 7
1.7 Biomarker Testing ............................................................................................................... 7
1.7.1 Anthropometric Measurement ............................................................................... 7
1.7.2 Hemoglobin Testing............................................................................................... 8
1.7.3 Micronutrient Testing ............................................................................................ 8
1.8 Data Processing ................................................................................................................... 8
1.9 Sample Coverage ................................................................................................................. 8
2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS .............................. 11
2.1 Characteristics of the Household Population ..................................................................... 11
2.1.1 Age and Sex Composition ................................................................................... 11
2.1.2 Household Composition ....................................................................................... 13
2.2 Education of the Household Population ............................................................................ 14
2.3 Housing Characteristics ..................................................................................................... 17
2.3.1 Water Supply ....................................................................................................... 18
2.3.2 Sanitation Facilities .............................................................................................. 20
2.3.3 Hand Washing ...................................................................................................... 21
2.3.4 Flooring Material and Cooking Arrangements .................................................... 22
2.4 Household Possessions ...................................................................................................... 23
2.5 Household Wealth ............................................................................................................. 23
2.6 Birth Registration .............................................................................................................. 24
2.7 Children’s Living Arrangements, Orphanhood, and School Attendance by
Survivorship of Parents ..................................................................................................... 25
2.7.1 Children’s Living Arrangements and Orphanhood .............................................. 25
2.7.2 School Attendance by Survivorship of Parents .................................................... 27
3 UTILIZATION OF HEALTH SERVICES FOR ACCIDENT, ILLNESS, OR INJURY ...... 29
3.1 Accidental Death or Injury ................................................................................................ 29
3.1.1 Frequency of Accidental Death or Injury ............................................................ 29
3.1.2 Type of Accident ................................................................................................. 30
3.2 Prevalence and Severity of Illness or Injury ...................................................................... 32
3.3 Treatment Sought for Illness or Injury .............................................................................. 33
3.4 Utilization of Health Care Facilities .................................................................................. 34
iv • Contents
3.5 Cost for Health Care .......................................................................................................... 36
3.5.1 Distribution of Cost for Health Care .................................................................... 36
3.5.2 Expenditures for Health Care ............................................................................... 36
3.5.3 Sources of Money for Health Care Expenditures ................................................ 38
4 DISABILITY ................................................................................................................................. 41
4.1 Disability among the General Household Population ........................................................ 41
4.2 Disability among Ill or Injured Household Members ........................................................ 43
4.3 Disability and Employment ............................................................................................... 44
5 RESPONDENT CHARACTERISTICS ...................................................................................... 47
5.1 Characteristics of Survey Respondents ............................................................................. 47
5.2 Educational Attainment and Literacy ................................................................................ 49
5.3 Access to Mass Media ....................................................................................................... 52
5.4 Employment ...................................................................................................................... 55
5.4.1 Employment Status .............................................................................................. 55
5.4.2 Occupation ........................................................................................................... 57
5.4.3 Earnings, Employers, and Continuity of Employment ........................................ 59
5.5 Health Insurance ................................................................................................................ 60
5.6 Use of Tobacco .................................................................................................................. 62
6 FERTILITY ................................................................................................................................... 67
6.1 Current Fertility Levels and Differentials .......................................................................... 67
6.2 Fertility Trends .................................................................................................................. 70
6.2.1 Comparison of Current and Cumulative Fertility Levels ..................................... 70
6.2.2 Retrospective Data ............................................................................................... 70
6.2.3 Comparison with Previous CDHS ....................................................................... 71
6.3 Children Ever Born and Living ......................................................................................... 72
6.4 Birth Intervals .................................................................................................................... 73
6.5 Age at First Birth ............................................................................................................... 75
6.6 Teenage Pregnancy and Motherhood ................................................................................ 76
7 PRACTICE OF ABORTION ....................................................................................................... 79
7.1 Number of Lifetime Induced Abortions ............................................................................ 79
7.2 Practice of Abortion in the Past Five Years ....................................................................... 81
7.2.1 Pregnancy Duration at the Time of Abortion ....................................................... 81
7.2.2 Place of Abortion ................................................................................................. 82
7.2.3 Persons Who Helped with the Abortion .............................................................. 83
7.2.4 Method Used for the Abortion ............................................................................. 83
8 FAMILY PLANNING .................................................................................................................. 85
8.1 Knowledge of Contraceptive Methods .............................................................................. 85
8.2 Current Use of Contraceptive Methods ............................................................................. 86
8.3 Use of Social Marketing Brands ........................................................................................ 89
8.4 Knowledge of Fertile Period .............................................................................................. 90
8.5 Timing of Sterilization....................................................................................................... 91
8.6 Source of Family Planning Methods ................................................................................. 91
8.7 Informed Choice ................................................................................................................ 92
8.8 Future Use of Contraception .............................................................................................. 93
8.9 Exposure to Family Planning Messages ............................................................................ 94
8.10 Contact of Nonusers with Family Planning Providers ....................................................... 95
Contents • v
9 OTHER PROXIMATE DETERMINANTS OF FERTILITY .................................................. 97
9.1 Marital Status ..................................................................................................................... 97
9.2 Polygamy ........................................................................................................................... 98
9.3 Age at First Union ............................................................................................................. 99
9.4 Age at First Sexual Intercourse ....................................................................................... 102
9.5 Recent Sexual Activity .................................................................................................... 105
9.6 Postpartum Amenorrhea, Abstinence, and Insusceptibility ............................................. 108
9.7 Termination of Exposure to Pregnancy ........................................................................... 109
10 FERTILITY PREFERENCES ................................................................................................... 111
10.1 Desire for More Children ................................................................................................ 111
10.2 Need and Demand for Family Planning Services ............................................................ 114
10.3 Ideal Family Size ............................................................................................................. 116
10.4 Fertility Planning ............................................................................................................. 118
11 ADULT AND MATERNAL MORTALITY ............................................................................. 121
11.1 Data Quality Issues .......................................................................................................... 121
11.2 Adult Mortality ................................................................................................................ 123
11.3 Maternal Mortality ........................................................................................................... 123
12 INFANT AND CHILD MORTALITY ...................................................................................... 127
12.1 Assessment of Data Quality ............................................................................................ 128
12.2 Levels and Trends in Childhood Mortality ...................................................................... 128
12.3 Socioeconomic Differentials in Childhood Mortality ..................................................... 129
12.4 Demographic Differentials in Mortality .......................................................................... 131
12.5 Perinatal Mortality ........................................................................................................... 132
12.6 High-Risk Fertility Behavior ........................................................................................... 133
13 MATERNAL HEALTH ............................................................................................................. 137
13.1 Antenatal Care ................................................................................................................. 137
13.1.1 Source of Antenatal Care ................................................................................... 137
13.1.2 Components of Antenatal Care .......................................................................... 139
13.1.3 Tetanus Toxoid Vaccinations ............................................................................ 141
13.2 Childbirth and Delivery ................................................................................................... 141
13.2.1 Place of Delivery................................................................................................ 142
13.2.2 Assistance at Delivery ........................................................................................ 143
13.3 Postnatal Care and Practices ............................................................................................ 144
13.4 Perceived Problems in Accessing Women’s Health Care ............................................... 149
14 CHILD HEALTH ........................................................................................................................ 151
14.1 Child’s Size at Birth ........................................................................................................ 151
14.2 Immunization of Children ............................................................................................... 152
14.3 Acute Respiratory Infection ............................................................................................. 155
14.4 Fever ................................................................................................................................ 157
14.5 Diarrhea ........................................................................................................................... 158
14.6 Feeding Practices ............................................................................................................. 161
14.7 Knowledge of ORS Packets ............................................................................................ 163
14.8 Stool Disposal .................................................................................................................. 163
15 EARLY CHILDHOOD EDUCATION AND DEVELOPMENT ........................................... 165
15.1 Early Childhood Education and Learning ....................................................................... 165
15.2 Adequate Care for Young Children ................................................................................. 169
15.3 Early Childhood Development ........................................................................................ 170
vi • Contents
16 NUTRITION OF CHILDREN AND WOMEN ........................................................................ 173
16.1 Nutritional Status of Children .......................................................................................... 174
16.1.1 Measurement of Nutritional Status among Young Children .............................. 174
16.1.2 Measures of Child Nutritional Status ................................................................. 175
16.1.3 Trends in Children’s Nutritional Status ............................................................. 177
16.2 Initiation of Breastfeeding ............................................................................................... 178
16.3 Breastfeeding Status by Age ............................................................................................ 180
16.4 Duration of Breastfeeding ............................................................................................... 181
16.5 Types of Complementary Foods ...................................................................................... 183
16.6 Infant and Young Child Feeding (IYCF) Practices ......................................................... 184
16.7 Prevalence of Anemia in Children ................................................................................... 187
16.8 Micronutrient Intake among Children ............................................................................. 189
16.9 Use of Iodized Salt .......................................................................................................... 191
16.10 Nutritional Status of Women ........................................................................................... 192
16.11 Prevalence of Anemia in Women .................................................................................... 194
16.12 Micronutrient Intake among Mothers .............................................................................. 196
17 MICRONUTRIENTS ................................................................................................................. 199
17.1 Coverage of Micronutrient Testing ................................................................................. 200
17.2 Iron, Hemoglobin, and Parasitic Infections ..................................................................... 200
17.2.1 Anemia and Iron Status in Mothers ................................................................... 201
17.2.2 Anemia and Iron Status in Children ................................................................... 201
17.2.3 Intestinal Parasite Infection ................................................................................ 203
17.3 Vitamin and Calcium Deficiency .................................................................................... 203
17.3.1 Vitamin and Calcium Deficiency among Mothers ............................................. 203
17.3.2 Vitamin and Calcium Deficiency among Children ............................................ 203
17.4 Urine Iodine Concentration ............................................................................................. 205
18 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR .......................... 207
18.1 Knowledge of HIV/AIDS and of Transmission and Prevention Methods....................... 207
18.1.1 Awareness of AIDS ........................................................................................... 207
18.1.2 HIV Prevention Methods ................................................................................... 208
18.1.3 Knowledge about Transmission ......................................................................... 210
18.1.4 Knowledge of Mother-to-Child Transmission ................................................... 213
18.2 Stigma Associated with AIDS and Attitudes Related to HIV/AIDS ............................... 215
18.3 Attitudes towards Negotiating Safer Sex ......................................................................... 217
18.4 Multiple Sexual Partnerships ........................................................................................... 218
18.5 Testing for HIV ............................................................................................................... 223
18.6 Reports of Recent Sexually Transmitted Infections ........................................................ 227
18.7 Injections ......................................................................................................................... 229
18.8 HIV/AIDS-Related Knowledge and Behavior among Youth .......................................... 230
18.8.1 Knowledge about HIV/AIDS and Source for Condoms .................................... 231
18.8.2 Age at First Sex and Condom Use at First Sexual Intercourse .......................... 232
18.8.3 Recent Sexual Activity ...................................................................................... 234
18.8.4 Multiple Sexual Partnerships ............................................................................. 235
18.8.5 HIV Testing ....................................................................................................... 236
19 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES ... 239
19.1 Employment and Forms of Earnings ............................................................................... 239
19.2 Control over Women’s and Men’s Earnings ................................................................... 240
19.3 Participation in Household Decision Making .................................................................. 243
19.4 Ownership of Assets ........................................................................................................ 247
19.5 Attitudes towards Wife Beating ...................................................................................... 249
Contents • vii
19.6 Women’s Empowerment Indicators ................................................................................ 252
19.7 Current Use of Contraception by Women’s Status .......................................................... 253
19.8 Ideal Family Size and Unmet Need by Women’s Status ................................................. 254
19.9 Reproductive Health Care and Women’s Empowerment Status ..................................... 255
20 DOMESTIC VIOLENCE ........................................................................................................... 257
20.1 Measurement of Violence ................................................................................................ 257
20.1.1 Use of Valid Measures of Violence ................................................................... 257
20.1.2 Ethical Considerations in the 2014 CDHS ......................................................... 258
20.1.3 Subsample for the Violence Module .................................................................. 259
20.2 Experience of Physical Violence ..................................................................................... 259
20.3 Perpetrators of Physical Violence .................................................................................... 261
20.4 Experience of Sexual Violence ........................................................................................ 262
20.5 Perpetrators of Sexual Violence ...................................................................................... 262
20.6 Age at First Experience of Sexual Violence .................................................................... 263
20.7 Experience of Different Forms of Violence .................................................................... 263
20.8 Violence during Pregnancy ............................................................................................. 264
20.9 Marital Control by Spouse ............................................................................................... 266
20.10 Forms of Spousal Violence .............................................................................................. 268
20.11 Spousal Violence by Background Characteristics ........................................................... 269
20.12 Violence by Spousal Characteristics and Women’s Empowerment Indicators ............... 271
20.13 Recent Spousal Violence by Any Husband or Partner .................................................... 273
20.14 Onset of Spousal Violence .............................................................................................. 273
20.15 Physical Consequences of Spousal Violence .................................................................. 274
20.16 Violence by Women against Their Husband ................................................................... 274
20.17 Help-seeking Behavior by Women Who Experience Violence ....................................... 276
REFERENCES ......................................................................................................................................... 279
APPENDIX A: SAMPLE IMPLEMENTATION .................................................................................. 281
A.1 Introduction ..................................................................................................................... 281
A.2 Sampling Frame ............................................................................................................... 281
A.3 Sampling Methodology and Procedure ........................................................................... 282
A.4 Sampling Probabilities ..................................................................................................... 284
APPENDIX B: ESTIMATES OF SAMPLING ERRORS .................................................................... 291
APPENDIX C: DATA QUALITY TABLES .......................................................................................... 317
APPENDIX D: PERSONS INVOLVED IN THE 2014 CAMBODIA DEMOGRAPHIC AND
HEALTH SURVEY .................................................................................................................... 323
APPENDIX E: QUESTIONNAIRES ...................................................................................................... 327
Tables and Figures • ix
TABLES AND FIGURES
1 INTRODUCTION ........................................................................................................................... 1
Table 1.1 Results of the household and individual interviews ............................................... 9
2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS .............................. 11
Table 2.1 Household population by age, sex, and residence ................................................ 12
Table 2.2 Population by age according to selected sources ................................................. 13
Table 2.3 Household composition ....................................................................................... 13
Table 2.4.1 Educational attainment of the female household population ............................... 14
Table 2.4.2 Educational attainment of the male household population .................................. 15
Table 2.5 School attendance ratios ...................................................................................... 16
Table 2.6 Household drinking water .................................................................................... 19
Table 2.7 Household sanitation facilities ............................................................................. 20
Table 2.8 Hand washing ...................................................................................................... 21
Table 2.9 Household characteristics .................................................................................... 22
Table 2.10 Household possessions ......................................................................................... 23
Table 2.11 Wealth quintiles ................................................................................................... 24
Table 2.12 Birth registration of children under age 5 ............................................................ 25
Table 2.13 Children’s living arrangements and orphanhood ................................................. 26
Table 2.14 School attendance by survivorship of parents ...................................................... 27
Figure 2.1 Population pyramid .............................................................................................. 12
Figure 2.2 Age-specific attendance rates ............................................................................... 17
3 UTILIZATION OF HEALTH SERVICES FOR ACCIDENT, ILLNESS, OR INJURY ...... 29
Table 3.1 Injury or death in an accident ............................................................................... 30
Table 3.2 Injury or death in an accident by type of accident ............................................... 31
Table 3.3 Prevalence and severity of illness or injury in previous 30 days ......................... 32
Table 3.4 Percentage of ill or injured population who sought treatment ............................. 33
Table 3.5 Percentage of ill or injured population who sought treatment ............................. 35
Table 3.6 Distribution of cost for health care ...................................................................... 36
Table 3.7 Expenditures for health care ................................................................................ 37
Table 3.8 Source of money (United States dollars) spent by persons who sought
treatment for health care ...................................................................................... 39
Figure 3.1 Percentage of ill or injured household members seeking treatment by order
of treatment and sector of health care .................................................................. 35
4 DISABILITY ................................................................................................................................. 41
Table 4.1 Disability among the household population ......................................................... 42
Table 4.2 Disability among the ill or injured population ..................................................... 43
Table 4.3 Disability and employment .................................................................................. 44
5 RESPONDENT CHARACTERISTICS ...................................................................................... 47
Table 5.1 Background characteristics of respondents .......................................................... 48
Table 5.2.1 Educational attainment: Women .......................................................................... 49
Table 5.2.2 Educational attainment: Men ............................................................................... 50
Table 5.3.1 Literacy: Women ................................................................................................. 51
Table 5.3.2 Literacy: Men ....................................................................................................... 52
x • Tables and Figures
Table 5.4.1 Exposure to mass media: Women ........................................................................ 53
Table 5.4.2 Exposure to mass media: Men ............................................................................. 54
Table 5.5.1 Employment status: Women ................................................................................ 55
Table 5.5.2 Employment status: Men ..................................................................................... 56
Table 5.6.1 Occupation: Women ............................................................................................ 58
Table 5.6.2 Occupation: Men .................................................................................................. 59
Table 5.7 Type of employment: Women ............................................................................. 60
Table 5.8.1 Health insurance coverage: Women .................................................................... 61
Table 5.8.2 Health insurance coverage: Men .......................................................................... 62
Table 5.9.1 Use of tobacco: Women ....................................................................................... 63
Table 5.9.2 Use of tobacco: Men ............................................................................................ 64
6 FERTILITY ................................................................................................................................... 67
Table 6.1 Current fertility .................................................................................................... 68
Table 6.2 Fertility by background characteristics ................................................................ 69
Table 6.3.1 Trends in age-specific fertility rates ..................................................................... 70
Table 6.3.2 Trends in fertility ................................................................................................. 71
Table 6.4 Children ever born and living .............................................................................. 73
Table 6.5 Birth intervals ...................................................................................................... 74
Table 6.6 Age at first birth ................................................................................................... 75
Table 6.7 Median age at first birth ....................................................................................... 76
Table 6.8 Teenage pregnancy and motherhood ................................................................... 77
Figure 6.1 Age-specific fertility rates for five-year periods preceding the survey ................ 71
Figure 6.2 Trends in age-specific fertility rates, Cambodia 2005, 2010, and 2014 ............... 72
7 PRACTICE OF ABORTION ....................................................................................................... 79
Table 7.1 Number of induced abortions ............................................................................... 80
Table 7.2 Pregnancy duration at the time of abortion .......................................................... 82
Table 7.3 Place of abortion .................................................................................................. 82
Table 7.4 Persons who helped with abortion ....................................................................... 83
Table 7.5 Method used for the abortion ............................................................................... 84
Figure 7.1 Distribution of women who have had an abortion by number of abortions ......... 81
8 FAMILY PLANNING .................................................................................................................. 85
Table 8.1 Knowledge of contraceptive methods .................................................................. 85
Table 8.2 Knowledge of contraceptive methods by background characteristics ................. 86
Table 8.3 Current use of contraception by age .................................................................... 87
Table 8.4.1 Current use of contraception by background characteristics ............................... 88
Table 8.4.2 Trends in current use of contraception ................................................................. 89
Table 8.5 Use of social marketing brand pills and condoms ............................................... 90
Table 8.6 Knowledge of fertile period ................................................................................. 91
Table 8.7 Timing of sterilization .......................................................................................... 91
Table 8.8 Source of modern contraception methods ............................................................ 92
Table 8.9 Informed choice ................................................................................................... 93
Table 8.10 Future use of contraception .................................................................................. 94
Table 8.11 Exposure to family planning messages ................................................................ 95
Table 8.12 Contact of nonusers with family planning providers ........................................... 96
9 OTHER PROXIMATE DETERMINANTS OF FERTILITY .................................................. 97
Table 9.1 Current marital status ........................................................................................... 98
Table 9.2 Number of women’s co-wives ............................................................................. 99
Table 9.3 Age at first marriage .......................................................................................... 100
Tables and Figures • xi
Table 9.4.1 Median age at first marriage: Women ................................................................ 101
Table 9.4.2 Median age at first marriage: Men ..................................................................... 102
Table 9.5 Age at first sexual intercourse ............................................................................ 103
Table 9.6.1 Median age at first intercourse: Women ............................................................ 104
Table 9.6.2 Median age at first intercourse: Men ................................................................. 105
Table 9.7.1 Recent sexual activity: Women .......................................................................... 106
Table 9.7.2 Recent sexual activity: Men ............................................................................... 107
Table 9.8 Postpartum amenorrhea, abstinence, and insusceptibility .................................. 108
Table 9.9 Median duration of amenorrhea, postpartum abstinence, and postpartum
insusceptibility ................................................................................................... 109
Table 9.10 Menopause ......................................................................................................... 110
10 FERTILITY PREFERENCES ................................................................................................... 111
Table 10.1 Fertility preferences by number of living children ............................................ 112
Table 10.2.1 Desire to limit childbearing: Women ................................................................. 113
Table 10.2.2 Desire to limit childbearing: Men ...................................................................... 114
Table 10.3 Need and demand for family planning among currently married women ......... 116
Table 10.4 Ideal number of children .................................................................................... 117
Table 10.5 Mean ideal number of children .......................................................................... 118
Table 10.6 Fertility planning status ...................................................................................... 118
Table 10.7 Wanted fertility rates .......................................................................................... 119
11 ADULT AND MATERNAL MORTALITY ............................................................................. 121
Table 11.1 Completeness of information on siblings ........................................................... 122
Table 11.2 Sibship size and sex ratio of siblings ................................................................. 122
Table 11.3 Adult mortality rates .......................................................................................... 123
Table 11.4 Maternal mortality ............................................................................................. 124
Figure 11.1 Confidence intervals for maternal mortality rates, Cambodia 2005, 2010,
and 2014 ............................................................................................................. 125
12 INFANT AND CHILD MORTALITY ...................................................................................... 127
Table 12.1 Early childhood mortality rates .......................................................................... 129
Table 12.2 Early childhood mortality rates by socioeconomic characteristics .................... 130
Table 12.3 Early childhood mortality rates by demographic characteristics ....................... 131
Table 12.4 Perinatal mortality .............................................................................................. 133
Table 12.5 High-risk fertility behavior ................................................................................ 134
Figure 12.1 Trends in childhood mortality, 2000-2014 ........................................................ 129
Figure 12.2 Infant mortality rates by socioeconomic characteristics .................................... 130
Figure 12.3 Infant mortality rates by demographic characteristics ....................................... 132
13 MATERNAL HEALTH ............................................................................................................. 137
Table 13.1 Antenatal care .................................................................................................... 138
Table 13.2 Number of antenatal care visits and timing of first visit .................................... 139
Table 13.3 Components of antenatal care ............................................................................ 140
Table 13.4 Tetanus toxoid injections ................................................................................... 141
Table 13.5 Place of delivery ................................................................................................ 142
Table 13.6 Assistance during delivery ................................................................................. 144
Table 13.7.1 Timing of first postnatal checkup ...................................................................... 145
Table 13.7.2 Type of provider of first postnatal checkup for the mother ............................... 146
Table 13.8.1 Timing of first postnatal checkup for the newborn ............................................ 147
Table 13.8.2 Type of provider of first postnatal checkup for the newborn ............................. 148
Table 13.9 Problems in accessing health care ...................................................................... 149
xii • Tables and Figures
14 CHILD HEALTH ........................................................................................................................ 151
Table 14.1 Child’s size and weight at birth.......................................................................... 152
Table 14.2 Vaccinations by source of information .............................................................. 153
Table 14.3 Vaccinations by background characteristics ...................................................... 154
Table 14.4 Prevalence and treatment of symptoms of ARI ................................................. 156
Table 14.5 Prevalence and treatment of fever ...................................................................... 158
Table 14.6 Prevalence of diarrhea ........................................................................................ 159
Table 14.7 Diarrhea treatment ............................................................................................. 161
Table 14.8 Feeding practices during diarrhea ...................................................................... 162
Table 14.9 Knowledge of ORS packets or pre-packaged liquids......................................... 163
Table 14.10 Disposal of children’s stools .............................................................................. 164
Figure 14.1 Trends in vaccination by age 12 months among children age 12-23 months,
2000-2014 .......................................................................................................... 155
15 EARLY CHILDHOOD EDUCATION AND DEVELOPMENT ........................................... 165
Table 15.1 Early childhood education ................................................................................. 166
Table 15.2 Support for learning ........................................................................................... 167
Table 15.3 Learning materials ............................................................................................. 168
Table 15.4 Inadequate care .................................................................................................. 169
Table 15.5 Early Child Development Index ........................................................................ 171
16 NUTRITION OF CHILDREN AND WOMEN ........................................................................ 173
Table 16.1 Nutritional status of children ............................................................................. 176
Table 16.2 Initial breastfeeding ........................................................................................... 179
Table 16.3 Breastfeeding status by age ................................................................................ 180
Table 16.4 Median duration of breastfeeding ...................................................................... 182
Table 16.5 Foods and liquids consumed by children in the day or night preceding the
interview ............................................................................................................ 184
Table 16.6 Infant and young child feeding (IYCF) practices .............................................. 185
Table 16.7 Prevalence of anemia in children ....................................................................... 188
Table 16.8 Micronutrient intake among children ................................................................. 190
Table 16.9 Presence of iodized salt in household ................................................................ 192
Table 16.10 Nutritional status of women ............................................................................... 193
Table 16.11 Prevalence of anemia in women ........................................................................ 195
Table 16.12 Micronutrient intake among mothers ................................................................. 197
Figure 16.1 Nutritional status of children by age .................................................................. 177
Figure 16.2 Trends in nutritional status of children under age 5 ........................................... 178
Figure 16.3 Infant feeding practices by age .......................................................................... 181
Figure 16.4 IYCF indicators on breastfeeding status ............................................................ 182
Figure 16.5 Trends in infant and young child feeding (IYCF) practices ............................... 186
Figure 16.6 Trends in anemia status among children under age 5 ........................................ 189
Figure 16.7 Trends in nutritional status among women age 15-49 ....................................... 194
Figure 16.8 Trends in anemia status among women age 15-49 ............................................ 196
17 MICRONUTRIENTS ................................................................................................................. 199
Table 17.1 Coverage of micronutrient testing by residence ................................................. 200
Table 17.2 Anemia, iron status, and soluble transferrin receptors among mothers ............. 201
Table 17.3 Type of hemoglobin among mothers by residence ............................................ 201
Table 17.4 Anemia, iron status, and soluble transferrin receptors (sTfRs) among children
born since January 2009 ..................................................................................... 202
Table 17.5 Iron status among children by age ..................................................................... 202
Tables and Figures • xiii
Table 17.6 Type of hemoglobin among children born since January 2009 by residence .... 202
Table 17.7 Intestinal parasitic infection in women and children ......................................... 203
Table 17.8 Blood level of vitamins A, B12, B9, and D and calcium in mothers ................. 203
Table 17.9.1 Blood level of vitamins A, B12, B9, and D and calcium in children ................. 204
Table 17.9.2 Blood level of vitamins A, B12, B9, and D and calcium in children by age ..... 204
Table 17.10 Urinary iodine excretion in mothers and children by residence ......................... 205
18 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR .......................... 207
Table 18.1 Knowledge of AIDS .......................................................................................... 208
Table 18.2 Knowledge of HIV prevention methods ............................................................ 209
Table 18.3.1 Comprehensive knowledge about AIDS: Women ............................................. 211
Table 18.3.2 Comprehensive knowledge about AIDS: Men .................................................. 212
Table 18.4 Knowledge of prevention of mother-to-child transmission of HIV ................... 214
Table 18.5.1 Accepting attitudes toward those living with HIV/AIDS: Women .................... 215
Table 18.5.2 Accepting attitudes toward those living with HIV/AIDS: Men ......................... 216
Table 18.6 Attitudes toward negotiating safer sexual relations with husband ..................... 218
Table 18.7.1 Multiple sexual partners: Women ...................................................................... 219
Table 18.7.2 Multiple sexual partners: Men ........................................................................... 221
Table 18.8 Payment for sexual intercourse and condom use at last paid sexual
intercourse .......................................................................................................... 222
Table 18.9.1 Coverage of prior HIV testing: Women ............................................................. 224
Table 18.9.2 Coverage of prior HIV testing: Men .................................................................. 225
Table 18.10 Pregnant women counseled and tested for HIV ................................................. 226
Table 18.11 Self-reported prevalence of sexually transmitted infections (STIs) and STI
symptoms ........................................................................................................... 228
Table 18.12 Prevalence of medical injections ........................................................................ 230
Table 18.13 Comprehensive knowledge about AIDS and of a source of condoms among
youth .................................................................................................................. 232
Table 18.14 Age at first sexual intercourse among young people ......................................... 233
Table 18.15 Premarital sexual intercourse and condom use during premarital sexual
intercourse among youth .................................................................................... 235
Table 18.16 Multiple sexual partners in the past 12 months among youth ............................ 236
Table 18.17 Recent HIV tests among youth .......................................................................... 237
19 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES ... 239
Table 19.1 Employment and cash earnings of currently married women and men ............. 240
Table 19.2.1 Control over women’s cash earnings and relative magnitude of women’s
cash earnings ...................................................................................................... 241
Table 19.2.2 Control over men’s cash earnings ...................................................................... 242
Table 19.3 Women’s control over their own earnings and over those of their husbands .... 243
Table 19.4 Participation in decision making ........................................................................ 244
Table 19.5.1 Women’s participation in decision making by background characteristics ....... 245
Table 19.5.2 Men’s participation in decision making by background characteristics ............ 246
Table 19.6.1 Ownership of assets: Women ............................................................................. 248
Table 19.6.2 Ownership of assets: Men .................................................................................. 249
Table 19.7.1 Attitude toward wife beating: Women ............................................................... 250
Table 19.7.2 Attitude toward wife beating: Men .................................................................... 252
Table 19.8 Indicators of women’s empowerment ................................................................ 253
Table 19.9 Current use of contraception by women’s empowerment .................................. 254
Table 19.10 Ideal number of children and unmet need for family planning by women’s
empowerment ..................................................................................................... 254
xiv • Tables and Figures
20 DOMESTIC VIOLENCE ........................................................................................................... 257
Table 20.1 Experience of physical violence ........................................................................ 260
Table 20.2 Persons committing physical violence ............................................................... 261
Table 20.3 Experience of sexual violence............................................................................ 262
Table 20.4 Persons committing sexual violence .................................................................. 263
Table 20.5 Age at first experience of sexual violence ......................................................... 263
Table 20.6 Experience of different forms of violence ......................................................... 264
Table 20.7 Experience of violence during pregnancy .......................................................... 265
Table 20.8 Marital control exercised by husbands ............................................................... 267
Table 20.9 Forms of spousal violence ................................................................................. 268
Table 20.10 Spousal violence by background characteristics ................................................ 270
Table 20.11 Spousal violence by husband’s characteristics and empowerment indicators ... 272
Table 20.12 Physical or sexual violence in the past 12 months by any husband/partner ....... 273
Table 20.13 Experience of spousal violence by duration of marriage ................................... 274
Table 20.14 Injuries to women due to spousal violence ........................................................ 274
Table 20.15 Women’s violence against their spouse ............................................................. 275
Table 20.16 Help seeking to stop violence ............................................................................ 276
Table 20.17 Sources for help to stop the violence ................................................................. 277
APPENDIX A: SAMPLE IMPLEMENTATION .................................................................................. 281
Table A.1 Distribution of households in the sampling frame (2008 GPC, updated)
by survey domain and by residence, Cambodia 2014 ........................................ 282
Table A.2 Distribution of enumeration areas in the sampling frame (2008 GPC,
updated) and average size of EAs by survey domain and by residence,
Cambodia 2014 .................................................................................................. 282
Table A.3 Sample allocation of EAs and households by domain and by type of
residence, Cambodia 2014 ................................................................................. 283
Table A.4 Sample allocation of expected number of interviews of women and men by
domain and by type of residence, Cambodia 2014 ............................................ 284
Table A.5 Sample implementation: Women ....................................................................... 286
Table A.6 Sample implementation: Men ............................................................................ 288
APPENDIX B: ESTIMATES OF SAMPLING ERRORS .................................................................... 291
Table B.1 List of selected variables for sampling errors, Cambodia 2014 ......................... 293
Table B.2 Sampling errors: Total sample, Cambodia 2014 ................................................ 294
Table B.3 Sampling errors: Urban sample, Cambodia 2014 .............................................. 295
Table B.4 Sampling errors: Rural sample, Cambodia 2014 ............................................... 296
Table B.5 Sampling errors: Banteay Meanchey sample, Cambodia 2014 .......................... 297
Table B.6 Sampling errors: Kampong Cham sample, Cambodia 2014 .............................. 298
Table B.7 Sampling errors: Kampong Chhnang sample, Cambodia 2014 ......................... 299
Table B.8 Sampling errors: Kampong Speu sample, Cambodia 2014 ................................ 300
Table B.9 Sampling errors: Kampong Thom sample, Cambodia 2014 .............................. 301
Table B.10 Sampling errors: Kandal sample, Cambodia 2014 ............................................. 302
Table B.11 Sampling errors: Kratie sample, Cambodia 2014 .............................................. 303
Table B.12 Sampling errors: Phnom Penh sample, Cambodia 2014 .................................... 304
Table B.13 Sampling errors: Prey Veng sample, Cambodia 2014 ....................................... 305
Table B.14 Sampling errors: Pursat sample, Cambodia 2014 .............................................. 306
Table B.15 Sampling errors: Siem Reap sample, Cambodia 2014 ....................................... 307
Table B.16 Sampling errors: Svay Rieng sample, Cambodia 2014 ...................................... 308
Table B.17 Sampling errors: Takeo sample, Cambodia 2014 .............................................. 309
Table B.18 Sampling errors: Otdar Meanchey sample, Cambodia 2014 .............................. 310
Table B.19 Sampling errors: Battambang and Pailin sample, Cambodia 2014 .................... 311
Table B.20 Sampling errors: Kampot and Kep sample, Cambodia 2014 ............................. 312
Tables and Figures • xv
Table B.21 Sampling errors: Preah Sihanouk and Koh Kong sample, Cambodia 2014 ....... 313
Table B.22 Sampling errors: Preah Vihear and Stung Treng sample, Cambodia 2014 ........ 314
Table B.23 Sampling errors: Mondul Kiri and Ratanak Kiri sample, Cambodia 2014 ........ 315
APPENDIX C: DATA QUALITY TABLES .......................................................................................... 317
Table C.1 Household age distribution ................................................................................ 317
Table C.2.1 Age distribution of eligible and interviewed women ......................................... 318
Table C.2.2 Age distribution of eligible and interviewed men .............................................. 318
Table C.3 Completeness of reporting ................................................................................. 318
Table C.4 Births by calendar years ..................................................................................... 319
Table C.5 Reporting of age at death in days ....................................................................... 319
Table C.6 Reporting of age at death in months .................................................................. 320
Table C.7 Nutritional status of children based on the NCHS/CDC/WHO International
Reference Population ......................................................................................... 321
Foreword • xvii
FOREWORD
he 2014 Cambodia Demographic and Health Survey (2014 CDHS) is the fourth survey of its kind to be
conducted successfully in Cambodia. Sponsors are the United States Agency for International
Development (USAID), the Australian Department of Foreign Affairs and Trade (Australia-DFAT),
United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), Japan International
Cooperation Agency (JICA), Korean International Cooperation Agency (KOICA) and the Health Sector Support
Program-Second Phase (HSSP-2). Technical assistance is provided by ICF International. The Directorate General
for Health (DGH) of the Ministry of Health and the National Institute of Statistics (NIS) of the Ministry of
Planning are the project implementation agencies.
This report includes information on demography, family planning, maternal mortality, infant and child
mortality, and women’s health care status, including related information, such as breastfeeding, antenatal care,
children’s immunization, childhood diseases, HIV/AIDS, and domestic violence. The questionnaires (Household,
Man’s, and Woman’s questionnaires) are designed to evaluate the nutritional status of mothers and children and
to measure the prevalence of anemia.
The 2014 CDHS findings are expected to be used by policymakers and program managers to evaluate
Cambodia’s demographic and health status and then to formulate appropriate population and health policies and
programs. The programs of reproductive health and child health and health facilities need to be expanded and
improved based on the survey findings.
We would like to thank USAID, Australia-DFAT, UNFPA, UNICEF, JICA, KOICA, and HSSP2 for
sponsoring this survey project and ICF International for providing technical assistance. We gratefully
acknowledge the support and encouragement extended by the Minister of Health and Minister of Planning; and
other members of the 2014 CDHS Executive Committee and Technical Committee who contributed to the survey
activities.
We express our sincere thanks to all persons involved in the implementation, analysis, and writing of the
2014 CDHS and especially thank the survey respondents, whose contributions made the survey a success.
T
Acknowledgments • xix
ACKNOWLEDGMENTS
he 2014 Cambodia Demographic and Health Survey (2014 CDHS) represents the continuing
commitment and efforts in Cambodia to obtain data on population and health. The survey also
reflects interest in obtaining information on maternal health, child health, and anemia prevalence.
The 2014 CDHS was sponsored by the United States Agency for International Development (USAID), the
Australian Department of Foreign Affairs and Trade (Australia-OF AT), United Nations Population Fund
(UNFPA), United Nations Children's Fund (UNICEF), Japan International Cooperation Agency (JICA),
Korean International Cooperation Agency (KOICA) and the Health Sector Support Program-Second Phase
(HSSP-2). The survey was implemented by the Directorate General for Health (DGH) of the Ministry of
Health (MOH) and by the National Institute of Statistics (NIS) of the Ministry of Planning (MOP). This
survey could not have been completed without the active support and the efforts of many institutions and
individuals. The active support and guidance of the Excellencies Secretaries of State; H.E. Prof. Eng Huot,
Ministry of Health, and H.E. San Sy Than, Ministry of Planning, are acknowledged with deep gratitude. We
also gratefully acknowledge the representatives of USAID, Australia-OF AT, UNFPA, UNICEF, JICA,
KOICA, and HSSP-2 and their staff for their support and valuable comments throughout the survey
activities.
Our deep appreciation also goes to the ICF International team led by Mr. Bernard Barrère,
Dr. Rathavuth Hong, and others. They are acknowledged with gratitude for their support as they facilitated
the survey and ensured its success.
We would like to express our appreciation for all team leaders, field editors, and interviewers from
NIS, DGH, and the central and local offices of the Ministry of Planning and Ministry of Health, whose
dedicated efforts ensured the quality and timeliness of the survey, and to all respondents for contributing
their time and for giving the required information, enabling us to produce high-quality data for the country.
Finally, we would like to thank members of the 2014 CDHS Executive Committee and Technical
Committee who contributed to the survey activities.
T
xx • Map of Cambodia
Introduction • 1
INTRODUCTION 1
Key Findings
• The 2014 Cambodia Demographic and Health Survey (CDHS) is a
nationally representative survey of 15,825 households with 17,578
women age 15-49 and 5,190 men age 15-49.
• The 2014 CDHS is the fourth Demographic and Health Survey conducted
in Cambodia as part of the worldwide Demographic and Health Surveys
project.
• The primary purpose of the CDHS is to furnish policymakers and planners
with detailed information on fertility and family planning; infant, child,
adult, and maternal mortality; maternal and child health; nutrition; and
knowledge of HIV/AIDS and other sexually transmitted infections.
• In all selected households, women age 15-49 and children age 6-59
months were tested for anemia.
1.1 GEODEMOGRAPHY, HISTORY, AND ECONOMY
1.1.1 Geodemography
ambodia is an agricultural country located in Southeast Asia. It borders with Thailand to the west,
Laos and Thailand to the north, the Gulf of Thailand to the southwest, and Vietnam to the east and
the south. It has a total land area of 181,035 square kilometers.
Cambodia has a tropical climate with two distinct seasons that set the rhythm of rural life. From
November to February, the cool, dry northeastern monsoon brings little rain, whereas from May to October
the southwestern monsoon carries strong winds, high humidity, and heavy rains. The mean annual
temperature for Phnom Penh, the capital city, is 27°C.
The 1962 population census was the last official census to be conducted prior to 1998; it revealed
a population of 5.7 million. The population census in 1998 recorded a population of 11.4 million with an
annual growth rate of 2.5 percent (National Institute of Statistics, 1999). The 2004 Inter-Censal Population
Survey showed that the annual growth rate had declined to 1.8 percent, with a total population of 13.1
million (National Institute of Statistics, 2004). The 2008 General Population Census (GPC) showed a
further decrease in the annual growth rate to 1.54, with a total population of 13.4 million (National Institute
of Statistics, 2009).
The proportion of the population living in rural areas is 80.5 percent; only 19.5 percent of the
country’s residents live in urban areas. The population density in the country as a whole is 75 per square
kilometer, with approximately 1.3 million inhabitants living in Phnom Penh. The average size of the
Cambodian household is 4.7. The total male to female sex ratio is 94.7. The literacy rate among adult
males is 84 percent, considerably higher than the rate among females (76 percent). Currently, it is
estimated that the percentage of the total population living below the poverty line fell to 21.1 percent in
2010 and decreased further to 19.8 percent in 2011 (MOP, 2012).
C
2 • Introduction
1.1.2 History
Cambodia gained complete independence from France under the leadership of Prince Norodom
Sihanouk on November 9, 1953. In March 1970, a military coup led by General Lon Nol overthrew Prince
Sihanouk.
On April 17, 1975, the Khmer Rouge ousted the Lon Nol regime and took control of the country.
Under the new regime, the country was renamed Democratic Kampuchea. Nearly 2 million Cambodian
people died during the Khmer Rouge’s radical and genocidal regime.
On January 7, 1979, the revolutionary army of the National Front for Solidarity and Liberation of
Cambodia defeated the Khmer Rouge regime and proclaimed the country the People’s Republic of
Kampuchea and later, in 1989, the State of Cambodia.
The country’s most important political event was the free elections held in May 1993 under the
close supervision of the United Nations Transitional Authority in Cambodia (UNTAC). At that time
Cambodia was proclaimed the Kingdom of Cambodia, and it is a constitutional monarchy. Four additional
free and fair elections took place in 1998, 2003, 2008, and 2013. Now Cambodia is stable and well on its
way to democracy and a promising future.
1.1.3 Economy
Since the 1991 Paris Peace Accord, Cambodia’s economy has made significant progress after
more than two decades of political unrest. However, Cambodia still remains one of the poorest and least
developed countries in Asia, with the gross domestic product per capita estimated at approximately 4.4
million Riel or $1,088 in 2014 (US$1 = 4,087 Riel) (International Monetary Fund, 2011). Agriculture,
mainly rice production, is still the main economic activity in Cambodia. Small-scale subsistence
agriculture, such as fisheries, forestry, and livestock, is another important sector. Garment factories and
tourism services are also important components of foreign direct investments.
1.2 HEALTH STATUS AND POLICY
Health outcomes have improved recently. The infant mortality rate has decreased from 45 per
1,000 live births in 2010 to 27 per 1,000 live births in 2014. The under-5 mortality rate decreased from 54
per 1,000 live births to 35 per 1,000 live births in the same period. Life expectancy at birth is 67.1 years for
males and 70.1 years for females (NIS, 2013). General government expenditures on health per capita
increased from US$8 in 2008 to US$11 in 2010, US$13 in 2012, and US$16 in 2014 (MOH, 2015). The
health status of the Cambodian people has steadily improved in a number of key areas. Nonetheless,
challenges remain in many other areas.
To improve the health status of the Cambodian people, the Ministry of Health developed the
Health Sector Strategic Plan for 2008-2015 (Ministry of Health, 2008). Its policy direction is as follows:
• Make services more responsive and closer to the public through implementation of a
decentralized service delivery function and a management function guided by the national
“Policy on Service Delivery” and the policy on “Decentralization and Deconcentration.”
• Strengthen sector-wide governance through implementation of a sector-wide approach,
focusing on increased national ownership and accountability to improved health outcomes,
harmonization and alignment, greater coordination, and effective partnerships among all
stakeholders.
• Scale up access to and coverage of health services, especially comprehensive reproductive,
maternal, newborn, and child health services, both demand and supply side, through
Introduction • 3
mechanisms such as institutionalization and expansion of contracting through Special
Operating Agencies, exemptions for the poor, health equity funds, and health insurance.
• Implement pro-poor health financing systems, including exemptions for the poor and
expansion of health equity funds, in combination with other forms of social assistance
mechanisms.
• Reinforce health legislation, professional ethics, and codes of conduct and strengthen
regulatory mechanisms, including for the production and distribution of pharmaceuticals, drug
quality control, cosmetics, and food safety and hygiene, to protect providers and consumers’
rights and their health.
• Improve quality in service delivery and management through establishment of and compliance
with national protocols, clinical practice guidelines, and quality standards, in particular
establishment of accreditation systems.
• Increase the competency and skills of the health workforce to deal with increased demands for
accountability and high-quality care, including through strengthening allied technical skills
and advanced technology through increased quality of training, career development,
appropriate incentives, and a good working environment.
• Strengthen and invest in health information systems and health research for evidence-based
policy-making, planning, performance monitoring, and evaluation.
• Increase investments in physical infrastructures, medical care equipment, and advanced
technology, as well as in improvement of non-medical support services including
management, maintenance, blood safety, and supply systems for drugs and commodities.
• Promote quality of life and healthy lifestyles by raising health awareness and creating
supportive environments, including through strengthening institutional structures, financial
and human resources, and IEC (information, education, and communication) materials for
health promotion, behavior change communication, and appropriate health-seeking practices.
• Prevent and control communicable and selected chronic and noncommunicable diseases and
strengthen disease surveillance systems for an effective response to emerging and reemerging
diseases.
• Strengthen public health interventions to deal with cross-cutting challenges, especially those
related to gender, health of minorities, hygiene and sanitation, school health, environmental
health risks, substance abuse/mental health, injury, occupational health, and disaster, through
timely responses and effective collaboration and coordination with other sectors.
• Promote effective public and private partnerships in service provision based on policy,
regulation, legislation, and technical standards.
• Encourage community engagement in health service delivery activities, management of health
facilities, and continuous quality improvement.
• Systematically strengthen institutions at all levels of the health system to implement the
policy agenda listed under the previous 14 elements.
4 • Introduction
1.3 OBJECTIVE AND SURVEY ORGANIZATION
The 2014 Cambodia Demographic and Health Survey (CDHS) is the fourth nationally
representative survey conducted in Cambodia on population and health issues. It uses the same
methodology as its predecessors, the 2000, 2005, and 2010 Cambodia Demographic and Health Surveys,
allowing policymakers to use these surveys to assess trends over time.
The primary objective of the CDHS is to provide the Ministry of Health (MOH), Ministry of
Planning (MOP), and other relevant institutions and users with updated and reliable data on infant and
child mortality, fertility preferences, family planning behavior, maternal mortality, utilization of maternal
and child health services, health expenditures, women’s status, and knowledge and behavior regarding
HIV/AIDS and other sexually transmitted infections. This information contributes to policy decisions,
planning, monitoring, and program evaluation for the development of Cambodia at both the national and
local government levels.
The long-term objectives of the survey are to build the capacity of the Ministry of Health and the
National Institute of Statistics (NIS) of the Ministry of Planning for planning, conducting, and analyzing
the results of further surveys.
The 2014 CDHS survey was conducted by the Directorate General for Health (DGH) of the
Ministry of Health and the National Institute of Statistics of the Ministry of Planning. The CDHS executive
committee and technical committee were established to oversee all technical aspects of implementation.
They consisted of representatives from the Ministry of Health, the Ministry of Planning, the National
Institute of Statistics, the U.S. Agency for International Development (USAID), the Australian Department
of Foreign Affairs and Trade (Australia-DFAT), the United Nations Population Fund (UNFPA), the United
Nations Children’s Fund (UNICEF), the Japan International Cooperation Agency (JICA), and the Korean
International Cooperation Agency (KOICA). Funding for the survey came from USAID, Australia-DFAT,
UNFPA, UNICEF, JICA, KOICA, and the Health Sector Support Program–Second Phase (HSSP-2).
Technical assistance was provided by ICF International.
1.4 SAMPLE DESIGN
The 2014 CDHS sample is a nationally representative sample of women and men between age 15
and 49 who completed interviews. To achieve a balance between the ability to provide estimates at the
subnational level and limiting the sample size, 19 sampling domains were defined, 14 of which correspond
to individual provinces and 5 of which correspond to grouped provinces:
• Fourteen individual provinces: Banteay Meanchey, Kampong Cham, Kampong Chhnang,
Kampong Speu, Kampong Thom, Kandal, Kratie, Phnom Penh, Prey Veng, Pursat, Siem
Reap, Svay Rieng, Takeo, and Otdar Meanchey
• Five groups of provinces: Battambang and Pailin, Kampot and Kep, Preah Sihanouk and Koh
Kong, Preah Vihear and Stung Treng, and Mondul Kiri and Ratanak Kiri
The sample of households was allocated to the sampling domains in such a way that estimates of
indicators could be produced with precision at the national level, as well as separately for urban and rural
areas of the country and for each of the 19 sampling domains.
The sampling frame used for the 2014 CDHS was derived from the list of all enumeration areas
(EAs) created for the 2008 Cambodia General Population Census (GPC), provided by NIS. The list had
been updated in 2012, and it excluded 241 EAs that are special settlement areas and not ordinary
residential areas. It included 28,455 EAs for the entire country. The GPC also created maps that delimited
the boundaries of each EA. Overall, 4,245 EAs were designated as urban and 24,210 as rural, with an
average size of 99 households per EA.
Introduction • 5
The survey used a stratified sample selected in two stages. Stratification was achieved by
separating every reporting domain into urban and rural areas. Thus, the 19 domains were stratified into a
total of 38 sampling strata. Samples were selected independently in every stratum through a two-stage
selection process. Implicit stratifications were achieved at each of the lower geographical or administrative
levels by sorting the sampling frame according to geographical/administrative order before sample
selection and by using a probability proportional to size selection strategy at the first stage of selection.
In the first stage, 611 EAs (188 in urban areas and 423 in rural areas) were selected with
probability proportional to size. The size of an EA was defined as the number of households residing in the
EA. Some of the largest EAs (more than 200 households) were divided into segments; only one segment
was selected randomly to be included in the survey. Thus, the 611 CDHS clusters were either an EA or a
segment of an EA. A listing of all households was carried out in each of the 611 clusters during the months
of February through April 2014. Listing teams also drew fresh maps delineating EA boundaries and
identifying all households. These maps and lists were used by field teams during data collection. The
household listings provided the frame from which households were selected in the second stage. In the
second stage selection, a fixed number of 24 households were selected from every urban cluster, and a
fixed number of 28 households were selected from every rural cluster, through equal probability systematic
sampling. Small areas and urban areas were oversampled, and this oversampling was corrected in the
analysis using sampling weights to ensure the natural representation of the sample for all 38 strata (19
domains by urban or rural area). Appendix A provides a complete description of the sample design and
weighting procedures.
All women age 15-49 who were either usual residents of the selected households or visitors
present in the household on the night before the survey were eligible to be interviewed. In addition, in a
subsample of one-third of the households selected for the survey, all men age 15-49 were eligible to be
interviewed (if they were either usual residents of the selected households or visitors present in the
household on the night before the survey). This was a cost-effective strategy given that the minimum
sample size required for the women’s survey was larger than that for the men’s survey because complex
indicators (such as total fertility and infant and child mortality rates) require larger sample sizes to achieve
a reasonable level of precision, and these data are derived from interviews with women.
In the subsample of households chosen for the male interviews (one-third of the total sample), all
women eligible for interviews and all children under age 5 were eligible for anemia testing. These same
women and children were also eligible for height and weight measurements to determine their nutritional
status.
In a subsample consisting of one in every six of the selected clusters, a survey component
focusing on micronutrient indicators was implemented among all eligible women age 15-49 who had
children under age born since January 2009, as well as among the children themselves. Since data on
micronutrient indicators are reported only at the national level and for urban and rural areas, a subsample
of clusters was cost-effective, producing a sample size large enough to provide estimations with adequate
precision.
1.5 QUESTIONNAIRES
Four questionnaires were used in the 2014 CDHS: the Household Questionnaire, the Woman’s
Questionnaire, the Man’s Questionnaire, and the Micronutrient Questionnaire. These questionnaires are
based on the questionnaires developed by the worldwide Demographic and Health Surveys (DHS)
Program and on the questionnaires used during the 2010 CDHS survey. To reflect relevant population and
health issues in Cambodia, the questionnaires were adapted during a series of technical meetings with
various stakeholders from government ministries and agencies, nongovernmental organizations, and
international donors. The final drafts of the questionnaires were discussed at a stakeholders’ meeting
6 • Introduction
organized by the National Institute of Statistics. The adapted questionnaires were translated from English
into Khmer and pretested in February and March 2014.
The Household Questionnaire was used to list all of the usual members and visitors in the selected
households. Basic information was collected on the characteristics of each person listed, including age,
sex, education, and relationship to the head of the household. For children under age 18, parents’ survival
status was determined. The Household Questionnaire also collected information on the following topics:
• Dwelling characteristics
• Accidental death and injury
• Physical impairment
• Utilization of health services and health expenditures for recent illness and injury
• Disability
• Possession of iodized salt
• Height and weight of women and children
• Hemoglobin measurements among women and children for diagnosing anemia
The Household Questionnaire was used to identify women and men eligible for an individual
interview. The Woman’s Questionnaire was used to collect information from all women age 15-49 and was
organized into the following sections:
• Respondent background characteristics
• Reproduction, including a complete birth and death history of respondents’ live births and
information on abortion
• Contraception
• Pregnancy, postnatal care, and women’s nutrition
• Immunization, health, children’s nutrition, and early childhood development
• Marriage and sexual activity
• Fertility preferences
• Husbands’ background and women’s work
• Domestic violence
• HIV/AIDS and other sexually transmitted infections
• Maternal mortality
The Man’s Questionnaire was administered to all men age 15-49 living in one-third of the
households in the CDHS sample. The Man’s Questionnaire was organized into the following sections:
• Respondent background characteristics
• Reproduction
• Marriage and sexual activity
• HIV/AIDS
• Other health issues
The Micronutrient Questionnaire was implemented in a subsample of one-sixth of the sampled
clusters for the collection of micronutrient specimens among eligible women and children. Specimens
collected included venous blood, urine, and stool samples.
The CDHS underwent a full pretest before commencement of the main data collection. All aspects
of data collection were pretested in February and March 2014. Forty-four women and men were trained
from February 27 to March 17, 2014, in the administration of the CDHS survey instruments, taking of
anthropometric measurements, and hemoglobin testing. Five days of fieldwork were followed by three
days of interviewer debriefing and correction of questionnaires. Pretest fieldwork was conducted in 79
Introduction • 7
households in two rural and two urban villages. Constructive input from interviewers was used to refine
the survey instruments and survey logistics. These pretest activities were used to finalize the
questionnaires. The majority of pretest participants also attended the training for the main survey, with
many of them serving as field editors and team leaders for the survey.
1.6 TRAINING AND FIELDWORK
The goal of training was to create 19 field teams capable of collecting data for the 2014 CDHS.
Each team was responsible for data collection in one of the 19 survey domains (comprising the 23
provinces and the capital city of Phnom Penh). Field teams were composed of five people (5 teams) or six
people (14 teams): a team leader, a field editor, two or three female interviewers, and one male
interviewer. Nineteen fully staffed field teams would require 114 field personnel, and at the end of training
109 field personnel were retained. Twenty-six days of training included four days of field practice in
Kandal province. Data processing personnel (3 data processing supervisors, 10 office editors/coders, 19
data entry operators, and 5 reserves) also attended classroom training.
Training began with the Household Questionnaire and was followed by the Woman’s
Questionnaire. Additional time was spent reviewing the Household Questionnaire, including consent
statements for hemoglobin testing, and conversion of ages and dates of birth from the Khmer calendar to
the Gregorian calendar. One week was devoted to additional activities, including the Man’s Questionnaire,
measurement of women’s and children’s height and weight, sample implementation and household
selection, testing of household salt for iodine, and organization of documents and materials for return to the
head office. After completion of training, including field practice, fieldwork was launched and teams
disbursed to their assigned provinces.
During the training period, the 19 CDHS team leaders were provided with the cluster information
for the provinces in which they would be working so that they could devise a data collection sequence for
their sample points. Team leaders were best equipped to perform this task because they hailed from their
own provinces. They also conducted the CDHS household listing operation (described in Appendix A) and
therefore were well acquainted with the areas in which they would be working. The progression of
fieldwork by geographic location had to take into account weather conditions during the rainy season.
Fieldwork supervision was carried out regularly by three CDHS survey coordinators from NIS and
MOH along with an ICF Macro consultant. Supervision visits were conducted throughout the six months
of data collection and included retrieval of questionnaires from the field. In addition, a quality control
program was run by the data processing team to detect key data collection errors for each team. These data
checks were used to provide regular feedback to each team based on its specific performance. Data
collection was conducted from June 2 to December 12, 2014.
The training and fieldwork for collection of stool, urine, and venous blood samples were
conducted separately by UNICEF in collaboration with the Institut de Recherche pour le Développement
(France) and Cambodia’s Ministry of Agriculture, Forestry, and Fisheries. Details are provided in the
micronutrient chapter.
1.7 BIOMARKER TESTING
1.7.1 Anthropometric Measurement
The 2014 CDHS included an anthropometric component in which children under age 5 in a
subsample of two-thirds of the households were measured for height and weight. Weight measurements
were taken using a lightweight, electronic SECA scale designed and manufactured under the guidance of
UNICEF. The scale allowed for the weighing of very young children through an automatic mother-child
adjustment that eliminates the mother’s weight while she is standing on the scale with her baby. Height
measurements were carried out using a SECA measuring board, also produced under the guidance of
8 • Introduction
UNICEF. Children younger than age 24 months were measured lying down (recumbent length) on the
board, whereas standing height was measured for older children. Three nutritional indices were calculated
using children’s age, height, and weight: height-for-age (stunting), weight-for-height (wasting), and
weight-for-age (underweight). The height and weight of women age 15-49 were also measured among the
two-thirds subsample of households selected in the 2014 CDHS.
1.7.2 Hemoglobin Testing
Hemoglobin testing is the primary method for anemia diagnosis. The 2014 CDHS included
anemia testing of children age 6 to 59 months and women age 15-49 in the two-thirds of CDHS households
that were not selected for the men’s interview. A consent statement was read to the eligible respondent or,
in the case of children and young unmarried women age 15-17, the parent or responsible adult. This
statement explained the purpose of the test, informed the individual that the results would be made
available as soon as the test was completed, and requested permission for the test to be carried out. Anemia
levels were determined by measuring the level of hemoglobin in the blood; a decreased concentration
characterizes anemia. The concentration of hemoglobin in the blood was measured in the field using the
HemoCue system. The HemoCue instrument is a special purpose photometer designed specifically for the
determination of hemoglobin levels. A capillary blood sample was taken from the palm side of the end of a
finger, by puncturing with a sterile, non-reusable, self-retractable lancet. The blood drop was collected in a
HemoCue microcuvette, which serves as a measuring tool, and placed in the HemoCue photometer to
determine the level of hemoglobin in the blood. A pamphlet was given to each respondent explaining
symptoms of anemia, prevention methods, and the individual results of the hemoglobin measurement of
the respondent and any children for whom she gave permission to be measured. Each person whose
hemoglobin level was lower than the recommended cutoff point (testing severely anemic) was advised to
visit a health facility for follow-up with a health professional.
1.7.3 Micronutrient Testing
The 2014 CDHS included a micronutrient component that was implemented in one out of six
clusters selected for the main survey. In these clusters, blood, urine, and stool samples were collected by
separate data collection teams from women who had had children born since January 2009 and from the
children themselves. The blood/urine/stool samples were sent to several laboratories inside and outside of
Cambodia.
1.8 DATA PROCESSING
Completed questionnaires were returned from the field to NIS headquarters, where they were
entered and edited by data processing personnel who were specially trained for this task and had also
attended questionnaire training of field staff. Data processing personnel included a data processing chief,
two assistants, four secondary editors and coordinators, 25 entry operators, and eight office editors.
Data processing for the 2014 CDHS began on 25 personal computers on July 6, 2014, five weeks
after the first interviews were conducted. Processing the data concurrently with data collection allowed for
regular monitoring of team performance and data quality. Field check tables were generated regularly
during the data processing to check various data quality parameters. As a result, feedback was given on a
regular basis, encouraging teams to continue in areas of high quality and to correct areas of needed
improvement. Feedback was individually tailored to each team. Data entry, which included 100 percent
double entry to minimize keying errors, and data editing were completed on January 8, 2015. Data
cleaning and finalization were completed on January 23, 2015.
1.9 SAMPLE COVERAGE
All of the 611 clusters selected for the sample were surveyed in the 2014 CDHS. A total of 16,356
households were selected, of which 15,937 were found to be occupied during data collection. Among these
Introduction • 9
households, 15,825 completed the Household Questionnaire, yielding a response rate of 99 percent (Table
1.1).
In these interviewed households, 18,012 women were identified as eligible for the individual
interview. Interviews were completed with 98 percent of these women. Of the 5,484 eligible men identified
in every third household, 95 percent were successfully interviewed. There was little variation in response
rates by urban-rural residence.
Table 1.1 Results of the household and individual interviews
Number of households, number of interviews, and response rates, according to
residence (unweighted), Cambodia 2014
Residence
Total Result Urban Rural
Household interviews
Households selected 4,512 11,844 16,356
Households occupied 4,399 11,538 15,937
Households interviewed 4,366 11,459 15,825
Household response rate1 99.2 99.3 99.3
Interviews with women age 15-49
Number of eligible women 5,842 12,170 18,012
Number of eligible women interviewed 5,667 11,911 17,578
Eligible women response rate2 97.0 97.9 97.6
Interviews with men age 15-49
Number of eligible men 1,641 3,843 5,484
Number of eligible men interviewed 1,540 3,650 5,190
Eligible men response rate2 93.8 95.0 94.6
1 Households interviewed/households occupied
2 Respondents interviewed/eligible respondents
Household Population and Housing Characteristics • 11
HOUSEHOLD POPULATION AND HOUSING
CHARACTERISTICS 2
Key Findings
• Forty-three percent of the population in Cambodia is age 19 or younger.
• Twenty-seven percent of household heads are women.
• Sixty-five percent of households use an improved source of drinking
water during the dry season and 84 percent during the rainy season.
• Two in three households (67 percent) use an appropriate method of
treating their drinking water, primarily boiling it (55 percent).
• Forty-six percent of households have an improved, not shared sanitation
facility.
• Slightly more than half of households (56 percent) have electricity.
• Nine in 10 Cambodians own a mobile phone.
• Nearly three-quarters of children (73 percent) under age 5 have their birth
registered.
his chapter summarizes the socioeconomic characteristics of households and respondents surveyed,
including age, sex, residence (urban-rural), educational status, household facilities, and household
characteristics. The profile of the households provided in this chapter will help in understanding the
results of the 2014 CDHS in the following chapters. In addition, it may provide useful information for
social and economic development planning.
Throughout this report, numbers in the tables reflect weighted numbers. Due to the way the
sample was designed, the number of weighted cases in some regions appears small, because they are
weighted to make the regional distribution nationally representative. However, roughly the same number
of households and women and men were interviewed in each province or group of provinces, and the
number of unweighted cases is always large enough to calculate the presented estimates. Estimates based
on an insufficient number of cases are shown in parentheses or not shown at all.
The 2014 CDHS collected information from all usual residents of a selected household (de jure
population) and persons who had stayed in the selected household the night before the interview (de facto
population). Although the difference between these two populations is small, to avoid double counting all
tables in this report refer to the de facto population unless otherwise specified. The CDHS used the same
definition of households as the 2008 census conducted by the National Institute of Statistics. A household
was defined as a person or group of related and unrelated persons who live together in the same dwelling
unit(s) or in connected premises, who acknowledge one adult member as the head of the household, and
who have common arrangements for cooking and eating meals.
2.1 CHARACTERISTICS OF THE HOUSEHOLD POPULATION
2.1.1 Age and Sex Composition
Age and sex are important demographic variables and are the primary basis of demographic
classification in vital statistics, censuses, and surveys. They are also important variables in the study of
mortality, fertility, and nuptiality. The effect of variations in sex composition from one population group to
another should be taken into account in comparative studies of mortality. In general, a cross-classification
with sex is useful for the effective analysis of all forms of data obtained in surveys.
T
12 • Household Population and Housing Characteristics
The survey collected information on age in completed years for each household member. When
the age was not known, interviewers inquired further for dates of birth in the Gregorian calendar, the
Khmer calendar, and/or a historical calendar. Age was then calculated using conversion charts specifically
designed for this purpose.
Table 2.1 presents the percent distribution of the household population by age, according to urbanrural residence and sex. The population spending the night before the survey in the households selected for
the survey included 69,471 individuals, of whom 48 percent were males and 52 percent were females.
The age structure of the household population is typical of a society with a young population and
recently declining fertility. The sex and age distribution of the population is also shown in the population
pyramid in Figure 2.1. Cambodia has a relatively broad-based pyramid structure because 43 percent of the
population is less than age 20.
Table 2.1 Household population by age, sex, and residence
Percent distribution of the de facto household population by five-year age groups, according to sex and
residence, Cambodia 2014
Urban Rural
Male Female Total Age Male Female Total Male Female Total
<5 10.2 8.9 9.5 12.2 10.8 11.5 11.8 10.5 11.2
5-9 10.2 8.7 9.4 13.4 11.6 12.5 12.9 11.2 12.0
10-14 9.5 9.1 9.3 12.3 11.2 11.7 11.9 10.9 11.4
15-19 9.5 8.9 9.2 9.2 7.8 8.4 9.2 7.9 8.6
20-24 10.0 10.9 10.5 8.1 7.9 8.0 8.4 8.4 8.4
25-29 9.6 9.5 9.5 7.5 7.4 7.5 7.9 7.8 7.8
30-34 9.4 9.7 9.6 7.9 8.0 7.9 8.2 8.3 8.2
35-39 4.8 4.7 4.8 5.0 5.0 5.0 4.9 5.0 5.0
40-44 5.7 5.7 5.7 5.2 5.5 5.4 5.3 5.5 5.4
45-49 5.0 5.2 5.1 4.8 5.2 5.0 4.9 5.2 5.0
50-54 5.0 4.9 5.0 4.4 5.2 4.9 4.5 5.2 4.9
55-59 3.8 4.4 4.1 2.9 4.4 3.7 3.0 4.4 3.7
60-64 2.7 3.5 3.1 2.3 3.4 2.9 2.4 3.4 2.9
65-69 1.5 2.5 2.0 1.9 2.5 2.2 1.8 2.5 2.2
70-74 1.4 1.3 1.3 1.3 1.7 1.5 1.3 1.6 1.5
75-79 0.8 1.2 1.0 0.9 1.2 1.0 0.8 1.2 1.0
80+ 0.7 1.0 0.9 0.8 1.1 1.0 0.8 1.1 0.9
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number 5,248 5,932 11,180 27,818 30,473 58,291 33,066 36,405 69,471
Figure 2.1 Population pyramid
Above the age of 10 years, the pyramid follows a typical pattern of decreasing numbers as age
increases. However, the percentage of people age 35 to 44 is less than would be expected because these are
the two age groups born in the decade of the 1970s. The early 1970s saw escalating civil war, and in the
8 6 4 2 0 2 4 6 8
<5
0-9
10-14
15-19
20-24
25-29
30-34
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80+
Percent
Age
Male Female
CDHS 2014
Household Population and Housing Characteristics • 13
late 1970s the Khmer Rouge ruled. This period of time was characterized by few births and high mortality,
including high infant and child mortality.
Cambodia has a large dependent population of children and adolescents, although with decreasing
fertility the proportion of the population under age 15 has recently declined. The proportion of those age 50
or older has slightly increased. Table 2.2 shows that the proportion of children under age 15 has remained
constant over the past four years, with this age group accounting for 35 percent of the population. Sixty
percent of the population is in the 15-64 age group, and 6 percent are age 65 or older.
Table 2.2 Population by age according to selected sources
Percent distribution of the de facto population by age group, according to selected sources, Cambodia 2014
Age
1998
census1
2000
CDHS2
2004
CIPS3
2005
CDHS4
2008
census5
2010
CDHS6
2014
CDHS
<15 42.8 42.7 38.6 38.9 33.7 34.5 34.5
15-49 46.9 46.3 49.5 47.9 53.4 50.5 48.4
50-64 6.8 7.4 8.0 8.6 8.6 10.0 11.5
65+ 3.5 3.6 3.9 4.6 4.3 5.0 5.6
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0
1 General Population Census of Cambodia, 1998 (National Institute of Statistics, 1999)
2 Cambodia Demographic and Health Survey, 2000 (National Institute of Statistics and ORC Macro, 2001)
3 Cambodia Inter-Censal Population Survey, 2004 (National Institute of Statistics, 2004)
4 Cambodia Demographic and Health Survey, 2005 (National Institute of Statistics and ORC Macro, 2006)
5 General Population Census of Cambodia, 2008 (National Institute of Statistics, 2009)
6 Cambodia Demographic and Health Survey, 2010 (National Institute of Statistics, Directorate General for
Health, and ICF Macro, 2011)
2.1.2 Household Composition
Table 2.3 shows the distribution of
households in the survey by the sex of the head of
the household and the number of household
members, according to urban and rural residence.
Households in Cambodia are predominantly maleheaded. However, 27 percent of households are
headed by women (28 percent and 27 percent in
urban and rural areas, respectively).
The average household size is 4.6 persons,
about the same as that observed in the 2010 CDHS
(4.7 persons per household). Urban households
have 5.0 persons per household on average and are
slightly larger than rural households (4.5 persons).
Table 2.3 also shows that 17 percent of
households include foster and/or orphaned
children. Overall, 13 percent of households have
foster children, 6 percent have single orphans, and
1 percent have double orphans. The variation
between rural and urban areas is small.
Table 2.3 Household composition
Percent distribution of households by sex of head of household and by
household size, mean size of household, and percentage of
households with orphans and foster children under age 18, according
to residence, Cambodia 2014
Residence
Total Characteristic Urban Rural
Household headship
Male 71.7 73.4 73.1
Female 28.3 26.6 26.9
Total 100.0 100.0 100.0
Number of usual members
1 3.2 3.4 3.4
2 8.2 9.4 9.2
3 13.5 17.0 16.5
4 20.8 24.0 23.5
5 19.6 19.5 19.6
6 13.8 12.8 12.9
7 7.9 7.4 7.5
8 5.5 3.3 3.7
9+ 7.5 3.2 3.8
Total 100.0 100.0 100.0
Mean size of households 5.0 4.5 4.6
Percentage of households with
orphans and foster children
under age 18
Foster children1 14.6 12.9 13.1
Double orphans 1.3 1.0 1.0
Single orphans2 4.5 5.6 5.5
Foster and/or orphan children 17.3 16.7 16.8
Number of households 2,284 13,541 15,825
Note: Table is based on de jure household members, i.e., usual
residents.
1 Foster children are those under age 18 living in households with
neither their mother nor their father present.
2 Includes children with one dead parent and an unknown survival
status of the other parent
14 • Household Population and Housing Characteristics
2.2 EDUCATION OF THE HOUSEHOLD POPULATION
Many behaviors, including those in the realms of reproduction, contraceptive use, child health,
and proper hygiene, are affected by the education of household members. Information on the educational
level of the female and male population age 6 and above is presented in Tables 2.4.1 and 2.4.2. Survey
results show that although the majority of Cambodians have not completed primary school, the country has
experienced strong improvement in educational attainment over time. Overall, 19 percent of females have
never attended school, as compared with 10 percent of males. Improvements over time have resulted in
only 2 percent of girls and 3 percent of boys age 10-14 having never attended school at all.
Table 2.4.1 Educational attainment of the female household population
Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median years
completed, according to background characteristics, Cambodia 2014
Background
characteristic
No education
Some
primary
Completed
primary1
Some
secondary
Completed
secondary2
More than
secondary
Don’t
know/
missing Total Number
Median
years
completed
Age
6-9 15.5 84.4 0.0 0.0 0.0 0.0 0.0 100.0 3,318 0.3
10-14 1.9 64.8 3.6 29.6 0.0 0.0 0.0 100.0 3,957 4.2
15-19 3.1 20.2 9.2 62.3 2.3 3.0 0.0 100.0 2,891 7.1
20-24 5.7 25.0 11.2 38.8 7.3 12.0 0.0 100.0 3,054 6.5
25-29 11.5 36.1 10.8 29.2 4.6 7.8 0.0 100.0 2,825 5.2
30-34 18.0 46.8 6.5 22.0 3.2 3.5 0.0 100.0 3,005 3.8
35-39 17.8 53.0 6.0 20.0 2.3 1.0 0.0 100.0 1,806 3.2
40-44 16.6 51.7 5.2 22.5 2.3 1.8 0.0 100.0 2,019 3.3
45-49 25.1 55.5 2.9 13.8 1.8 0.9 0.0 100.0 1,883 2.3
50-54 37.1 53.7 3.0 5.3 0.6 0.2 0.0 100.0 1,889 1.2
55-59 33.0 52.4 4.3 9.2 0.6 0.4 0.1 100.0 1,613 1.6
60-64 36.6 47.8 6.5 7.5 1.2 0.4 0.0 100.0 1,248 1.4
65+ 63.8 27.7 3.0 5.0 0.3 0.2 0.0 100.0 2,316 0.0
Residence
Urban 10.7 35.5 5.4 31.8 5.8 10.8 0.0 100.0 5,307 5.5
Rural 20.6 50.5 5.7 20.7 1.4 1.1 0.0 100.0 26,521 2.7
Province
Banteay Meanchey 19.6 52.8 4.7 19.6 2.2 1.1 0.0 100.0 1,340 2.6
Kampong Cham 19.9 51.9 6.6 19.2 1.3 1.1 0.0 100.0 3,985 2.4
Kampong Chhnang 15.3 50.3 7.0 23.0 2.5 1.9 0.0 100.0 1,218 3.2
Kampong Speu 18.7 46.7 7.1 25.4 1.2 0.9 0.1 100.0 2,027 3.5
Kampong Thom 19.1 54.0 6.0 17.5 1.7 1.6 0.0 100.0 1,589 2.5
Kandal 16.4 48.1 6.2 26.1 1.4 1.9 0.0 100.0 2,454 3.5
Kratie 20.1 55.4 5.0 17.1 1.4 1.0 0.0 100.0 903 2.2
Phnom Penh 9.9 34.6 5.0 31.7 5.5 13.3 0.0 100.0 3,135 5.7
Prey Veng 22.1 49.4 5.3 21.3 1.1 0.7 0.1 100.0 2,172 2.8
Pursat 22.5 51.1 6.5 17.0 2.0 1.0 0.0 100.0 1,239 2.3
Siem Reap 26.3 47.8 4.8 17.0 2.0 2.1 0.0 100.0 2,015 2.2
Svay Rieng 12.4 59.5 4.9 20.9 1.0 1.4 0.0 100.0 1,229 2.8
Takeo 22.7 40.0 5.1 27.5 2.7 2.0 0.0 100.0 2,023 3.6
Otdar Meanchey 28.4 45.5 5.3 18.9 1.5 0.5 0.0 100.0 509 1.9
Battambang/Pailin 16.5 47.0 5.5 25.1 2.9 2.9 0.0 100.0 2,446 3.6
Kampot/Kep 15.9 51.3 4.9 24.3 2.0 1.7 0.0 100.0 1,449 3.3
Preah Sihanouk/Koh Kong 15.8 46.2 6.8 25.2 2.3 3.6 0.0 100.0 696 3.9
Preah Vihear/Stung Treng 26.2 52.1 3.8 15.4 1.1 1.5 0.0 100.0 760 1.8
Mondul Kiri/Ratanak Kiri 33.9 43.6 4.2 16.7 0.8 0.9 0.0 100.0 639 1.2
Wealth quintile
Lowest 28.9 56.8 4.3 9.6 0.3 0.1 0.0 100.0 6,013 1.4
Second 23.7 54.1 5.5 16.0 0.5 0.2 0.0 100.0 6,370 2.2
Middle 18.9 50.9 5.6 23.1 1.0 0.4 0.0 100.0 6,313 3.0
Fourth 15.0 44.7 6.8 28.2 2.9 2.5 0.0 100.0 6,507 4.0
Highest 9.2 34.8 6.0 34.5 5.7 9.9 0.0 100.0 6,625 5.7
Total 18.9 48.0 5.6 22.6 2.1 2.7 0.0 100.0 31,828 3.1
Note: Totals include 4 women with information on age missing.
1 Completed grade 6 at the primary level
2 Completed grade 12 at the secondary level
Household Population and Housing Characteristics • 15
Table 2.4.2 Educational attainment of the male household population
Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median years
completed, according to background characteristics, Cambodia 2014
Background
characteristic
No education
Some
primary
Completed
primary1
Some
secondary
Completed
secondary2
More than
secondary
Don’t
know/
missing Total Number
Median
years
completed
Age
6-9 19.3 80.6 0.0 0.0 0.0 0.0 0.0 100.0 3,486 0.1
10-14 2.5 70.8 2.4 24.2 0.0 0.0 0.0 100.0 3,930 3.8
15-19 4.7 25.2 7.9 57.6 1.8 2.7 0.0 100.0 3,053 6.7
20-24 5.1 25.2 9.7 41.0 8.0 11.0 0.0 100.0 2,770 6.7
25-29 7.3 29.6 8.4 34.5 7.9 12.2 0.1 100.0 2,602 6.3
30-34 9.7 36.2 7.7 30.4 8.1 8.0 0.0 100.0 2,698 5.4
35-39 11.5 41.6 6.7 28.6 6.8 4.8 0.0 100.0 1,634 4.7
40-44 8.6 35.9 6.5 34.8 8.5 5.8 0.0 100.0 1,746 5.7
45-49 10.3 39.3 7.3 33.6 5.6 4.0 0.0 100.0 1,606 5.1
50-54 17.7 49.3 8.4 19.3 2.7 2.6 0.0 100.0 1,496 2.9
55-59 18.8 48.6 10.0 17.4 3.5 1.6 0.0 100.0 992 3.1
60-64 16.2 47.4 11.4 21.0 2.8 1.2 0.0 100.0 791 3.5
65+ 23.4 40.5 11.8 20.4 2.5 1.3 0.1 100.0 1,572 3.6
Residence
Urban 4.3 28.7 5.6 35.9 8.9 16.6 0.0 100.0 4,623 7.2
Rural 11.6 49.0 6.8 27.2 3.3 2.0 0.0 100.0 23,756 3.9
Province
Banteay Meanchey 10.3 50.0 5.9 28.5 3.6 1.9 0.0 100.0 1,112 3.9
Kampong Cham 11.1 54.2 7.5 23.2 1.7 2.3 0.0 100.0 3,489 3.5
Kampong Chhnang 8.5 50.9 7.5 25.3 4.4 3.4 0.0 100.0 1,006 4.2
Kampong Speu 9.3 43.9 7.0 33.2 4.6 1.8 0.0 100.0 1,851 4.7
Kampong Thom 12.5 51.7 8.4 22.2 1.9 3.2 0.1 100.0 1,365 3.7
Kandal 8.9 45.3 6.7 32.2 4.4 2.6 0.0 100.0 2,287 4.6
Kratie 12.8 55.9 5.0 22.5 2.7 1.1 0.0 100.0 839 3.0
Phnom Penh 4.0 25.5 4.6 36.6 9.0 20.3 0.0 100.0 2,750 7.7
Prey Veng 9.8 45.9 6.8 33.4 2.3 1.6 0.1 100.0 1,922 4.5
Pursat 12.0 52.4 7.7 22.7 4.1 1.1 0.0 100.0 1,100 3.3
Siem Reap 20.1 47.9 5.1 19.3 4.5 3.0 0.1 100.0 1,807 2.7
Svay Rieng 3.8 46.4 6.3 34.5 5.3 3.7 0.0 100.0 1,053 5.0
Takeo 11.6 37.0 6.5 36.0 4.3 4.6 0.0 100.0 1,857 5.1
Otdar Meanchey 13.9 50.8 6.3 24.5 3.5 0.9 0.0 100.0 518 3.1
Battambang/Pailin 6.9 45.5 8.9 30.3 5.0 3.4 0.0 100.0 2,216 4.7
Kampot/Kep 8.3 48.0 6.8 29.9 4.4 2.7 0.0 100.0 1,245 4.3
Preah Sihanouk/Koh Kong 9.0 41.2 7.3 30.9 5.1 6.4 0.0 100.0 655 5.0
Preah Vihear/Stung Treng 19.3 55.5 3.9 16.0 2.5 2.9 0.0 100.0 651 2.3
Mondul Kiri/Ratanak Kiri 23.8 44.2 3.6 22.5 3.4 2.6 0.0 100.0 655 2.4
Wealth quintile
Lowest 19.9 58.9 5.9 14.2 1.0 0.2 0.0 100.0 5,424 2.3
Second 12.9 56.3 6.9 21.6 1.5 0.8 0.0 100.0 5,669 3.2
Middle 9.5 47.4 8.0 30.5 2.9 1.7 0.0 100.0 5,614 4.3
Fourth 6.9 41.2 6.7 36.6 5.5 3.0 0.0 100.0 5,876 5.2
Highest 3.6 26.0 5.6 39.2 9.7 15.9 0.0 100.0 5,796 7.5
Total 10.4 45.7 6.6 28.7 4.2 4.4 0.0 100.0 28,379 4.3
1 Completed grade 6 at the primary level
2 Completed grade 12 at the secondary level
Forty-eight percent of females and 46 percent of males in the household population have had some
primary schooling without having completed primary school. However, 37 percent of the male population
has gone on to attend secondary or higher schooling, compared with only 27 percent of females. Sixty-two
percent of males and 68 percent of females age 15-19 have gone on to secondary school. Sixty percent of
males and 58 percent of females age 20-24 have done so. As would be expected, higher percentages of
males and females in urban areas than rural areas have gone on to secondary schooling. There is a great
deal of variation in educational attainment across provinces. The outliers are Mondul Kiri/Ratanak Kiri and
Phnom Penh, where 24 percent and 4 percent of males, respectively, and 34 percent and 10 percent of
females, respectively, have never been to school.
Data on net attendance ratios (NARs) and gross attendance ratios (GARs) by school level, sex,
residence, and province are shown in Table 2.5. The NAR indicates participation in primary schooling for
the population age 6-12 and secondary schooling for the population age 13-18. The GAR measures
participation at each level of schooling among those age 6-24. The GAR is nearly always higher than the
NAR for the same level because the GAR includes participation by those who may be older or younger
than the official age range for that level. An NAR of 100 percent would indicate that all of those in the
official age range for the level are attending at that level. The GAR can exceed 100 percent if there is
significant overage or underage participation at a given level of schooling. Overage participation for a
given level of schooling occurs when students start school earlier, repeat one or more grades, or drop out of
school and later return.
16 • Household Population and Housing Characteristics
Table 2.5 School attendance ratios
Net attendance ratios (NARs) and gross attendance ratios (GARs) for the de facto household population by sex and level of schooling, and
the gender parity index (GPI), according to background characteristics, Cambodia 2014
Net attendance ratio1 Gross attendance ratio2
Background
characteristic Male Female Total
Gender
parity index3 Male Female Total
Gender
parity index3
PRIMARY SCHOOL
Residence
Urban 85.0 83.0 84.0 0.98 94.9 93.0 94.0 0.98
Rural 80.9 83.4 82.1 1.03 95.8 94.8 95.3 0.99
Province
Banteay Meanchey 78.5 82.1 80.5 1.05 92.9 88.2 90.4 0.95
Kampong Cham 80.6 88.3 84.5 1.10 98.2 97.3 97.7 0.99
Kampong Chhnang 85.5 83.8 84.6 0.98 99.2 98.2 98.7 0.99
Kampong Speu 80.8 84.5 82.6 1.05 97.5 98.1 97.8 1.01
Kampong Thom 80.9 82.0 81.5 1.01 95.1 93.9 94.5 0.99
Kandal 77.4 81.0 79.0 1.05 87.8 87.8 87.8 1.00
Kratie 74.8 77.6 76.2 1.04 91.1 90.4 90.7 0.99
Phnom Penh 82.3 82.7 82.5 1.00 92.3 94.0 93.1 1.02
Prey Veng 87.1 79.6 83.7 0.91 98.4 92.7 95.8 0.94
Pursat 81.4 80.5 80.9 0.99 98.8 96.9 97.9 0.98
Siem Reap 78.8 82.7 80.7 1.05 88.2 92.6 90.3 1.05
Svay Rieng 87.0 88.5 87.8 1.02 98.9 96.4 97.6 0.97
Takeo 83.6 86.4 85.0 1.03 100.6 96.2 98.4 0.96
Otdar Meanchey 81.3 78.8 80.2 0.97 101.3 89.4 95.7 0.88
Battambang/Pailin 86.7 84.2 85.5 0.97 100.4 96.4 98.4 0.96
Kampot/Kep 85.0 86.9 85.9 1.02 98.2 97.1 97.6 0.99
Preah Sihanouk/Koh Kong 83.6 82.2 82.9 0.98 99.0 96.1 97.6 0.97
Preah Vihear/Stung Treng 72.6 78.5 75.5 1.08 94.5 96.2 95.3 1.02
Mondul Kiri/Ratanak Kiri 67.1 75.0 71.2 1.12 88.5 94.0 91.4 1.06
Wealth quintile
Lowest 75.5 82.0 78.6 1.09 91.4 96.6 93.9 1.06
Second 81.7 82.9 82.3 1.01 96.8 97.2 97.0 1.00
Middle 82.9 83.5 83.3 1.01 97.2 93.0 95.1 0.96
Fourth 84.7 86.6 85.6 1.02 100.6 94.4 97.5 0.94
Highest 85.0 82.1 83.6 0.97 93.6 89.9 91.7 0.96
Total 81.4 83.4 82.4 1.02 95.7 94.5 95.1 0.99
SECONDARY SCHOOL
Residence
Urban 58.9 54.3 56.5 0.92 75.5 67.7 71.4 0.90
Rural 39.5 42.3 40.9 1.07 48.6 51.5 50.0 1.06
Province
Banteay Meanchey 46.6 43.0 44.8 0.92 53.7 52.4 53.1 0.98
Kampong Cham 35.1 46.7 40.9 1.33 43.3 55.6 49.4 1.28
Kampong Chhnang 46.7 49.9 48.4 1.07 52.3 58.1 55.4 1.11
Kampong Speu 41.4 30.6 36.2 0.74 50.0 35.9 43.2 0.72
Kampong Thom 36.8 43.6 40.1 1.18 47.6 54.0 50.8 1.13
Kandal 40.8 37.9 39.3 0.93 53.1 42.5 47.9 0.80
Kratie 29.7 38.0 33.7 1.28 38.0 46.7 42.2 1.23
Phnom Penh 57.9 49.9 53.9 0.86 73.0 61.1 67.1 0.84
Prey Veng 50.8 51.5 51.1 1.01 58.8 65.5 61.9 1.11
Pursat 24.4 33.5 28.9 1.37 36.7 43.4 40.0 1.18
Siem Reap 34.6 34.9 34.8 1.01 44.1 44.3 44.2 1.00
Svay Rieng 58.0 47.3 53.2 0.82 71.5 61.9 67.3 0.87
Takeo 58.1 66.8 62.1 1.15 74.9 82.1 78.2 1.10
Otdar Meanchey 29.8 32.6 31.1 1.09 36.1 41.3 38.5 1.14
Battambang/Pailin 40.5 52.8 46.8 1.30 48.2 65.4 57.0 1.36
Kampot/Kep 47.4 54.8 50.9 1.16 59.0 66.0 62.3 1.12
Preah Sihanouk/Koh Kong 45.4 43.3 44.3 0.95 53.1 56.2 54.7 1.06
Preah Vihear/Stung Treng 21.2 27.1 24.2 1.28 28.7 34.2 31.6 1.19
Mondul Kiri/Ratanak Kiri 23.6 20.2 21.8 0.85 30.2 24.2 27.1 0.80
Wealth quintile
Lowest 17.0 25.0 20.8 1.47 23.1 29.6 26.2 1.28
Second 30.7 34.4 32.5 1.12 37.2 41.8 39.4 1.12
Middle 45.9 45.6 45.8 0.99 58.5 56.3 57.4 0.96
Fourth 53.1 55.4 54.2 1.04 64.6 65.3 64.9 1.01
Highest 66.5 58.9 62.5 0.88 81.4 75.1 78.1 0.92
Total 42.4 44.3 43.3 1.05 52.6 54.2 53.4 1.03
1 The NAR for primary school is the percentage of the primary school age (6-12 years) population that is attending primary school. The
NAR for secondary school is the percentage of the secondary school age (13-18 years) population that is attending secondary school. By
definition the NAR cannot exceed 100 percent.
2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary school age
population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official
secondary school age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR
can exceed 100 percent.
3 The gender parity index for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males. The
gender parity index for secondary school is the ratio of the secondary school NAR (GAR) for females to the NAR (GAR) for males.
Household Population and Housing Characteristics • 17
Of those children who should be attending primary school, 81 percent of females and 83 percent
of males are currently doing so. In 2010, 85 percent of children who should have been attending primary
school were doing so. The NAR is significantly lower at the secondary school level and at about the same
level found in 2010. Forty-three percent of secondary school-age youths are in school at that level (this
figure was 44 percent in 2010). Similar to 2010, there is little difference between the NAR of males and
females at both the primary and the secondary level.
Table 2.5 also shows the gender parity index (GPI) for primary and secondary school. The GPI for
primary school is the ratio of the primary school NAR/GAR for females to the NAR/GAR for males. The
GPI for secondary school is the ratio of the secondary school NAR/GAR for females to the NAR/GAR for
males. The primary school GPI for NAR of 1.02 indicates gender parity at the primary level, reflecting the
fact that about the same proportions of girls and boys attend primary school. The GPI for NAR of 1.05 at
the secondary school level indicates near parity at the secondary level. The GPIs for NAR in urban areas
and rural areas indicate parity or near parity at the primary level (0.98 and 1.03, respectively). However,
the GPI for NAR at the secondary level in urban areas is 0.92, reflecting the fact that a smaller proportion
of girls than boys in urban areas attend secondary school. The GPI for NAR varies across provinces, and
this variation is far more evident at the secondary school level than at the primary school level (Table 2.5).
The GPI for GAR at the primary level (0.99) and at the secondary level (1.03) indicates near parity. The
primary school GPI and the secondary school GPI for GAR follow patterns of the GPIs for NAR.
Figure 2.2 illustrates age-specific attendance rates, that is, the percentage of a given age cohort
attending school regardless of the level attended (primary, secondary, or higher). Although the minimum
age for schooling in Cambodia is 6 years, some children enroll prior to this age, and only about three in
every five children age 6 are attending school.
Figure 2.2 Age-specific attendance rates
Similar to 2010, boys and girls attend school in about equal proportions. Up to and including age
13, the proportion of girls attending school is slightly higher than for boys, and then it is slightly lower
than for boys at age 14 to 16. From age 17 to 23, young men attend school at a noticeably higher
proportion than young women. At age 24, the proportions of men and women attending school are about
equal.
2.3 HOUSING CHARACTERISTICS
Types of water sources and sanitation facilities are important determinants of the health status of
household members and particularly of children. Proper hygienic and sanitation practices can reduce
0
10
20
30
40
50
60
70
80
90
100
5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
Percent
Age
Male Female
CDHS 2014
Note: Figure shows percentage of the de jure household population
age 5-24 years attending school
18 • Household Population and Housing Characteristics
exposure to and the seriousness of major childhood diseases such as diarrhea. The CDHS asked
respondents about the household source of drinking water, the time required round trip to obtain that water,
and the type of sanitation facility used by the household. In Cambodia, the source of drinking water can
vary between the dry season and the rainy season, so separate questions were asked for the different
seasons. If households had more than one source of drinking water, respondents were asked to identify the
most commonly used source.
2.3.1 Water Supply
Table 2.6 shows that sources of drinking water were the same during the dry and rainy seasons for
92 percent of urban households and 67 percent of rural households. The source of drinking water is an
indicator of whether it is suitable for drinking. Sources that are considered likely to be of suitable quality
are listed under “Improved source” and those that may not be of suitable quality are listed under “Nonimproved source,” reflecting the categorizations proposed by the World Health Organization (WHO), the
United Nations Children’s Fund (UNICEF), and the Joint Monitoring Programme (JMP) for Water Supply
and Sanitation.
During the dry season, 35 percent of households in Cambodia consume drinking water from a
non-improved source. This percentage declines to 16 percent of households during the rainy season, when
more households utilize rainwater for drinking water. The main source of drinking water during the rainy
season is rainwater for nearly two of five households. Rainwater is the most common source of drinking
water during the rainy season for rural households.
Even if water is not piped directly into the dwelling or yard, it is common for the source of water
to be on the household premises, especially during the rainy season. Seventy-five percent of households
report that their source of drinking water during the rainy season is located on the household premises. The
variation between urban households and rural households is insignificant. During the dry season, the
percentage of households with their source of drinking water on the premises declines to 69 percent and 51
percent among urban and rural households, respectively. Among those households neither having a source
of drinking water on the premises nor having water delivered, the majority are within 30 minutes or less in
round trip time of obtaining it. During the dry season only 6 percent of households are 30 minutes or
longer away from a source, and during the rainy season that number drops to just 2 percent requiring 30
minutes or more.
Household Population and Housing Characteristics • 19
Table 2.6 Household drinking water
Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and
treatment of drinking water, according to residence, Cambodia 2014
Households Population
Characteristic Urban Rural Total Urban Rural Total
Source of drinking water during dry
season
Improved source 95.0 60.1 65.2 95.1 58.8 64.5
Piped water into dwelling/yard/plot 51.7 5.7 12.3 54.0 5.7 13.3
Public tap/standpipe 1.8 0.5 0.7 1.9 0.5 0.8
Tube well or borehole 7.7 31.1 27.8 7.2 30.0 26.4
Protected dug well 1.4 4.0 3.6 1.4 4.2 3.8
Protected spring 0.2 0.3 0.3 0.2 0.3 0.3
Rainwater 5.5 10.1 9.4 4.9 9.6 8.9
Bottled water 26.7 8.4 11.0 25.7 8.4 11.1
Non-improved source 4.9 39.8 34.8 4.7 41.2 35.4
Unprotected dug well 1.6 13.4 11.7 1.5 13.8 11.9
Unprotected spring 0.1 1.3 1.1 0.1 1.3 1.1
Tanker truck/cart with small tank 1.6 3.9 3.6 1.6 3.9 3.6
Surface water 1.6 21.2 18.4 1.4 22.2 18.9
Other 0.1 0.0 0.0 0.2 0.0 0.0
Total 100.0 100.0 100.0 100.0 100.0 100.0
Time to obtain drinking water
(round trip)
Water on premises 69.1 51.3 53.9 70.4 50.9 54.0
Less than 30 minutes 27.6 39.5 37.8 26.1 39.5 37.4
30 minutes or longer 1.3 7.1 6.3 1.6 7.5 6.6
Don’t know/missing 2.0 2.1 2.1 1.9 2.1 2.1
Total 100.0 100.0 100.0 100.0 100.0 100.0
Source of drinking water during
rainy season
Improved source 97.6 81.4 83.7 97.5 80.6 83.3
Piped water into dwelling/yard/plot 49.9 4.7 11.2 51.9 4.6 12.1
Public tap/standpipe 1.6 0.5 0.7 1.7 0.5 0.7
Tube well or borehole 6.7 25.4 22.7 6.2 24.1 21.3
Protected dug well 1.2 2.8 2.5 1.2 2.9 2.6
Protected spring 0.2 0.2 0.2 0.1 0.2 0.2
Rainwater 13.4 40.8 36.9 12.7 41.4 36.9
Bottled water 24.7 7.0 9.6 23.6 6.9 9.5
Non-improved source 2.3 18.5 16.2 2.3 19.3 16.6
Unprotected dug well 1.1 9.3 8.1 1.1 9.5 8.2
Unprotected spring 0.0 0.7 0.6 0.0 0.8 0.7
Tanker truck/cart with small tank 0.6 0.9 0.8 0.7 0.9 0.8
Surface water 0.6 7.7 6.6 0.6 8.1 6.9
Other 0.1 0.0 0.0 0.1 0.0 0.0
Missing 0.0 0.1 0.1 0.0 0.1 0.1
Total 100.0 100.0 100.0 100.0 100.0 100.0
Time to obtain drinking water
(round trip) during rainy season
Water on premises 73.7 74.9 74.8 74.7 75.2 75.1
Less than 30 minutes 24.0 21.9 22.2 22.8 21.4 21.6
30 minutes or longer 0.8 2.1 1.9 0.9 2.3 2.1
Don’t know/missing 1.5 1.1 1.1 1.5 1.1 1.2
Total 100.0 100.0 100.0 100.0 100.0 100.0
Percentage using same water
within dry and rainy season 91.5 67.3 70.8 91.7 66.2 70.2
Water treatment prior to drinking1
Boiled 56.7 54.9 55.1 56.6 54.4 54.7
Bleach/chlorine added 0.1 0.3 0.2 0.0 0.3 0.2
Strained through cloth 0.3 0.7 0.6 0.3 0.7 0.6
Ceramic, sand, or other filter 15.9 16.7 16.6 17.0 16.9 16.9
Solar disinfection 0.3 0.1 0.1 0.3 0.1 0.1
Stand and settle 0.7 5.3 4.7 0.7 5.3 4.6
Other 0.6 0.2 0.3 0.5 0.2 0.3
No treatment 30.4 30.8 30.8 29.9 31.4 31.2
Percentage using an appropriate
treatment method2 68.7 67.0 67.3 69.3 66.6 67.0
Number 2,284 13,541 15,825 11,469 61,489 72,958
1 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent.
2 Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting.
20 • Household Population and Housing Characteristics
Fifty-five percent of households boil their water prior to drinking. There is little variation between
urban and rural areas in the proportion of households that boil their water prior to drinking. Seventeen
percent of households use a ceramic, sand, or other type of filter to filter their water prior to drinking.
Among those that do not boil their water, the most common action is to do nothing to treat the water prior
to drinking. Overall, 31 percent of households report that they do nothing to treat their drinking water
before consuming it. Drinking water without prior treatment is equally likely among urban and rural
households. However, the likelihood of drinking water without prior treatment is somewhat higher than in
2010.
2.3.2 Sanitation Facilities
A household’s toilet facility is classified as hygienic if it is used only by household members (is
not shared by other households) and if the type of toilet effectively separates human waste from human
contact. The types of facilities most likely to accomplish this are toilets that flush or pour flush into a piped
sewer system, septic tank, or pit latrine; ventilated improved pit (VIP) latrines; pit latrines with a slab; and
composting toilets. Households that share their toilet facility or do not effectively separate human waste
from human contact are classified as unhygienic. These categories are those proposed by the
WHO/UNICEF Joint Monitoring Program.
Table 2.7 Household sanitation facilities
Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence,
Cambodia 2014
Households Population
Type of toilet/latrine facility Urban Rural Total Urban Rural Total
Improved, not shared facility
Flush/pour flush to piped sewer
system 37.4 0.7 6.0 38.8 0.7 6.7
Flush/pour flush to septic tank 45.2 37.2 38.4 45.7 38.6 39.7
Flush/pour flush to pit latrine 0.5 1.0 0.9 0.4 0.9 0.9
Ventilated improved pit (VIP) latrine 0.0 0.1 0.0 0.0 0.0 0.0
Pit latrine with slab 0.1 0.5 0.5 0.1 0.6 0.5
Composting toilet 0.0 0.2 0.2 0.0 0.3 0.2
Total 83.2 39.7 46.0 85.0 41.2 48.1
Shared facility1
Flush/pour flush to piped sewer
system 2.3 0.2 0.5 1.8 0.2 0.5
Flush/pour flush to septic tank 6.1 8.7 8.3 5.5 8.3 7.9
Flush/pour flush to pit latrine 0.1 0.2 0.2 0.1 0.1 0.1
Ventilated improved pit (VIP) latrine 0.0 0.0 0.0 0.0 0.0 0.0
Pit latrine with slab 0.0 0.1 0.1 0.0 0.1 0.1
Composting toilet 0.0 0.0 0.0 0.0 0.0 0.0
Total 8.6 9.1 9.0 7.5 8.7 8.5
Non-improved facility
Flush/pour flush not to sewer/septic
tank/pit latrine 1.0 0.2 0.3 1.0 0.2 0.3
Pit latrine without slab/open pit 0.0 0.1 0.1 0.0 0.1 0.1
Bucket 0.0 0.1 0.1 0.0 0.1 0.1
Hanging toilet/hanging latrine 0.3 0.4 0.4 0.3 0.4 0.4
No facility/bush/field 6.9 50.4 44.1 6.2 49.3 42.5
Missing 0.0 0.0 0.0 0.0 0.0 0.0
Total 8.2 51.2 45.0 7.6 50.1 43.4
Total 100.0 100.0 100.0 100.0 100.0 100.0
Number 2,284 13,541 15,825 11,469 61,489 72,958
1 Facilities that would be considered improved if they were not shared by two or more households
Households vary greatly in access to hygienic facilities by urban and rural residence, as shown in
Table 2.7. The majority of households in rural areas have no toilet facility, with half of households (50
percent) reporting no toilet facility and making use of fields or bush areas. This figure was reported among
only 7 percent of urban households. Access to hygienic facilities has improved substantially, as the
percentage of households which have no facilities declined from 57 percent in 2010 to 44 percent in 2014.
Household Population and Housing Characteristics • 21
2.3.3 Hand Washing
Washing hands with water and soap before preparing and eating food and after leaving the toilet is
a simple and inexpensive practice that protects against many diseases. During the survey, interviewers
asked to see the place members of the household used for hand washing and observed whether water and
soap or some other cleansing agent was available.
Table 2.8 shows that interviewers observed a place for hand washing in 85 percent of
households—a significant increase from 66 percent observed in 2010. Eighty percent of these households
had water and soap for hand washing, and 19 percent had water only. In urban areas, nearly all households
(97 percent) had a place for hand washing, as compared with 83 percent of households in rural areas.
Ninety-four percent of urban households had soap and water available at a hand washing place, compared
with only 77 percent of rural households. A higher percentage of households in rural areas than urban areas
had water but no soap (22 percent versus 6 percent).
Among the provinces, interviewers observed a place for hand washing in only 42 percent of the
households in Mondul Kiri/Ratanak Kiri and 55 percent of the households in Takeo. Among households
where a place for hand washing was observed, the lowest proportions with soap and water were in Takeo
(59 percent) and Kandal (60 percent). The proportion of households with a place for hand washing
increases with increasing wealth, from 74 percent among households in the lowest quintile to 96 percent
among those in the highest quintile. Thirty percent of households in the lowest wealth quintile have water
but no soap, compared with only 6 percent of households in the highest quintile.
Table 2.8 Hand washing
Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was
observed, percent distribution by availability of water, soap, and other cleansing agents, Cambodia 2014
Percentage of
households
where place
for washing
hands was
observed
Number of
households
Among households where place for hand washing was observed, percentage with:
Number of
households
with place for
hand washing
observed
Background
characteristic
Soap and
water1
Water and
cleansing
agent2 other
than soap
only Water only
Soap but no
water3
No water,
no soap, no
other
cleansing
agent Missing Total
Residence
Urban 97.1 2,284 94.1 0.0 5.7 0.0 0.1 0.0 100.0 2,217
Rural 82.6 13,541 77.0 0.1 22.0 0.2 0.8 0.0 100.0 11,189
Province
Banteay Meanchey 98.3 670 94.1 0.2 5.7 0.0 0.0 0.0 100.0 658
Kampong Cham 82.0 1,997 89.4 0.1 10.2 0.2 0.0 0.0 100.0 1,638
Kampong Chhnang 83.1 608 87.2 0.0 12.8 0.0 0.0 0.0 100.0 506
Kampong Speu 99.0 973 69.8 0.0 30.2 0.0 0.0 0.0 100.0 963
Kampong Thom 97.5 801 85.3 0.1 11.5 0.5 2.5 0.0 100.0 781
Kandal 89.5 1,259 59.8 0.0 39.3 0.3 0.6 0.0 100.0 1,127
Kratie 87.9 451 70.9 0.8 26.6 0.8 1.0 0.0 100.0 397
Phnom Penh 98.8 1,293 98.5 0.0 1.4 0.0 0.0 0.0 100.0 1,278
Prey Veng 60.1 1,228 93.0 0.2 6.8 0.0 0.0 0.0 100.0 738
Pursat 96.5 611 61.8 0.0 36.8 0.0 1.4 0.0 100.0 589
Siem Reap 63.6 1,000 95.8 0.0 4.2 0.0 0.0 0.0 100.0 636
Svay Rieng 93.2 678 78.2 0.0 21.5 0.1 0.2 0.0 100.0 632
Takeo 54.9 1,011 59.1 0.1 35.3 0.3 5.3 0.0 100.0 555
Otdar Meanchey 89.9 271 89.2 0.0 10.7 0.0 0.2 0.0 100.0 244
Battambang/Pailin 96.7 1,222 60.9 0.0 37.5 0.2 1.4 0.0 100.0 1,181
Kampot/Kep 90.2 762 70.4 0.0 29.0 0.4 0.2 0.0 100.0 687
Preah Sihanouk/Koh Kong 99.8 320 98.1 0.0 1.9 0.0 0.0 0.0 100.0 319
Preah Vihear/Stung Treng 96.1 361 88.7 0.0 11.2 0.1 0.0 0.0 100.0 346
Mondul Kiri/Ratanak Kiri 41.9 309 77.3 0.4 22.2 0.0 0.0 0.1 100.0 130
Wealth quintile
Lowest 73.7 3,208 68.1 0.1 30.4 0.3 1.1 0.0 100.0 2,364
Second 79.6 3,320 74.0 0.1 24.8 0.2 0.8 0.0 100.0 2,642
Middle 85.1 3,147 77.9 0.1 21.1 0.1 0.8 0.0 100.0 2,677
Fourth 90.0 3,176 82.3 0.0 16.8 0.2 0.6 0.0 100.0 2,859
Highest 96.3 2,975 94.2 0.0 5.8 0.0 0.1 0.0 100.0 2,865
Total 84.7 15,825 79.8 0.1 19.3 0.2 0.7 0.0 100.0 13,406
1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and
water and another cleansing agent.
2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand.
3 Includes households with soap only as well as those with soap and another cleansing agent
22 • Household Population and Housing Characteristics
2.3.4 Flooring Material and Cooking Arrangements
Table 2.9 presents the distribution of households by dwelling characteristics. Nearly all
households in urban areas (97 percent) live in dwellings with electricity, whereas in rural areas only about
half of households (49 percent) have electricity. Ceramic tiles are the most common type of flooring
material in urban areas, and wood planks are the most common material in rural areas. Thirty-six percent
of urban households live in dwellings with ceramic tiles, followed by 26 percent who live in dwellings
with wood planks. In rural areas, approximately half of households live in dwellings with wood plank
flooring, followed by one-quarter who live in dwellings with palm or bamboo flooring1. About two-thirds
of rural households (66 percent) sleep together in one room, whereas only 42 percent of urban households
do so. In urban areas, 57 percent of households use two or more rooms for sleeping.
Firewood is the most common source of fuel for cooking in rural areas, with 85 percent of rural
households using firewood for this purpose. There is more variability in urban areas as to what is used for
cooking fuel. Twenty-two percent of urban households use firewood, 59 percent use liquid petroleum gas,
and 16 percent use charcoal. Sixty-one percent of urban households and 37 percent of rural households
report that they do their cooking in the house.
Table 2.9 Household characteristics
Percent distribution of households by housing characteristics and percentage of households using solid fuel for
cooking, according to residence, Cambodia 2014
Households Population
Housing characteristic Urban Rural Total Urban Rural Total
Electricity
Yes 96.9 49.2 56.1 97.3 49.8 57.1
No 3.1 50.8 43.9 2.7 50.2 42.8
Total 100.0 100.0 100.0 100.0 100.0 100.0
Flooring material
Earth, sand 3.1 9.2 8.3 2.9 8.7 7.8
Dung 0.1 0.0 0.0 0.1 0.0 0.0
Wood/planks 26.1 51.1 47.5 26.7 52.7 48.7
Palm/bamboo 3.7 23.6 20.7 3.5 22.7 19.8
Parquet or polished wood 0.1 0.1 0.1 0.1 0.1 0.1
Vinyl or asphalt strips 0.0 0.1 0.1 0.0 0.0 0.0
Ceramic tiles 35.6 5.3 9.6 35.3 5.5 10.1
Cement tiles 19.2 2.8 5.2 20.0 2.8 5.5
Cement 12.1 7.7 8.4 11.4 7.2 7.9
Floating house 0.1 0.1 0.1 0.0 0.2 0.2
Total 100.0 100.0 100.0 100.0 100.0 100.0
Rooms used for sleeping
One 42.2 65.8 62.4 38.1 63.9 59.9
Two 27.4 23.8 24.3 27.5 24.7 25.2
Three or more 29.8 8.7 11.8 33.8 9.8 13.5
Missing 0.6 1.7 1.5 0.6 1.6 1.4
Total 100.0 100.0 100.0 100.0 100.0 100.0
Cooking fuel
Electricity 2.1 0.6 0.8 2.0 0.6 0.8
LPG/natural gas/biogas 58.8 7.7 15.0 59.0 7.2 15.2
Charcoal 16.3 6.5 7.9 16.3 6.5 8.0
Wood 22.1 84.6 75.6 22.3 85.2 75.4
Agricultural crop 0.0 0.3 0.2 0.0 0.3 0.2
Animal dung 0.0 0.1 0.1 0.0 0.1 0.1
No food cooked in household 0.7 0.2 0.3 0.4 0.1 0.1
Total 100.0 100.0 100.0 100.0 100.0 100.0
Place for cooking
In the house 60.9 37.0 40.4 60.6 36.5 40.3
In a separate building 17.1 25.8 24.6 17.8 26.9 25.5
Outdoors 20.4 34.1 32.1 20.4 33.5 31.5
No food cooked in household 1.4 3.1 2.8 1.1 3.0 2.7
Other 0.1 0.0 0.0 0.0 0.0 0.0
Total 100.0 100.0 100.0 100.0 100.0 100.0
Number 2,284 13,541 15,825 13,753 75,030 88,783
LPG = Liquid petroleum gas
1 If there was more than one type of flooring, interviewers recorded the predominant flooring material.
Household Population and Housing Characteristics • 23
2.4 HOUSEHOLD POSSESSIONS
Information on ownership of durable goods and other possessions is presented in Table 2.10. The
availability of durable consumer goods is a good indicator of a household’s socioeconomic level, and
particular goods have specific benefits. For example, radio access can increase exposure to innovative
ideas, whereas transport vehicles can provide access to services out of the local area.
Sixty-six percent of households in Cambodia own a television, and 87 percent own a mobile
telephone. Ownership of mobile telephones is almost universal among urban households (96 percent) and
is very common among rural households (86 percent). About two of five households (39 percent) own a
generator/battery or a solar panel.
Twenty-six percent of urban households own a car, truck, or van, an increase from 22 percent in
2010. About two-thirds of all households (68 percent) own a motorcycle, an increase from 54 percent of
households in 2010. The percentage of households owning a boat remains unchanged at about 8 percent.
Sixty-nine percent of all households own some land, which is about the same as the 2010 figure of
68 percent. Sixty-six percent of households own at least one farm animal, also about the same as the figure
reported in 2010 (67 percent).
Table 2.10 Household possessions
Percentage of households possessing various household effects, means of transportation, agricultural land, and
livestock/farm animals by residence, Cambodia 2014
Households Population
Possession Urban Rural Total Urban Rural Total
Household effects
Radio 50.4 38.2 40.0 52.9 38.4 40.7
Television 91.4 61.4 65.7 93.6 63.9 68.6
Mobile telephone 96.1 85.7 87.2 97.1 88.4 89.8
Non-mobile telephone 12.2 5.5 6.5 13.2 5.8 7.0
Refrigerator 40.4 2.5 8.0 43.5 2.7 9.1
Wardrobe 72.7 38.5 43.4 75.1 39.7 45.3
Sewing machine 17.6 6.7 8.3 19.2 7.1 9.0
CD/DVD player 47.7 27.3 30.2 51.4 30.0 33.4
Generator/battery/solar 7.9 43.9 38.7 9.2 44.9 39.3
Watch 43.7 14.9 19.0 47.7 16.2 21.1
Means of transport
Bicycle/cyclo 54.9 65.7 64.2 59.8 68.9 67.5
Animal-drawn cart 1.0 14.2 12.3 1.1 15.4 13.2
Motorcycle/scooter 83.2 65.5 68.0 86.6 69.9 72.5
Car/truck 26.0 12.1 14.1 29.1 13.4 15.8
Boat with a motor 1.3 4.5 4.1 1.7 5.3 4.8
Motorcycle cart 6.7 3.3 3.8 8.5 3.7 4.5
Boat without a motor 1.1 4.7 4.1 1.3 5.3 4.6
Ownership of agricultural land 28.7 75.9 69.1 29.5 77.1 69.6
Ownership of farm animals1 21.9 73.0 65.6 22.9 76.2 67.8
Number 2,284 13,541 15,825 11,469 61,489 72,958
1 Water buffaloes, cows, bulls, horses, donkeys, mules, goats, sheep, pigs, chickens, ducks, or elephants
2.5 HOUSEHOLD WEALTH
In addition to standard background characteristics, many of the results in this report are shown by
wealth quintiles, an indicator of the economic status of households. The 2014 CDHS did not collect data
on consumption or income, but the information collected on dwelling and household characteristics,
consumer goods, and assets is used as a measure of socioeconomic status. The resulting wealth index is an
indicator of relative level of wealth that is used as a proxy for expenditure and income measures.
Each household asset for which information is collected is assigned a weight or factor score
generated through principal components analysis. The resulting asset scores are standardized in relation to
a standard normal distribution with a mean of zero and a standard deviation of one.
24 • Household Population and Housing Characteristics
These standardized scores are then used to create the break points that define wealth quintiles.
Each household is assigned a standardized score for each asset, where the score differs depending on
whether or not the household owns that asset (or, in the case of sleeping arrangements, the number of
people per room). These scores are summed by household, and individuals are ranked according to the
total score of the household in which they reside. The sample is then divided into population quintiles (i.e.,
five groups with the same number of individuals in each). At the national level, approximately 20 percent
of the household population is grouped into each wealth quintile.
A single asset index is developed on the basis of data from the entire country sample and used in
all of the tabulations presented. The reader should keep in mind that wealth quintiles are expressed in terms
of quintiles of individuals in the population rather than quintiles of individuals at risk for any one health or
population indicator. For example, quintile rates for infant mortality refer to infant mortality rates per
1,000 live births among all people in the population quintile concerned, as distinct from quintiles of live
births or newly born infants, who constitute the only members of the population at risk of mortality during
infancy.
The wealth index has been compared against poverty rates and gross domestic product per capita
in India and against expenditure data from household surveys in Nepal, Pakistan, and Indonesia (Filmer
and Pritchett, 1998) as well as Guatemala (Rutstein, 1999). The evidence from those studies suggests that
the asset index is highly comparable to conventionally measured consumption expenditures.
Table 2.11 shows the distribution of the household population into five wealth quintiles (five
equally divided levels) based on the wealth index by residence. These distributions indicate the degree to
which wealth is evenly (or unevenly) distributed across Cambodia. As expected, urban areas are wealthier
than rural areas. For example, 84 percent of Phnom Penh’s population falls in the highest wealth quintile.
By contrast, Pursat has the lowest representation in the highest wealth quintile, with only 5 percent of its
population falling in that quintile.
Table 2.11 Wealth quintiles
Percent distribution of the de jure population by wealth quintiles, according to residence and province, Cambodia 2014
Wealth quintile
Total
Number of
persons Residence/region Lowest Second Middle Fourth Highest
Residence
Urban 1.3 1.8 4.1 14.9 78.0 100.0 11,469
Rural 23.5 23.4 23.0 20.9 9.2 100.0 61,489
Province
Banteay Meanchey 6.0 12.1 22.6 36.4 22.9 100.0 3,134
Kampong Cham 25.2 21.0 25.3 17.5 11.0 100.0 9,454
Kampong Chhnang 35.5 25.6 17.9 11.2 9.9 100.0 2,574
Kampong Speu 20.4 21.3 25.6 24.4 8.2 100.0 4,665
Kampong Thom 35.9 27.5 15.3 12.7 8.8 100.0 3,632
Kandal 5.3 13.3 27.4 33.7 20.2 100.0 5,674
Kratie 43.0 21.5 14.7 15.0 5.8 100.0 2,160
Phnom Penh 0.3 1.3 3.0 11.0 84.4 100.0 6,814
Prey Veng 22.6 27.6 26.9 15.6 7.3 100.0 4,942
Pursat 34.2 29.6 16.0 15.5 4.7 100.0 2,839
Siem Reap 30.9 25.3 15.8 11.6 16.4 100.0 4,811
Svay Rieng 23.4 30.0 24.7 14.9 6.9 100.0 2,736
Takeo 8.5 21.4 27.2 34.3 8.6 100.0 4,475
Otdar Meanchey 23.5 27.3 19.8 17.2 12.2 100.0 1,203
Battambang/Pailin 9.1 13.6 20.8 29.4 27.1 100.0 5,623
Kampot/Kep 23.2 28.5 23.6 17.2 7.5 100.0 3,220
Preah Sihanouk/Koh Kong 8.0 9.3 11.0 28.3 43.5 100.0 1,622
Preah Vihear/Stung Treng 47.1 27.3 12.9 7.0 5.7 100.0 1,813
Mondul Kiri/Ratanak Kiri 30.8 26.1 11.4 13.5 18.1 100.0 1,567
Total 20.0 20.0 20.0 20.0 20.0 100.0 72,958
2.6 BIRTH REGISTRATION
The registration of births is the inscription of the facts of a birth into an official log. A birth
certificate is issued as proof of the registration of the birth. Information on the registration of births was
Household Population and Housing Characteristics • 25
collected in the household interview by asking whether children under age 5 had a birth certificate. If the
interviewer was told that the child did not have a birth certificate, the interviewer probed further to
ascertain whether the child’s birth had been registered with the civil authority. Nearly two-thirds of
children (64 percent) had a birth certificate, and the births of 73 percent of children under age 5 were
registered. These figures are significantly higher than those found in the 2010 CDHS (51 percent and 62
percent, respectively). However, levels of registration varied greatly across the country, as shown in Table
2.12.
Table 2.12 Birth registration of children under age 5
Percentage of de jure children under age 5 whose births are registered with the civil
authorities, according to background characteristics, Cambodia 2014
Children whose births are registered
Number of
children
Background
characteristic
Percentage
who had a
birth
certificate
Percentage
who did not
have a birth
certificate
Percentage
registered
Age
<2 59.4 7.8 67.2 3,125
2-4 66.8 10.5 77.4 4,680
Sex
Male 64.8 8.9 73.7 3,940
Female 62.9 10.0 72.9 3,865
Residence
Urban 75.5 8.8 84.4 1,066
Rural 62.0 9.5 71.6 6,739
Province
Banteay Meanchey 61.7 10.5 72.2 372
Kampong Cham 54.1 15.8 69.9 1,086
Kampong Chhnang 71.5 4.0 75.5 263
Kampong Speu 74.0 4.2 78.1 478
Kampong Thom 59.7 4.0 63.7 364
Kandal 80.1 4.0 84.1 530
Kratie 40.5 4.8 45.3 271
Phnom Penh 84.9 4.5 89.4 607
Prey Veng 73.7 5.5 79.2 592
Pursat 52.0 10.7 62.7 313
Siem Reap 70.5 2.0 72.6 536
Svay Rieng 84.7 2.8 87.5 297
Takeo 60.4 15.3 75.7 408
Otdar Meanchey 73.5 7.9 81.4 140
Battambang/Pailin 32.6 37.8 70.5 613
Kampot/Kep 75.8 1.1 76.9 321
Preah Sihanouk/Koh Kong 72.8 0.8 73.6 170
Preah Vihear/Stung Treng 62.8 3.7 66.5 234
Mondul Kiri/Ratanak Kiri 32.8 7.0 39.7 211
Wealth quintile
Lowest 52.5 6.7 59.1 1,878
Second 60.7 8.8 69.6 1,586
Middle 65.6 9.9 75.4 1,554
Fourth 69.1 11.7 80.8 1,347
Highest 75.5 11.1 86.6 1,439
Total 63.9 9.4 73.3 7,805
2.7 CHILDREN’S LIVING ARRANGEMENTS, ORPHANHOOD, AND SCHOOL ATTENDANCE
BY SURVIVORSHIP OF PARENTS
2.7.1 Children’s Living Arrangements and Orphanhood
Because the family is the primary safety net for children, any strategy aimed at protecting children
must place a high priority on strengthening the family’s capacities to care for children. It is therefore
essential to identify orphaned children and find out whether those who have one or both parents alive are
living with either or both surviving parents. Table 2.13 presents these two types of information for children
under age 18, according to background characteristics.
26 • Household Population and Housing Characteristics
Table 2.13 Children’s living arrangements and orphanhood
Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, the percentage of children not living with a biological parent,
and the percentage of children with one or both parents dead, according to background characteristics, Cambodia 2014
Living
with both
parents
Living with
mother but not
with father
Living with father
but not with
mother Not living with either parent
Total
Percentage
not living
with a
biological
parent
Percentage
with one or
both
parents
dead1
Number
of children
Background
characteristic
Father
alive
Father
dead
Mother
alive
Mother
dead
Both
alive
Only
father
alive
Only
mother
alive
Both
dead
Missing
information
on father/
mother
Age
0-4 82.8 6.4 0.9 0.6 0.1 8.5 0.1 0.3 0.3 0.0 100.0 9.2 1.7 7,805
<2 85.9 7.2 0.7 0.3 0.0 5.3 0.2 0.2 0.2 0.0 100.0 5.8 1.2 3,125
2-4 80.7 5.9 1.1 0.8 0.1 10.7 0.1 0.4 0.3 0.0 100.0 11.4 2.0 4,680
5-9 78.3 5.3 2.2 1.1 0.6 10.6 0.4 0.7 0.8 0.0 100.0 12.5 4.6 8,377
10-14 76.1 5.5 4.6 1.2 0.9 9.2 0.6 0.9 0.8 0.1 100.0 11.5 7.8 8,069
15-17 72.3 5.8 7.2 1.3 1.9 8.0 0.8 1.1 1.5 0.1 100.0 11.4 12.5 3,963
Sex
Male 77.9 5.9 3.4 1.0 0.7 9.3 0.5 0.6 0.7 0.1 100.0 11.0 5.8 14,346
Female 78.2 5.5 3.1 1.1 0.8 9.3 0.4 0.8 0.8 0.0 100.0 11.3 5.9 13,868
Residence
Urban 75.1 7.2 2.6 1.5 0.7 10.2 0.7 0.8 0.9 0.2 100.0 12.7 5.6 3,745
Rural 78.5 5.5 3.4 1.0 0.7 9.1 0.4 0.7 0.7 0.0 100.0 10.9 5.9 24,470
Province
Banteay Meanchey 67.6 4.5 2.9 0.8 0.4 23.2 0.3 0.1 0.2 0.0 100.0 23.8 3.8 1,251
Kampong Cham 77.7 5.8 3.4 0.9 0.9 9.0 0.2 0.8 1.2 0.1 100.0 11.2 6.6 3,723
Kampong Chhnang 74.4 7.9 5.7 1.2 0.7 9.0 0.3 0.4 0.4 0.0 100.0 10.1 7.4 1,014
Kampong Speu 85.6 5.1 2.1 0.4 0.8 5.5 0.1 0.2 0.2 0.0 100.0 6.0 3.4 1,832
Kampong Thom 78.9 6.4 3.3 0.8 0.9 8.1 0.4 0.3 0.8 0.0 100.0 9.7 5.7 1,514
Kandal 81.3 6.4 3.9 0.3 0.5 6.3 0.2 0.5 0.7 0.0 100.0 7.6 5.7 2,047
Kratie 84.5 3.7 2.2 0.6 0.4 6.0 1.7 0.5 0.4 0.0 100.0 8.6 5.1 885
Phnom Penh 77.3 7.0 2.2 1.3 0.8 8.4 0.9 0.9 0.9 0.3 100.0 11.1 5.6 2,079
Prey Veng 66.9 10.0 3.3 1.4 0.8 16.1 0.3 0.6 0.5 0.0 100.0 17.5 5.5 1,913
Pursat 81.9 3.6 4.0 1.7 0.2 7.1 0.3 0.6 0.6 0.1 100.0 8.6 5.7 1,156
Siem Reap 80.0 5.1 4.3 0.6 1.0 6.6 0.5 0.8 0.9 0.1 100.0 8.8 7.5 2,037
Svay Rieng 78.7 4.6 2.5 1.3 0.4 10.5 0.2 0.7 1.0 0.0 100.0 12.5 4.9 976
Takeo 73.6 6.5 4.2 1.7 0.7 9.5 0.1 2.3 1.3 0.0 100.0 13.2 8.6 1,678
Otdar Meanchey 83.8 2.3 2.5 1.5 0.4 7.1 0.5 0.4 1.5 0.1 100.0 9.4 5.3 515
Battambang/Pailin 74.9 5.1 1.5 2.0 0.9 13.2 0.7 0.9 0.7 0.2 100.0 15.5 4.7 2,243
Kampot/Kep 79.9 3.6 3.2 0.8 0.8 9.9 0.8 0.7 0.4 0.0 100.0 11.7 5.9 1,246
Preah Sihanouk/
Koh Kong 81.5 5.8 1.9 1.9 0.8 7.1 0.1 0.6 0.3 0.0 100.0 8.1 3.7 612
Preah Vihear/Stung
Treng 85.6 3.9 6.1 0.5 0.6 2.3 0.3 0.1 0.5 0.0 100.0 3.2 7.6 808
Mondul Kiri/Ratanak
Kiri 86.2 4.5 3.4 0.5 0.6 2.8 0.6 0.3 1.1 0.0 100.0 4.8 5.9 685
Wealth quintile
Lowest 79.5 5.5 4.5 1.0 0.9 7.0 0.3 0.6 0.8 0.0 100.0 8.7 7.0 6,616
Second 77.7 5.7 3.7 1.1 1.0 8.9 0.5 0.5 0.8 0.0 100.0 10.8 6.5 6,023
Middle 77.4 6.1 2.6 1.2 0.5 10.2 0.4 0.8 0.6 0.1 100.0 12.0 5.0 5,574
Fourth 77.2 5.5 3.0 0.7 0.5 11.1 0.5 0.8 0.7 0.0 100.0 13.1 5.5 5,213
Highest 78.3 5.9 2.0 1.1 0.7 9.7 0.4 0.8 0.8 0.2 100.0 11.8 4.7 4,788
Total <15 79.0 5.7 2.6 1.0 0.5 9.5 0.4 0.6 0.6 0.1 100.0 11.1 4.7 24,252
Total <18 78.1 5.7 3.3 1.0 0.7 9.3 0.4 0.7 0.7 0.1 100.0 11.1 5.8 28,215
Note: Table is based on de jure members, i.e., usual residents.
1 Includes children with father dead, mother dead, both dead, and one parent dead but missing information on survival status of the other parent
The data show that 78 percent of Cambodian children under age 18 live with both of their parents.
This proportion declines steadily with age, from a high of 86 percent among children under age 2 to a low
of 72 percent among children age 15 to 17. There is little variation according to the child’s sex. The
proportion of children living with both of their parents is slightly higher in rural areas (79 percent) than in
urban areas (75 percent). The lowest proportions of children living with both parents are in Prey Veng (67
percent) and Banteay Meanchey (68 percent). Nine percent of children under age 18 live with their mother
only, whether their father is alive (6 percent) or deceased (3 percent), and 2 percent live with their father
only. Eleven percent do not live with either parent.
Overall, 6 percent of children under age 18 have lost one or both parents: less than 1 percent have
lost both parents, 5 percent have lost their father, and 2 percent have lost their mother. Because a parent’s
Household Population and Housing Characteristics • 27
risk of dying increases with time, the proportion of children who have lost their father and/or mother
increases significantly with age, from 1 percent among children less than age 2 and 2 percent among
children age 2 to 4 to 5 percent among children age 5 to 9. It increases further to 8 percent among children
age 10 to 14 and 13 percent among children age 15 to 17.
2.7.2 School Attendance by Survivorship of Parents
Access to education is considered an “essential service” and is included among the key
components of national responses to guarantee orphans access to services on an equal basis with other
children.
To assess whether orphans are educationally disadvantaged in relation to other children, an
indicator was devised to compare school attendance among orphans and non-orphans. The results are
presented in Table 2.14 for children age 10 to 14, the age group in which school attendance is generally
assumed for all children.
The data show a clear relationship between parent survivorship and school attendance of children
age 10 to 14. According to the 2014 CDHS, 89 percent of children whose parents are both alive and who
are living with one or both of their parents attend school, as compared with only 78 percent of children
who have lost both parents. The ratio of school attendance for orphaned and non-orphaned children is less
than 1 (0.88), indicating an educational disadvantage for orphans.
Table 2.14 School attendance by survivorship of parents
For de jure children 10-14 years of age, the percentage attending school by parental survival and the ratio of
the percentage attending, by parental survival, according to background characteristics, Cambodia 2014
Percentage attending school by survivorship of parents
Background
characteristic
Both parents
deceased Number
Both parents
alive and living
with at least
one parent Number Ratio1
Sex
Male (65.0) 24 88.4 3,360 0.74
Female (86.0) 39 89.1 3,323 0.97
Residence
Urban (89.9) 8 93.4 842 0.96
Rural (76.2) 55 88.1 5,841 0.86
Province
Banteay Meanchey * 0 85.4 248 1.17
Kampong Cham * 2 91.0 882 1.10
Kampong Chhnang * 3 93.5 240 1.07
Kampong Speu * 3 86.7 504 1.15
Kampong Thom * 5 84.7 375 0.72
Kandal * 6 83.4 475 0.35
Kratie * 2 89.6 202 1.12
Phnom Penh * 2 94.2 452 1.06
Prey Veng * 5 93.1 414 0.37
Pursat * 2 86.2 298 1.10
Siem Reap * 6 81.5 479 1.23
Svay Rieng * 1 93.2 246 1.07
Takeo * 6 95.2 386 0.82
Otdar Meanchey * 4 86.1 125 0.85
Battambang/Pailin * 8 90.0 489 1.11
Kampot/Kep * 3 90.8 326 0.73
Preah Sihanouk/Koh Kong * 1 92.0 157 0.88
Preah Vihear/Stung Treng * 1 84.3 196 1.19
Mondul Kiri/Ratanak Kiri * 2 80.5 189 1.02
Wealth quintile
Lowest * 18 81.0 1,626 0.81
Second * 14 86.7 1,446 0.79
Middle * 10 89.9 1,339 0.83
Fourth * 11 93.9 1,249 1.04
Highest * 10 96.1 1,023 0.99
Total 78.0 63 88.7 6,683 0.88
Note: Table is based only on children who usually live in the household.
1 Ratio of the percentage with both parents deceased to the percentage with both parents alive and living
with a parent
Utilization of Health Services for Accident, Illness, or Injury • 29
UTILIZATION OF HEALTH SERVICES FOR
ACCIDENT, ILLNESS, OR INJURY 3
Key Findings
• Two percent of household members were injured or killed in an accident
in the years before the survey.
• Seven in 10 injuries or deaths are attributed to road accidents.
• Thirteen percent of household members had an illness or injury in the
month before the survey. Among them 95 percent sought a first
treatment, 22 percent a second treatment, and 7 percent a third
treatment.
n 1998, the Ministry of Health was beginning to implement a redesigned health coverage plan created
to improve the accessibility and quality of government health services. The major aim of the new
health care plan was to create a network of health centers throughout the country delivering the
“Minimum Package of Activities” services. The data collected in the 1998 National Health Survey
provided a baseline of health conditions in the country before implementation of the new health coverage
plan. The CDHS surveys implemented in 2000, 2005, and 2010 assessed progress every five years under
the coverage plan, and the 2014 CDHS provides updated progress on those health conditions.
Utilization of health services was assessed in the Household Questionnaire. The questions were
asked to all households in the sample. First, information was collected to assess the prevalence of injuries
and deaths due to accidents in the past year. Second, the respondent was asked whether any household
members suffered from any physical impairment. Third, the respondent was asked about the severity of
illness or injury and the subsequent utilization of health services among all members of the household who
had been ill or injured in the 30 days preceding the interview.
3.1 ACCIDENTAL DEATH OR INJURY
All households reported on whether any household member had suffered accidental injury or
death in the 12 months preceding the household interview. If anyone had been injured, the cause of the
injury was recorded. The respondent to the Household Questionnaire was further asked whether the
accident victim was alive or dead and, if dead, whether the death was the result of the reported accident.
The questions were designed in this order to definitively assess the cause of injury and, if a death was
noted, the cause of death.
3.1.1 Frequency of Accidental Death or Injury
Accidental injuries and deaths in Cambodia were not common (Table 3.1). Two percent of the
population had suffered an injury or death by accident in the past 12 months. Accidental injuries were
much more common than accidental deaths; for every 1,000 people in the population, 17 suffered an injury
and 1 suffered an accidental death.
The percentage of the population injured in the past 12 months increased with age from 0.7
percent among children age 0-9 to a peak of 2.6 percent among adults age 20-39. The percentage
experiencing accidental injury decreased thereafter, to 1.7 percent among adults age 40-59 and 1.5 percent
among those age 60 and above.
Males were more than twice as likely as females to be injured in an accident. Overall, 2.4 percent
of males had been injured in an accident in the past 12 months, as compared with 1.1 percent of females.
I
30 • Utilization of Health Services for Accident, Illness, or Injury
Although there were no differences in accidental injuries by urban-rural residence, there were differences
across provinces. The highest percentage of accidental injury was reported in Kratie, with 3.3 percent of
the household population experiencing an injury in the preceding 12 months. The lowest rates of accidental
injury were in Preah Vihear/Stung Treng (0.2 percent) and Otdar Meanchey (0.8 percent). The percentage
of accidental death ranged from 0.0 to 0.2 percent across provinces.
Table 3.1 Injury or death in an accident
Percentage of the de jure household population injured or killed in an accident in the past 12
months, according to background characteristics, Cambodia 2014
Background
characteristic
Result of accident Total injured or
killed
Total number
of de jure
household
members Injured Killed
Age
0-9 0.7 0.2 0.9 16,182
10-19 1.6 0.1 1.6 14,576
20-39 2.6 0.0 2.6 22,161
40-59 1.7 0.0 1.7 13,959
60+ 1.5 0.0 1.6 6,079
Sex
Male 2.4 0.0 2.5 35,336
Female 1.1 0.1 1.1 37,622
Residence
Urban 1.7 0.0 1.7 11,469
Rural 1.7 0.1 1.8 61,489
Province
Banteay Meanchey 1.4 0.1 1.5 3,134
Kampong Cham 2.1 0.0 2.1 9,454
Kampong Chhnang 2.9 0.1 3.0 2,574
Kampong Speu 1.4 0.1 1.5 4,665
Kampong Thom 1.4 0.0 1.4 3,632
Kandal 2.1 0.0 2.1 5,674
Kratie 3.3 0.0 3.3 2,160
Phnom Penh 1.7 0.0 1.7 6,814
Prey Veng 1.1 0.1 1.2 4,942
Pursat 1.1 0.1 1.2 2,839
Siem Reap 1.6 0.0 1.7 4,811
Svay Rieng 1.4 0.1 1.5 2,736
Takeo 1.6 0.1 1.7 4,475
Otdar Meanchey 0.8 0.0 0.8 1,203
Battambang/Pailin 2.1 0.1 2.2 5,623
Kampot/Kep 1.7 0.1 1.8 3,220
Preah Sihanouk/Koh Kong 2.3 0.0 2.3 1,622
Preah Vihear/Stung Treng 0.2 0.0 0.3 1,813
Mondul Kiri/Ratanak Kiri 1.6 0.2 1.8 1,567
Total 1.7 0.1 1.8 72,958
3.1.2 Type of Accident
Table 3.2 presents data on accidental injury by type of accident, according to the background
characteristics of age, sex, residence, and province. Data on accidental deaths are also included, but these
data are not available by age and sex.
Road accidents accounted for the greatest proportion of accidental injuries and deaths. More than
7 of 10 people who had been injured or killed in the previous 12 months were injured as a result of a road
accident. Nine percent of injuries/deaths were the result of a fall, and 5 percent were the result of a snake
or animal bite. Two percent of injuries/deaths resulted from violence. One percent of injuries/deaths were
the result of burning, while less than 1 percent each were the result of a gunshot, drowning, and poisoning.
Nine percent of injuries/deaths were due to other or unknown causes.
Utilization of Health Services for Accident, Illness, or Injury • 31
Table 3.2 Injury or death in an accident by type of accident
Percentage of the de jure household population injured or killed in an accident in the past 12 months by type of accident, according to age and sex, Cambodia
2014
Type of accident
Don’t
know/
missing Total
Number
of persons
injured
Background
characteristic Gunshot
Road
accident
Severe
burning
Snake/
animal
bite
Fall from
tree/
building Drowning1
Poisoning
(chemical) Violence Other
INJURED
Age
0-9 0.0 48.7 2.0 13.5 22.5 0.0 0.0 1.5 6.6 5.1 100.0 121
10-19 0.0 67.8 2.0 5.1 9.2 0.0 0.0 3.7 12.1 0.0 100.0 230
20-39 0.7 79.4 1.1 3.3 6.1 0.0 0.4 2.7 6.3 0.0 100.0 581
40-59 0.1 73.1 0.9 4.5 11.1 0.0 0.6 1.6 8.2 0.0 100.0 243
60+ 0.0 60.3 0.0 6.4 13.1 0.0 0.0 1.1 17.6 1.4 100.0 92
Sex
Male 0.5 74.1 0.2 4.9 8.6 0.0 0.3 3.0 8.2 0.3 100.0 864
Female 0.0 66.8 3.5 5.6 12.0 0.0 0.3 1.3 9.3 1.3 100.0 402
Total 0.3 71.8 1.2 5.1 9.7 0.0 0.3 2.4 8.6 0.6 100.0 1,267
INJURED OR KILLED
Residence
Urban 1.5 81.8 0.6 2.0 5.5 0.0 0.1 3.1 4.8 0.5 100.0 197
Rural 0.3 69.6 1.3 5.5 10.1 0.9 0.3 2.3 9.2 0.6 100.0 1,109
Province
Banteay Meanchey 0.0 62.5 9.5 4.0 14.4 0.0 0.0 0.0 9.6 0.0 100.0 47
Kampong Cham 0.0 67.3 1.8 6.6 14.4 0.0 0.0 0.0 8.0 1.9 100.0 199
Kampong Chhnang 0.0 64.8 0.0 2.7 15.4 1.1 0.0 3.4 12.6 0.0 100.0 78
Kampong Speu 0.0 90.4 0.0 0.0 4.2 0.0 0.0 0.0 5.4 0.0 100.0 69
Kampong Thom 0.4 63.7 2.9 7.0 14.6 2.3 0.0 2.4 4.5 2.2 100.0 53
Kandal 0.0 71.1 1.5 2.2 6.2 0.0 0.0 5.2 13.8 0.0 100.0 120
Kratie 0.0 56.4 0.8 10.7 15.5 0.0 4.4 0.9 11.4 0.0 100.0 72
Phnom Penh 2.3 84.5 0.8 3.5 2.8 0.0 0.0 2.0 4.1 0.0 100.0 115
Prey Veng (5.2) (71.9) (0.0) (3.0) (8.2) (5.5) (0.0) (2.6) (3.5) (0.0) (100.0) 60
Pursat (0.0) (59.9) (0.0) (6.8) (19.1) (8.6) (0.0) (0.5) (5.0) (0.0) (100.0) 34
Siem Reap 0.0 81.1 0.0 0.0 8.2 0.0 0.0 5.9 4.9 0.0 100.0 81
Svay Rieng 0.0 75.8 3.8 0.0 12.7 0.0 0.0 0.0 7.8 0.0 100.0 41
Takeo 0.0 68.9 1.7 5.4 6.7 2.0 0.0 1.8 11.9 1.7 100.0 76
Otdar Meanchey (0.0) (89.0) (0.0) (0.0) (6.6) (0.0) (0.0) (4.4) (0.0) (0.0) (100.0) 10
Battambang/Pailin 0.0 80.4 0.0 2.9 5.5 0.0 0.0 4.1 7.0 0.0 100.0 123
Kampot/Kep 0.0 56.0 0.0 17.2 6.5 0.0 0.5 3.9 13.9 2.1 100.0 57
Preah Sihanouk/Koh
Kong 0.0 67.1 0.0 4.0 8.2 0.0 0.0 6.5 14.1 0.0 100.0 38
Preah Vihear/Stung
Treng * * * * * * * * * * * 5
Mondul Kiri/Ratanak
Kiri 0.0 63.8 0.0 20.5 2.2 2.1 0.0 0.8 10.5 0.0 100.0 28
Total 0.5 71.4 1.2 4.9 9.4 0.8 0.3 2.4 8.5 0.6 100.0 1,306
Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has
been suppressed.
1All drowning cases reported were deceased
Cause of injury varied by age, but road accidents were the most commonly cited source of injury
for people of all ages, especially those age 20-39. After road accidents, animal/snake bites and falls from
trees/buildings were the most common causes of injuries among children age 0-9, accounting for 14
percent and 23 percent of injuries, respectively. Gunshots accounted for a higher percentage of injuries
among people age 20-39 than for any other age group. Severe burning accounted for a higher percentage
among children and young adults less than age 20 than among other age groups. Violence as a cause of
injury was most common among people age 10-39. There were significant differences in accidental
injuries in the preceding 12 months by sex. While males were more likely than females to be injured in
road accidents (74 percent versus 67 percent), females were more likely to be injured from severe burning
and falls than males.
There were other significant differences in accidental injuries/deaths in the preceding 12 months
by urban-rural residence and province. Not surprisingly, road accidents accounted for a higher percentage
of injuries/deaths in urban areas (82 percent) than in rural areas (70 percent). Falls accounted for a higher
proportion of accidental injuries or deaths in rural areas than in urban areas (10 percent versus 6 percent).
The distribution of causes of injuries/deaths by province should be analyzed with caution because sample
sizes were small in some provinces.
32 • Utilization of Health Services for Accident, Illness, or Injury
3.2 PREVALENCE AND SEVERITY OF ILLNESS OR INJURY
All households were asked whether any members had been sick or injured at any time in the 30
days before the interview. If any members had been sick, their names were recorded to ask specifically
about their conditions in the questions that followed. The Household Questionnaire allotted space for
information to be recorded for up to three household members. Interviewers were instructed to use extra
questionnaires to record the information on all household members who were ill or injured. The respondent
was asked to judge the illness or injury as slight, moderate, or serious. Finally, questions were asked as to
whether ill or injured household members sought care, where they sought care, how much they spent on
transport, and how much they spent on treatment. These questions were repeated to collect information on
patterns of health care-seeking behavior. For example, a man might first seek treatment from a Kru Khmer
traditional healer but later visit a health clinic if the illness continued. Up to three care-seeking attempts
were recorded on the questionnaire for each ill or injured person.
Thirteen percent of household members had been ill in the 30 days prior to the interview (Table
3.3). However, this percentage may underrepresent the actual prevalence of morbidity and injury for two
reasons. The questions were asked only about living household members at the time of the interview.
Therefore, the recorded episodes of illness and injury excluded any cases that ended in the death of a
household member in the 30 days prior to the interview. Furthermore, the responses were based on the 30day recall of one respondent in the household. That respondent might not have been aware of all of the
illnesses or injuries that had occurred within the household. It is likely that illnesses or injuries that
occurred at the beginning of the 30-day period or that were of mild severity were forgotten and not
reported.
Table 3.3 Prevalence and severity of illness or injury in previous 30 days
Percent distribution of the de jure household population ill or injured in the previous 30 days by severity of
illness or injury, according to background characteristics, Cambodia 2014
Severity of illness or injury
Any illness
or injury
Number of
persons
Background
characteristics
Not ill or
injured Slight Moderate Serious
Age
0-9 83.1 10.1 5.7 1.2 16.9 16,182
10-19 93.7 3.0 2.6 0.6 6.3 14,576
20-39 90.6 3.9 4.6 0.9 9.4 22,161
40-59 82.7 6.2 9.3 1.8 17.3 13,959
60+ 75.5 7.5 13.4 3.6 24.5 6,079
Sex
Male 88.8 5.1 4.8 1.3 11.2 35,336
Female 84.9 6.5 7.3 1.3 15.1 37,622
Residence
Urban 84.7 9.1 5.2 0.9 15.3 11,469
Rural 87.1 5.2 6.3 1.4 12.9 61,489
Province
Banteay Meanchey 87.8 4.3 6.0 1.8 12.2 3,134
Kampong Cham 86.3 6.2 6.1 1.4 13.7 9,454
Kampong Chhnang 82.0 5.8 10.7 1.5 18.0 2,574
Kampong Speu 85.9 7.2 5.9 0.9 14.1 4,665
Kampong Thom 87.7 5.9 5.3 1.1 12.3 3,632
Kandal 87.3 4.1 7.2 1.3 12.7 5,674
Kratie 82.7 6.6 9.0 1.6 17.3 2,160
Phnom Penh 76.8 15.8 6.8 0.6 23.2 6,814
Prey Veng 92.1 1.8 5.0 1.1 7.9 4,942
Pursat 93.7 2.3 2.8 1.2 6.3 2,839
Siem Reap 90.9 2.9 5.1 1.1 9.1 4,811
Svay Rieng 83.2 7.6 7.6 1.6 16.8 2,736
Takeo 91.3 1.9 4.6 2.2 8.7 4,475
Otdar Meanchey 89.9 4.2 5.2 0.7 10.1 1,203
Battambang/Pailin 86.7 6.6 5.1 1.5 13.3 5,623
Kampot/Kep 86.9 3.0 9.0 1.1 13.1 3,220
Preah Sihanouk/Koh Kong 88.3 5.5 5.0 1.2 11.7 1,622
Preah Vihear/Stung Treng 85.0 5.7 7.1 2.0 15.0 1,813
Mondul Kiri/Ratanak Kiri 91.9 4.8 2.0 1.3 8.1 1,567
Total 86.8 5.8 6.1 1.3 13.2 72,958
Utilization of Health Services for Accident, Illness, or Injury • 33
The majority (90 percent) of all illnesses or injuries were slight or moderate in severity. Only 1.3
percent of household members experienced a serious illness or injury. The highest percentage of illness or
injury was found among persons age 60 and older; 25 percent had an illness or injury. Females and urban
residents suffered slightly more illnesses and injuries than males and rural residents. The highest
percentages of illness or injury were found in Phnom Penh (23 percent), Kampong Chhnang (18 percent),
and Kratie and Svay Rieng (17 percent each).
3.3 TREATMENT SOUGHT FOR ILLNESS OR INJURY
Table 3.4 presents the percentage of ill or injured household members who sought treatment
according to the number of times they did so. The type of treatment recorded included, but was not limited
to, care provided by medically trained professionals. For example, if a sick child was first given a remedy
by a Kru Khmer traditional healer, this was recorded as the first treatment. If the parents later observed that
the child was still ill and went to a shop in the market for medicine, this was recorded as the second
treatment. If the medicine was not effective and the parents took the child to a doctor at a private clinic,
this was recorded as the third treatment.
Table 3.4 Percentage of ill or injured population who sought treatment
Percentage of de jure household members ill or injured in the past 30 days who sought a first,
second, and third treatment, according to background characteristics, Cambodia 2014
Treatment for illness or injury Number of
ill/injured
population
Background
characteristics
First
treatment
Second
treatment
Third
treatment
Severity of illness or injury1
Slight 93.2 17.8 5.2 4,249
Moderate 96.3 23.5 7.7 4,442
Serious 98.4 36.1 12.6 956
Age
0-9 97.1 21.8 6.1 2,742
10-19 97.0 18.5 5.2 912
20-39 95.0 24.1 7.2 2,094
40-59 93.6 22.9 8.6 2,416
60+ 93.1 21.4 7.4 1,492
Sex
Male 95.6 22.3 6.8 3,973
Female 94.8 22.1 7.3 5,683
Residence
Urban 96.1 28.5 11.5 1,755
Rural 94.9 20.8 6.1 7,902
Province
Banteay Meanchey 96.1 16.8 4.9 381
Kampong Cham 93.0 17.3 5.8 1,296
Kampong Chhnang 99.2 26.9 5.1 464
Kampong Speu 96.7 7.5 2.0 657
Kampong Thom 96.2 9.5 1.5 448
Kandal 95.6 31.6 11.5 718
Kratie 94.5 9.2 1.1 373
Phnom Penh 96.8 37.9 16.3 1,582
Prey Veng 98.3 40.4 16.2 390
Pursat 91.1 12.3 0.0 180
Siem Reap 96.5 23.8 6.2 440
Svay Rieng 95.7 18.9 3.4 460
Takeo 94.3 28.0 10.9 389
Otdar Meanchey 87.8 16.6 1.0 121
Battambang/Pailin 91.2 15.0 3.2 748
Kampot/Kep 96.5 16.6 3.5 420
Preah Sihanouk/Koh Kong 97.2 17.1 3.8 189
Preah Vihear/Stung Treng 92.2 16.4 1.5 273
Mondul Kiri/Ratanak Kiri 86.1 13.7 3.2 126
Total 95.1 22.2 7.1 9,656
1 Includes 10 cases of don’t know or missing severity of illness or injury
34 • Utilization of Health Services for Accident, Illness, or Injury
Ninety-five percent of household members who were ill sought at least one treatment (Table 3.4),
a slight increase from the 2010 CDHS. Twenty-two percent of those ill or injured sought at least two
treatments, and 7 percent sought at least three treatments. In general, there was a positive relationship
between the severity of illness or injury and the number of times treatment was sought. Persons with
serious illnesses or injuries were more likely to seek treatment than those with moderate illnesses or
injuries. These latter individuals in turn were more likely to seek treatment than those with slight illnesses
or injuries. Ninety-three percent of those with a slight illness, 96 percent of those with a moderate illness,
and 98 percent of those with a serious illness or injury sought a first treatment. The corresponding
percentages among those who sought a second treatment were 18 percent, 24 percent, and 36 percent. Five
percent of those with slight illnesses or injuries were treated three times or more, as compared with 13
percent of those with serious illnesses or injuries. There were small differences in health-seeking behavior
by sex and age. Urban residents were twice as likely to seek a third treatment as rural residents (12 percent
versus 6 percent).
The provinces with the highest percentages of ill or injured persons seeking treatment were
Kampong Chhnang (99 percent) and Prey Veng (98 percent), whereas the province with the lowest
percentage was Mondul Kiri/Ratanak Kiri (86 percent).
3.4 UTILIZATION OF HEALTH CARE FACILITIES
Information on the location of health care providers was collected to determine where persons
who were ill or injured went for treatment. Health care providers were distinguished by public sector,
private sector, and non-medical sector. Interviewers were provided with descriptions of the different types
of hospitals, clinics, pharmacies, and other health venues. If, during data collection, the interviewer had
difficulties distinguishing among the various types, the team supervisor or field editor ascertained the
correct designation from local sources.
Table 3.5 presents data on utilization of health services by type of residence (urban-rural). Small
differences in patterns of health care use can be observed, with the private sector in general used most
often, followed by the public sector and then the non-medical sector.
Within the public sector, health centers were most often visited for treatment of illnesses and
injuries in rural areas (13 percent), whereas national hospitals were the most common source for treatment
in urban areas (7 percent). Within the private sector, private pharmacies were most often visited for
treatment in urban areas (41 percent), and private clinics were the most common source in rural areas (17
percent). Private pharmacies were much more likely to be visited for first treatment in urban areas than in
rural areas (41 percent versus 13 percent), whereas trained health workers and nurses were more
commonly sought out for first-time treatment in rural areas than in urban areas (29 percent versus 10
percent). Within the non-medical sector, shops or markets were the overwhelming choice as a source of
health care.
Utilization of Health Services for Accident, Illness, or Injury • 35
Table 3.5 Percentage of ill or injured population who sought treatment
Percent distribution of de jure household members who were ill or injured in the past 30 days by place of treatment, according to urban-rural
residence, Cambodia 2014
Residence
Total Urban Rural
Place of treatment
First
treatment
Second
treatment
Third
treatment
First
treatment
Second
treatment
Third
treatment
First
treatment
Second
treatment
Third
treatment
Did not seek treatment 3.9 71.5 88.5 5.1 79.2 93.9 4.9 77.8 92.9
Public sector 14.9 4.0 1.3 23.5 4.8 1.4 21.9 4.7 1.4
National hospital (PP) 6.5 2.2 0.9 3.6 1.0 0.5 4.2 1.2 0.5
Provincial hospital (RH) 2.2 0.2 0.1 3.1 0.6 0.1 3.0 0.5 0.1
District hospital (RH) 0.5 0.4 0.0 2.9 0.7 0.3 2.5 0.7 0.2
Health center 5.0 1.1 0.4 12.8 2.2 0.5 11.4 2.0 0.4
Health post 0.0 0.0 0.0 0.2 0.0 0.0 0.2 0.0 0.0
Outreach 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Other public 0.7 0.1 0.0 0.8 0.2 0.1 0.7 0.2 0.1
Private sector 78.1 23.9 9.9 64.7 14.5 4.3 67.1 16.2 5.3
Private hospital 3.3 1.0 0.2 3.6 1.0 0.3 3.6 1.0 0.3
Private clinic 22.6 6.7 2.4 17.2 5.0 1.3 18.2 5.3 1.5
Private pharmacy 40.6 13.4 6.1 12.7 2.2 0.8 17.8 4.2 1.8
Home/office of trained
health worker/nurse 5.4 1.6 0.4 14.4 3.7 1.0 12.8 3.3 0.9
Visit of trained health
worker/nurse 4.7 0.9 0.6 15.0 2.2 0.8 13.1 2.0 0.8
Other private medical 1.5 0.4 0.2 1.7 0.4 0.1 1.7 0.4 0.1
Non-medical sector 1.0 0.4 0.2 5.3 1.1 0.3 4.5 1.0 0.3
Shop/market 0.7 0.2 0.1 4.3 0.5 0.1 3.6 0.4 0.1
Kru Khmer/magician 0.3 0.1 0.1 0.9 0.6 0.1 0.8 0.5 0.1
Monk/religious leader 0.0 0.0 0.0 0.1 0.0 0.0 0.1 0.0 0.0
Traditional birth attendant 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0
Outside of country/other 2.1 0.2 0.1 1.5 0.3 0.1 1.6 0.3 0.1
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number 1,755 1,755 1,755 7,902 7,902 7,902 9,656 9,656 9,656
Figure 3.1 summarizes the findings detailed in Table 3.5. The private sector is the most popular
source for all three types of treatments. After the private sector, people most often choose the public sector
for first, second, and third treatments, whereas the non-medical sector is the least popular choice for
seeking treatment.
Figure 3.1 Percentage of ill or injured household members seeking treatment
by order of treatment and sector of health care
0.3
1
5
5
16
67
1
5
22
Third treatment
Second treatment
First treatment
Percentage
Public sector
Private sector
Non-medical sector
CDHS 2014
36 • Utilization of Health Services for Accident, Illness, or Injury
3.5 COST FOR HEALTH CARE
3.5.1 Distribution of Cost for Health Care
For each ill or injured person, the respondent was asked to state the costs expended for
transportation and treatment for each visit to a health care provider. These costs were reported only for
living people who had been recently ill or injured and did not include costs incurred for people who had
died in the 30 days preceding the interview. Costs are presented in US dollars in Table 3.6. In the case of
all treatments, 9 percent of household members spent $1 or less for transportation and treatment for illness
or injury, and 21 percent spent $1 to $4. Ten percent of all household members spent $50-$99 for
transportation and treatment for illness or injury, and another 10 percent spent $100 or more.
These expenditures varied by type of spending. For transport, 48 percent of household members
spent less than $1, 35 percent spent $1 to $4, 8 percent spent $5 to $9, and the rest spent $10 or more. For
health care, 6 in 10 household members spent up to $19, 18 percent spent between $20 and $49, 10 percent
spent between $50 and $99, and 9 percent spent $100 or more. There were small variations in spending
according to order of treatment.
Table 3.6 Distribution of cost for health care
Percent distribution of de jure household members who were ill or injured in the past 30 days and sought treatment by amount of money spent for
transport and health care, according to number of treatments, Cambodia 2014
Treatment for illness or injury
Amount spent for
transport and
health care
First treatment Second treatment Third treatment All treatments
Transport
Health
care Total Transport
Health
care Total Transport
Health
care Total Transport
Health
care Total
$0-1 50.4 17.3 10.6 46.0 16.4 9.7 51.6 19.2 11.7 48.4 14.9 9.3
$1-4 35.1 20.9 23.7 37.5 22.1 23.9 32.5 26.5 28.7 34.5 19.1 21.1
$5-9 7.5 13.9 15.1 8.4 14.8 15.4 7.6 15.1 16.0 8.1 13.1 13.9
$10-19 4.1 15.8 16.5 4.1 17.7 18.8 3.5 16.5 17.7 4.6 16.0 16.3
$20-49 1.2 15.9 16.6 2.3 15.8 17.7 1.5 13.5 14.8 2.3 17.5 18.5
$50-99 0.4 7.9 8.3 0.5 7.0 7.6 1.1 2.9 3.9 0.7 9.6 10.0
$100+ 0.4 7.7 7.9 0.6 5.6 6.0 1.2 5.1 5.7 0.6 9.2 9.6
Don’t know/
missing 0.8 0.6 1.2 0.6 0.4 0.9 1.0 1.1 1.5 0.8 0.7 1.4
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number 9,186 9,186 9,186 2,143 2,143 2,143 684 684 684 9,186 9,186 9,186
3.5.2 Expenditures for Health Care
Table 3.7 presents the mean cost of transport and treatment by order of treatment and background
characteristics. Mean total costs for first, second, and third treatments are $41.08, $34.27, and $32.19,
respectively. Mean cost of transport increases with treatment order, from $2.78 for the first treatment to
$3.59 for the second treatment and then $4.94 for the third treatment.
The mean cost of transport and health care varies according to type of health sector, severity of
illness or injury, age group, sex, residence, and province. Examining total costs by type of health sector
shows that the highest mean expenditure is for “outside of country/other” treatment, which may include
going to Singapore, Thailand, or Vietnam or seeking specialized services. This is true for both costs of
transport and costs of health care.
Total cost has continued to increase in the past four years, from a mean of $32.37 in 2010 to
$39.36 in 2014. Increases have been observed in both the public and private sectors, in the first and third
treatment cycles, and in transport as well as health care costs. Total “outside of country/other” costs have
declined from the level reported in the 2010 CDHS, from $324.26 to $234.93. “Outside of country/other”
treatment is the most expensive treatment option due to high transport ($33.86) and health care ($201.08)
costs.
Utilization of Health Services for Accident, Illness, or Injury • 37
Table 3.7 Expenditures for health care
Mean expenditures in United States dollars for transport and health care by de jure household members who were ill or injured in the past 30 days and sought
treatment by order of treatments, according to background characteristics, Cambodia 2014
Treatment for illness or injury
First treatment Second treatment Third treatment All treatments
Background
characteristic Transport
Health
care Total Transport
Health
care Total Transport
Health
care Total Transport
Health
care Total
Type of health sector
Public 4.57 48.76 53.33 6.81 27.22 34.03 8.17 32.20 40.36 5.11 44.39 49.51
Private 1.72 33.00 34.72 2.03 30.16 32.19 2.61 21.27 23.88 1.83 31.78 33.61
Non-medical 0.66 8.54 9.20 2.75 18.71 21.45 0.43 5.56 5.98 1.01 10.12 11.12
Outside of country/
other 28.48 202.49 230.97 43.27 155.88 199.15 83.19 293.65 376.83 33.86 201.08 234.93
Severity of illness or
injury
Slight 1.22 11.82 13.04 1.23 8.78 10.00 2.51 17.62 20.12 1.28 11.61 12.89
Moderate 2.59 36.97 39.56 2.84 27.13 29.97 2.57 26.32 28.89 2.63 34.50 37.14
Serious 10.22 156.53 166.75 11.16 90.23 101.39 16.27 47.91 64.18 10.96 131.12 142.08
Age
0-9 1.62 10.90 12.52 2.92 11.49 14.41 4.08 5.51 9.59 1.97 10.74 12.71
10-19 1.95 23.69 25.64 3.32 21.87 25.19 1.70 9.37 11.07 2.15 22.78 24.93
20-39 3.28 49.60 52.88 2.72 31.21 33.93 2.60 21.68 24.28 3.14 44.54 47.67
40-59 3.25 47.90 51.15 5.03 45.60 50.63 9.45 45.01 54.46 4.01 47.28 51.28
60+ 4.04 68.52 72.55 3.89 44.77 48.66 2.10 41.84 43.94 3.90 62.73 66.62
Sex
Male 2.74 38.20 40.94 3.83 36.14 39.97 3.77 20.93 24.69 2.99 36.89 39.88
Female 2.80 38.38 41.18 3.43 26.86 30.28 5.70 31.36 37.06 3.08 35.90 38.99
Residence
Urban 3.39 48.49 51.88 2.41 22.69 25.09 4.74 32.82 37.56 3.30 41.76 45.05
Rural 2.64 36.00 38.64 3.95 33.12 37.08 5.02 24.93 29.95 2.98 34.95 37.94
Province
Banteay Meanchey 3.63 53.97 57.59 5.14 48.72 53.86 11.01 46.96 57.97 4.15 52.93 57.08
Kampong Cham 2.71 34.11 36.82 5.70 44.42 50.12 13.98 54.87 68.85 3.71 36.67 40.38
Kampong Chhnang 2.21 32.62 34.83 2.28 38.86 41.14 3.00 44.70 47.70 2.26 34.34 36.60
Kampong Speu 2.28 36.44 38.72 2.39 19.64 22.03 1.23 13.07 14.31 2.27 34.79 37.06
Kampong Thom 1.61 26.16 27.77 7.21 94.18 101.39 3.29 23.88 27.17 2.13 32.19 34.32
Kandal 1.84 46.81 48.64 1.36 12.21 13.57 4.04 18.32 22.36 1.91 36.62 38.53
Kratie 2.88 27.83 30.71 4.08 51.43 55.51 3.87 38.15 42.02 3.00 30.02 33.02
Phnom Penh 2.65 33.59 36.24 1.23 13.21 14.44 2.22 18.24 20.46 2.25 26.82 29.06
Prey Veng 3.54 66.03 69.57 3.10 24.54 27.64 2.53 27.14 29.68 3.32 51.15 54.47
Pursat 3.64 71.72 75.36 5.84 63.55 69.40 na na na 3.90 70.75 74.65
Siem Reap 3.45 37.77 41.21 6.29 40.46 46.75 10.91 43.36 54.27 4.34 38.55 42.89
Svay Rieng 2.32 42.75 45.07 3.10 61.09 64.19 1.44 19.03 20.47 2.42 45.04 47.47
Takeo 3.97 45.15 49.12 3.16 27.19 30.35 3.09 17.77 20.86 3.73 39.24 42.98
Otdar Meanchey 9.70 36.80 46.50 31.14 51.97 83.11 178.65 178.75 357.40 14.74 40.58 55.33
Battambang/Pailin 2.97 37.06 40.03 8.49 51.72 60.21 5.74 33.05 38.79 3.82 38.99 42.82
Kampot/Kep 1.63 34.82 36.45 1.22 13.26 14.48 0.95 8.17 9.13 1.55 30.99 32.54
Preah Sihanouk/Koh
Kong 2.84 29.35 32.19 4.70 33.89 38.59 4.58 46.14 50.72 3.17 30.55 33.72
Preah Vihear/Stung
Treng 2.32 21.64 23.96 3.73 19.39 23.13 23.59 139.47 163.05 2.82 22.92 25.74
Mondul Kiri/Ratanak
Kiri 7.10 49.35 56.45 18.40 166.02 184.42 1.59 8.02 9.60 8.59 65.33 73.92
Total 2.78 38.30 41.08 3.59 30.68 34.27 4.94 27.25 32.19 3.05 36.31 39.36
na = No third treatment was reported
In general, health care costs increased significantly by severity of illness or injury. The total mean
cost of health care increased from $11.61 for slight illness or injury to $131.12 for serious conditions. This
followed the same pattern established in the 2010 CDHS.
Overall, average health care costs rise consistently with the patient’s age, from $10.74 for children
age 0-9 to $62.73 for people age 60 or older. Health care expenditures by sex show that men and women
spent about the same on health care ($36.89 and $35.90, respectively). A comparison with the findings of
the 2010 CDHS shows that health care spending seems to have become more equitable. In 2010, men spent
more than women on health care ($34.28 versus $26.90).
Total health care costs have remained higher in urban areas than in rural areas since the 2010
CDHS. However, the urban-rural difference in health care costs has narrowed considerably due to a
decline in costs in urban areas. In urban areas average health care costs decreased from $74.79 in 2010 to
38 • Utilization of Health Services for Accident, Illness, or Injury
$41.76 in 2014, and in rural areas costs increased from $23.55 to $34.95 over the same period. The average
transport cost per treatment has not changed much over the past four years (from $2.38 to $3.05). The
difference in transport costs in urban and rural areas is small ($3.30 versus $2.98).
Health care expenditures vary greatly in Cambodia’s provinces. The cost of health care is highest
in Pursat ($70.75) and lowest in Preah Vihear/Stung Treng ($22.92).
3.5.3 Sources of Money for Health Care Expenditures
Because the health care system in Cambodia is largely fee-based, it is important to know the
source of the money used to pay for health care. One goal of the health care system is to have appropriate
funding mechanisms for the population to acquire health care without deepening poverty. Table 3.8 shows
the different sources of money spent by people seeking treatment for health care. Percentages could sum to
greater than 100 because a person could use money from more than one source.
Table 3.8 shows the different sources of money spent by persons who sought treatment for health
care. The total percent could be greater than 100 because a person could use money from more than one
source. Similar to 2010, the two major sources of money spent on health care are wages or income and
savings; in 2014, 64 percent of people who sought health care used money from wages/income and 31
percent used savings. Gifts from relatives or friends and sale of assets were mentioned as a source of
funding by 14 percent and 8 percent of those who obtained health care, respectively. Twelve percent of
those who had health care treatment said they used money from tontine,1 and 4 percent used money from a
health equity fund. Each of the other sources of funding was mentioned by 1 percent or less of respondents.
There are small differences in the source of money spent on health care by type of health sector. In
all sectors, the most common source of funding is wages or income (50 percent to 72 percent), followed by
savings (22 percent to 33 percent). Gifts from relatives are the next most common source of funding for
health care (13 percent to 17 percent).
As severity of illness or injury increases, dependence on loans, sale of assets, gifts, and savings
increases; however, spending of wages or income declines as severity of illness or injury increases.
Wages/income was the most common source of funding regardless of the total cost of treatments;
however, as treatment costs increase, the proportion of people who use funds from loans, sale of assets,
gifts from relatives, and savings also increases. Health equity funds were used by 15 percent of those
spending $0 to $1.
There were no substantial differences in the source of money used for health care costs by the
patient’s sex. Urban residents were more likely than rural residents to use wages (86 percent versus 59
percent) but less likely to use savings (13 percent versus 35 percent) for health care.
Large differences were found in the sources of money for health care costs by province. Patients
in Phnom Penh, Preah Vihear/Stung Treng, and Kandal were most likely to use wages to pay for their
health care (92 percent, 89 percent, and 87 percent, respectively) and among the least likely to use their
savings (5 percent and 15 percent, respectively).
Conversely, Kampong Chhnang and Kampot/Kep are the provinces in which health care users are
most likely to use savings for health care spending (86 percent and 76 percent, respectively). Patients in
Prey Veng are least likely to use wages for health care spending (9 percent). Patients in Svay Rieng (34
percent) had the highest reliance on sale of assets for health care spending. Patients in Otdar Meanchey
were most likely to use a health equity fund to finance their health care spending. Approximately 1 of 3
patients (32 percent) in Prey Veng reported gifts from relatives or friends as a source of funding for health
care costs.
1 Tontine is an informal group saving and loan scheme in Cambodia.
Utilization of Health Services for Accident, Illness, or Injury • 39
Table 3.8 Source of money (United States dollars) spent by persons who sought treatment for health care
Among de jure household members who were ill or injured in the 30 days before the survey and who sought treatment, percentage who reported specific sources of
expenditures for transport and health care, according to background characteristics, Cambodia 2014
Source of money for health care
Background
characteristic
Health
equity
fund Voucher
Free
exemption NGO
National
Security
Fund
Community
based
health
insurance
Employer Commercial
health
insurance
Wages/
income
Loan/
tontine
Sale of
assets
Gift from
relative Savings
Other/
missing Number1
Type of health sector
Public 13.1 0.3 3.5 0.8 0.1 0.7 0.2 0.3 50.4 11.1 7.3 13.1 30.9 0.0 1,958
Private 1.4 0.1 0.2 0.2 0.0 0.1 0.3 0.0 67.5 12.9 7.7 14.3 31.5 0.1 6,594
Non-medical 2.4 0.3 0.5 0.6 0.0 0.0 0.0 0.0 72.1 11.3 7.2 16.6 33.4 0.3 472
Other 1.1 0.0 1.9 1.4 0.0 0.0 1.0 0.0 62.6 9.6 7.7 16.9 22.4 2.7 161
Severity of illness or
injury2
Slight 3.7 0.1 0.8 0.2 0.0 0.1 0.1 0.0 74.6 9.1 4.5 9.6 24.4 0.0 3,961
Moderate 4.1 0.2 1.3 0.4 0.0 0.3 0.4 0.2 57.7 13.1 8.4 16.1 36.3 0.2 4,277
Serious 4.6 0.3 0.4 0.3 0.1 0.1 0.7 0.0 47.5 23.0 16.9 25.6 38.2 0.2 941
Cost of transport and
health care
$0-1 15.2 0.1 5.0 1.6 0.2 0.2 0.9 0.0 55.9 2.4 1.5 7.8 25.0 0.7 851
$1-4 4.9 0.2 1.1 0.2 0.1 0.4 0.4 0.1 72.7 4.7 3.8 8.9 26.6 0.1 1,934
$5-9 3.4 0.0 0.9 0.5 0.0 0.2 0.0 0.1 68.7 8.6 6.4 9.7 32.1 0.0 1,274
$10-19 2.8 0.1 0.3 0.2 0.0 0.0 0.1 0.1 64.1 12.4 6.7 13.9 33.0 0.1 1,499
$20-49 1.6 0.1 0.4 0.1 0.0 0.2 0.0 0.1 60.9 15.8 9.2 19.1 34.4 0.0 1,702
$50-99 1.2 0.1 0.0 0.0 0.0 0.0 0.2 0.0 60.7 22.8 12.5 20.1 32.4 0.0 917
$100+ 1.5 0.2 0.0 0.1 0.0 0.0 0.2 0.0 56.7 27.9 17.3 23.7 37.1 0.0 883
Sex
Male 3.9 0.1 1.0 0.4 0.0 0.3 0.4 0.0 65.0 11.8 7.3 12.9 31.2 0.2 3,799
Female 4.0 0.2 0.9 0.3 0.0 0.1 0.2 0.1 63.3 12.8 7.8 15.2 31.4 0.0 5,387
Residence
Urban 3.3 0.0 1.1 0.9 0.0 0.1 0.5 0.1 85.7 6.8 1.6 11.2 13.2 0.0 1,686
Rural 4.1 0.2 1.0 0.2 0.0 0.2 0.2 0.1 59.1 13.7 8.9 14.9 35.4 0.1 7,500
Province
Banteay Meanchey 3.1 0.0 0.8 0.3 0.0 0.2 0.0 0.0 57.8 16.1 8.4 31.1 35.0 0.0 366
Kampong Cham 4.0 0.3 0.5 0.2 0.0 0.3 0.5 0.0 62.1 19.9 6.6 12.1 33.8 0.3 1,206
Kampong Chhnang 7.4 0.0 1.4 0.2 0.0 0.0 0.3 0.0 42.2 7.3 13.9 16.0 85.8 0.0 460
Kampong Speu 0.9 0.0 0.2 0.0 0.0 0.0 0.0 0.0 64.5 7.0 11.3 14.7 22.4 0.0 635
Kampong Thom 5.4 0.0 0.3 0.0 0.0 0.7 0.0 0.0 63.2 6.1 6.5 4.8 40.3 0.0 431
Kandal 0.7 0.2 0.4 0.2 0.0 0.0 0.3 0.0 86.6 6.2 1.7 18.6 14.7 0.0 687
Kratie 4.0 0.1 0.7 0.6 0.0 0.0 0.0 0.0 70.8 12.4 5.7 12.6 31.8 0.4 352
Phnom Penh 3.6 0.0 1.7 0.9 0.0 0.1 0.7 0.1 92.1 8.5 1.0 8.6 4.6 0.0 1,532
Prey Veng 2.1 0.0 0.4 0.0 0.0 0.0 0.0 0.0 8.7 20.5 12.2 32.0 64.4 0.0 384
Pursat 9.1 0.0 0.5 0.2 0.9 1.2 0.0 0.4 24.3 12.0 8.0 8.6 59.3 0.0 164
Siem Reap 5.4 0.8 1.1 0.0 0.0 1.4 0.0 0.0 52.6 22.5 5.9 5.3 32.8 0.0 424
Svay Rieng 0.4 0.0 0.5 0.0 0.0 0.0 0.2 0.0 64.1 19.1 34.3 23.9 34.5 0.2 440
Takeo 7.7 1.2 0.8 0.0 0.4 0.0 0.0 1.3 36.1 12.3 19.2 20.5 36.2 0.8 367
Otdar Meanchey 13.3 0.0 1.1 0.2 0.0 0.0 0.0 0.0 61.7 18.9 4.0 5.5 51.5 0.0 106
Battambang/Pailin 6.0 0.1 0.8 0.4 0.0 0.0 0.7 0.0 66.7 15.5 2.0 21.0 13.9 0.0 683
Kampot/Kep 1.9 0.0 2.7 0.5 0.0 0.0 0.0 0.0 36.3 7.6 10.2 8.7 75.6 0.0 406
Preah Sihanouk/
Koh Kong 8.5 0.3 0.6 1.2 0.0 0.0 0.3 0.2 56.2 5.6 1.8 10.3 41.1 0.2 184
Preah Vihear/
Stung Treng 3.6 0.0 3.9 0.0 0.0 0.0 0.0 0.0 89.2 11.3 2.2 4.2 9.9 0.0 251
Mondul Kiri/
Ratanak Kiri 2.7 0.4 0.2 1.7 0.0 0.0 0.0 0.0 74.3 2.8 1.7 3.1 21.8 0.6 109
Total 4.0 0.2 1.0 0.3 0.0 0.2 0.3 0.1 64.0 12.4 7.6 14.2 31.3 0.1 9,186
1 Total includes 127 non-monetary cases (1 in-kind case and 126 cases of don’t know or missing amount of spending)
2 Includes 7 cases for which information on severity of illness is missing
Disability • 41
DISABILITY 4
Key Findings
• Overall, 10 percent of household members age 5 and older suffer with at
least one form of disability.
• Twenty-one percent of household members who were ill or injured in the
30 days prior to the interview are disabled.
• The most common types of disabilities reported in the survey are
difficulties in seeing, walking or climbing stairs, and concentrating.
• One in 10 men who are not currently employed are disabled, as
compared with only 5 percent among other men.
ersons with disabilities are considered vulnerable in Cambodia. The commitment of the Royal
Government of Cambodia (RGC) to improving the lives of people with disabilities through
recognition of their rights was demonstrated through ratification of the Convention on the Rights of
Persons with Disabilities (CRPD) in 2012. The RGC has also enacted a number of disability laws and
strategic plans in recent years. The government has developed a National Disability Policy to promote
effective service delivery to persons with disabilities, and recently the Disability Rights Initiative
Cambodia (DRIC) was jointly developed by the Australian government, the United Nations Development
Program (UNDP), the World Health Organization (WHO), and the United Nations Children’s Fund
(UNICEF). The main objective of this latter initiative is to improve the quality of life of persons with
disabilities in Cambodia.
People with disabilities are disadvantaged in workplaces and in other public places. Understanding
the prevalence of disabilities in the population and the associated circumstances can improve efforts to
remove disabling barriers and provide services that allow people with disabilities to integrate better into
society. In the 2014 CDHS, information was collected on each household member age 5 and older about
whether he or she had difficulties with seeing, hearing, walking or climbing stairs, remembering or
concentrating, performing self-care, or communicating. The survey also collected information as to the
severity of these disabilities, that is, whether a disabled person has some difficulty performing the listed
activities, a great deal of difficulty, or cannot perform the listed activities at all.
4.1 DISABILITY AMONG THE GENERAL HOUSEHOLD POPULATION
Table 4.1 presents the prevalence of disability in Cambodia according to type of disability and
level of difficulty. The first column shows the proportion of the population with no disabilities. The next
group of columns shows the proportion of the population with some level of difficulty performing various
types of functions, while the final set of columns shows those with a great degree of difficulty or no ability
to perform the described functions at all.
According to the survey, 10 percent of persons age 5 and over have some form of disability.
Difficulties in seeing, walking or climbing stairs, and concentrating are the most common types of
disabilities reported. Five percent of household members have difficulty seeing, 3 percent have difficulty
hearing, 4 percent have difficulty walking or climbing stairs, and 4 percent have difficulties with
remembering or concentrating. Only 1 percent of the population has at least some difficulty with self-care
and 2 percent with communicating.
P
42 • Disability
The prevalence of disability increases with age, from 2 percent among children age 5-14 to 44
percent among those age 60 and above. The prevalence of disability is 13 percent among persons age 3559.
Table 4.1 Disability among the household population
Percentage of the de jure household population age 5 and over with specific types of physical disabilities, according to background characteristics, Cambodia 2014
Background
characteristic
No difficulties
Some difficulty, a lot of difficulty, or cannot do
Any
domain
A lot of difficulty or cannot do
Number
Any
domain Seeing Hearing Walking
Concentrating
Selfcare
Communicating Seeing Hearing Walking
Concentrating
Selfcare
Communicating
Age
5-14 98.2 1.8 0.3 0.5 0.3 0.7 0.6 0.5 0.5 0.1 0.1 0.1 0.2 0.2 0.3 16,446
15-34 96.5 3.5 1.0 1.0 0.8 1.6 0.3 0.8 0.9 0.1 0.3 0.2 0.4 0.2 0.5 24,987
35-59 86.8 13.2 6.6 2.7 4.4 5.2 0.7 1.2 2.0 0.4 0.4 0.9 0.5 0.3 0.6 17,640
60+ 55.7 44.2 30.5 17.0 22.3 21.5 6.9 7.9 11.8 5.3 3.2 5.5 3.6 3.0 2.2 6,079
Sex
Male 91.5 8.5 4.2 2.5 3.1 3.5 1.0 1.3 1.9 0.5 0.6 0.8 0.6 0.4 0.6 31,395
Female 89.5 10.5 5.9 3.1 4.2 4.9 1.2 1.7 2.3 0.8 0.6 0.9 0.8 0.5 0.6 33,757
Marital status1
Never married 94.9 5.1 1.5 1.5 1.3 2.3 0.9 1.9 2.2 0.3 0.6 0.6 1.0 0.4 1.3 11,787
Married 88.4 11.6 6.4 3.1 4.4 4.9 0.8 1.1 1.9 0.6 0.5 0.8 0.4 0.3 0.3 31,883
Widowed 63.1 36.7 25.0 14.7 19.2 18.4 6.2 7.1 10.5 4.6 2.8 5.3 3.6 2.8 2.2 3,913
Divorced 86.9 13.1 6.2 2.8 3.6 6.3 1.6 2.7 2.9 0.8 0.8 0.7 1.5 0.9 1.4 1,099
Education
No education 79.4 20.5 12.0 7.7 9.1 10.4 3.8 5.1 6.4 2.3 2.1 2.4 2.5 1.8 2.4 10,587
Primary 91.3 8.7 4.5 2.4 3.2 3.5 0.7 1.0 1.6 0.5 0.4 0.7 0.4 0.3 0.3 33,787
Secondary 94.5 5.5 2.6 1.1 1.9 2.2 0.4 0.5 0.9 0.2 0.1 0.4 0.3 0.1 0.2 18,393
Higher 97.2 2.8 1.3 0.4 0.4 1.7 0.0 0.2 0.4 0.1 0.1 0.1 0.1 0.0 0.1 2,378
Household size2
1-4 89.1 10.9 6.2 3.2 4.3 4.9 1.2 1.7 2.3 0.8 0.6 0.9 0.8 0.4 0.6 27,500
5+ 91.5 8.5 4.3 2.6 3.2 3.7 1.1 1.4 2.0 0.6 0.6 0.9 0.6 0.5 0.6 37,588
Region
Banteay Meanchey 89.8 10.1 6.4 2.0 4.1 2.8 1.2 1.0 1.5 0.4 0.4 0.8 0.3 0.2 0.4 2,763
Kampong Cham 88.2 11.7 6.6 4.0 4.5 4.4 1.1 1.8 2.6 1.0 0.8 0.8 0.9 0.7 0.8 8,368
Kampong Chhnang 94.7 5.3 3.6 1.8 1.9 1.7 1.1 1.1 1.6 0.6 0.4 0.6 0.5 0.5 0.3 2,311
Kampong Speu 94.9 5.1 1.9 2.2 1.5 1.2 0.7 1.4 1.9 0.4 0.7 0.7 0.7 0.5 0.6 4,187
Kampong Thom 92.5 7.5 4.5 2.7 2.9 2.3 1.1 1.0 2.1 0.6 0.8 1.1 0.5 0.6 0.6 3,268
Kandal 88.9 11.1 6.3 4.0 2.6 5.3 1.4 2.1 2.7 0.9 0.9 1.0 0.7 0.6 0.8 5,144
Kratie 92.7 7.2 3.1 2.1 1.7 3.4 0.8 1.9 1.7 0.4 0.4 0.5 0.6 0.3 0.9 1,889
Phnom Penh 91.0 9.0 4.8 2.4 2.3 4.5 0.7 1.1 2.5 0.9 0.4 0.9 0.7 0.2 0.7 6,206
Prey Veng 90.8 9.2 5.2 3.0 3.2 3.9 1.4 1.8 2.0 0.6 0.5 1.0 0.5 0.5 0.7 4,351
Pursat 91.8 8.1 4.6 2.2 4.7 3.5 1.4 1.7 2.5 0.6 0.5 1.2 0.6 0.7 0.7 2,526
Siem Reap 89.6 10.3 5.0 3.6 2.8 5.3 0.8 1.5 1.3 0.3 0.4 0.4 0.5 0.3 0.4 4,275
Svay Rieng 90.4 9.6 5.4 2.9 2.6 3.9 0.4 1.0 1.5 0.3 0.4 0.5 0.7 0.2 0.5 2,440
Takeo 94.0 6.0 2.8 1.9 2.9 3.3 1.6 1.9 1.5 0.6 0.4 0.8 0.7 0.5 0.6 4,067
Otdar Meanchey 93.3 6.6 4.3 1.8 3.2 2.0 1.0 1.0 2.3 0.9 0.7 1.1 1.0 0.5 0.5 1,063
Battambang/Pailin 80.3 19.7 9.7 2.8 12.4 11.0 1.1 1.2 3.4 1.1 0.6 1.7 1.4 0.4 0.6 5,010
Kampot/Kep 93.8 6.2 2.7 2.4 2.9 2.5 2.6 2.6 2.5 0.9 0.8 1.1 0.9 0.9 0.7 2,900
Preah Sihanouk/
Koh Kong 95.6 4.4 1.9 1.3 1.7 1.7 0.9 1.1 0.7 0.2 0.1 0.3 0.2 0.3 0.1 1,452
Preah Vihear/
Stung Treng 85.0 15.0 8.8 5.1 4.0 7.4 0.8 1.2 1.9 0.5 0.5 0.6 0.6 0.2 0.5 1,579
Mondul Kiri/
Ratanak Kiri 97.8 2.1 1.0 0.9 0.6 0.5 0.2 0.4 0.8 0.3 0.2 0.3 0.2 0.1 0.2 1,356
Residence
Urban 91.3 8.7 4.8 2.3 3.0 4.0 0.9 1.1 2.2 0.7 0.4 0.9 0.6 0.3 0.6 10,403
Rural 90.3 9.7 5.1 2.9 3.8 4.3 1.1 1.6 2.1 0.7 0.6 0.8 0.7 0.5 0.6 54,750
Ill or injured in the
past 30 days
Yes 79.3 20.7 11.8 6.3 10.3 10.0 3.1 3.5 5.8 2.2 1.4 2.9 1.6 1.5 1.4 7,852
No 92.0 8.0 4.2 2.3 2.8 3.4 0.8 1.2 1.6 0.5 0.5 0.6 0.6 0.3 0.5 57,301
Total 90.5 9.5 5.1 2.8 3.7 4.2 1.1 1.5 2.1 0.7 0.6 0.9 0.7 0.5 0.6 65,153
Note: Total includes 2 cases for which information on illness or injury in the past 30 days is missing, 21 cases for which information on marital status is missing, and 8
cases for which information on education is missing.
1 Marital status was asked only for household members age 15 or older.
2 Households with only de facto member(s) are excluded.
Disability • 43
Females are slightly more likely to suffer from some level of disability than their male
counterparts (11 percent versus 9 percent). The prevalence of disability is much higher among household
members who are widowed (37 percent) than those who are divorced (13 percent), currently in a union (12
percent), or single (5 percent). There is a notable association between disability and education. Household
members who have no education (21 percent) are more than twice as likely to suffer from some level of
disability as those with a primary education (9 percent) and seven times as likely as those with more than a
secondary education (3 percent). There is little difference according to urban or rural residence. However,
the level of disability varies substantially by province, from 2 percent in Mondul Kiri/Ratanak Kiri to 20
percent in Battambang/Pailin. Household members who recently suffered an illness or injury (in the 30
days prior to the interview) are more likely than those who did not (21 percent versus 8 percent) to report a
disability.
Only 2 percent of the household population suffers from a severe disability (a great degree of
difficulty or lack of ability to perform the function at all). This indicates that the majority of disabled
people experience a moderate level of disability. Overall, less than 1 percent of the population age 5 and
older is severely suffering from each form of disability. The distribution of more severe disabilities by
background characteristics follows a pattern similar to that observed among overall disability.
4.2 DISABILITY AMONG ILL OR INJURED HOUSEHOLD MEMBERS
Table 4.2 presents information about disability among household members who were ill or injured
in the 30 days prior to the survey. It is worth noting that respondents were not asked the order in which
these two morbidities occurred. Therefore, the relationship between disability and illness or injury as
discussed here is purely an association and does not indicate cause and effect.
Table 4.2 Disability among the ill or injured population
Among the de jure household population age 5 and over who were ill or injured in the 30 days before the survey, percentage with specific types of physical disabilities,
according to background characteristics, Cambodia 2014
Background
characteristic
No difficulties
Some difficulty, a lot of difficulty, or cannot do A lot of difficulty or cannot do
Number
Any
domain Seeing Hearing Walking
Concentrating
Selfcare
Communicating
Any
domain Seeing Hearing Walking
Concentrating
Selfcare
Communicating
Sought advice or
health facility
contact
Did not seek
treatment 64.4 33.2 20.2 8.9 18.3 18.7 3.9 7.4 7.0 3.5 3.7 3.8 3.0 2.5 4.0 418
Public sector 77.5 21.3 12.3 6.6 11.4 11.0 4.7 5.1 7.0 2.4 2.0 3.3 1.4 2.3 1.9 1,590
Private pharmacy 80.4 17.6 9.7 4.5 6.8 9.2 2.8 2.8 5.5 2.1 1.1 2.4 2.0 1.2 1.2 1,384
Other private
facilities 78.1 20.0 11.3 6.7 10.3 9.3 2.7 3.0 5.7 2.2 1.1 2.9 1.6 1.2 1.2 3,903
Other/missing 75.7 21.6 13.6 4.9 9.2 8.2 1.0 1.3 3.2 1.1 0.5 2.0 0.5 0.5 0.4 558
Transport cost
Free/no cost 77.2 20.6 12.5 6.0 9.9 9.7 2.9 2.9 5.8 2.9 1.1 2.9 1.3 1.5 0.9 2,393
Paid money 78.6 19.7 10.9 6.2 9.8 9.6 3.1 3.5 5.7 1.8 1.3 2.8 1.7 1.3 1.5 4,980
Other/don’t know/
missing 66.9 30.7 17.9 8.9 16.8 16.7 4.1 6.9 6.8 3.1 3.2 4.0 2.9 2.6 3.9 480
Treatment cost
Free/no cost 74.6 23.7 13.1 7.0 12.7 12.4 4.7 5.0 5.3 1.9 1.9 2.1 1.2 2.1 1.3 542
Paid money 78.5 19.6 11.2 6.1 9.6 9.3 2.9 3.2 5.8 2.2 1.2 2.8 1.6 1.4 1.3 6,842
Other/don’t know/
missing 65.1 32.4 19.3 8.3 17.7 17.4 4.1 7.0 7.1 3.1 3.3 4.0 2.7 2.4 4.0 468
Health care
financing
mechanism
Health equity fund 72.2 25.2 13.0 6.3 16.8 11.1 3.3 3.3 6.2 1.7 1.9 2.8 1.0 1.3 1.0 315
Other subsidy 74.4 20.9 15.6 2.8 5.4 5.7 1.3 2.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 102
Insurance (77.2) 22.8 20.8 10.4 10.4 9.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 41
Out of pocket 77.8 20.4 11.7 6.3 10.0 10.0 3.1 3.6 5.9 2.3 1.4 2.9 1.7 1.5 1.5 7,381
Total 77.5 20.7 11.8 6.3 10.3 10.0 3.1 3.5 5.8 2.2 1.4 2.9 1.6 1.5 1.4 7,852
Note: Total includes 14 cases for which information on health care financing mechanism is missing. Figures in parentheses are based on 25-49 unweighted cases.
44 • Disability
The prevalence of disability among ill or injured household members is about two times higher
than that among the general household population (21 percent versus 10 percent). Difficulties in seeing (12
percent), walking or climbing stairs (10 percent), and remembering or concentrating (10 percent) are the
most common types of disabilities reported among the ill and injured population.
According to source of treatment, level of disability is higher among those who did not seek any
treatment for their illness or injury (33 percent) than among those who sought treatment in a public health
facility (21 percent), a private facility (20 percent), or a pharmacy (18 percent). The percentage of people
with a disability is slightly higher among those who received free treatment for their illness or injury than
among those who paid for treatment (24 percent versus 20 percent). However, the difference in prevalence
by cost of transport is minimal. The prevalence of disability among ill or injured people by type of health
care financing shows that the percentage with a disability is slightly higher among those for whom the cost
of treatment for their illness or injury was paid by a health equity fund (25 percent) than among those who
received other forms of subsidies (21 percent), those who have insurance (23 percent), and those who paid
out of their pocket for the treatment of their illness or injury (20 percent).
Six percent of ill and injured household members suffer from more severe disabilities (i.e., they
have a great deal of difficulty or cannot perform the function at all). Similar to the general population, this
finding indicates that the majority of ill or injured people experience a moderate level of disability. The
distribution of more severe disability among the ill or injured population by background characteristics
follows somewhat the same pattern observed for overall disability.
4.3 DISABILITY AND EMPLOYMENT
Table 4.3 presents information about disability by type of employment. Since information on
employment was collected only among interviewed women and men age 15-49, this table provides data on
disability and employment among only household members age 15-49 who were eligible for an individual
interview and completed the interview.
Table 4.3 Disability and employment
Percentage of interviewed women and men age 15-49 with a physical disability according to employment status, Cambodia 2014
Employment status
No difficulties
Some difficulty, a lot of difficulty, or cannot do A lot of difficulty or cannot do
Number
Any
domain Seeing Hearing Walking
Concen
trating
Selfcare
Communicating
Any
domain Seeing Hearing Walking
Concen
trating
Selfcare
Communicating
WOMEN
Employed in the 12
months preceding
the survey
Currently employed1 95.1 4.9 2.3 0.9 1.0 1.8 0.0 0.3 0.3 0.1 0.1 0.1 0.0 0.0 0.1 12,436
Not currently
employed 94.4 5.6 2.7 1.0 1.9 2.2 0.0 0.2 0.6 0.1 0.0 0.2 0.3 0.0 0.1 1,542
Not employed in the
12 months
preceding the
survey 93.8 6.2 2.4 0.8 2.0 2.7 0.4 0.8 1.1 0.3 0.1 0.7 0.2 0.1 0.3 3,599
Total 94.7 5.3 2.3 0.9 1.3 2.0 0.1 0.4 0.5 0.2 0.1 0.2 0.1 0.0 0.1 17,578
MEN
Employed in the 12
months preceding
the survey
Currently employed1 95.2 4.7 1.8 0.9 1.2 1.6 0.3 0.2 0.4 0.2 0.0 0.2 0.1 0.1 0.0 4,547
Not currently
employed 89.8 10.2 2.5 4.4 2.3 3.8 0.9 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 271
Not employed in the
12 months
preceding the
survey 94.8 5.2 1.4 0.2 3.0 1.7 0.3 1.1 2.0 1.0 0.2 0.7 0.3 0.0 0.3 372
Total 94.9 5.0 1.8 1.0 1.4 1.7 0.3 0.3 0.5 0.2 0.0 0.2 0.1 0.1 0.0 5,190
Note: Total includes 1 woman for whom information on employment is missing.
1 “Currently employed” is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and
were absent from work for leave, illness, vacation, or any other such reason.
Disability • 45
According to the 2014 CDHS, only 5 percent of interviewed women and men age 15-49 suffer
from at least one form of disability. Difficulties in seeing and concentrating (2 percent each) are the most
common types of disabilities reported among these women and men.
The prevalence of disability among women who are currently employed is 5 percent, slightly
lower than among those who are not currently employed and those who were not employed in the 12
months preceding the survey (6 percent each). Men who are not currently employed are twice as likely to
be disabled as men who are currently employed and those not employed in the 12 months preceding the
survey (10 percent versus 5 percent each). Severe disability is only reported for less than 1 percent among
this group.
Respondent Characteristics • 47
RESPONDENT CHARACTERISTICS 5
Key Findings
• Thirteen percent of women and 6 percent of men age 15-49 have no
education; an additional 40 percent and 52 percent have at least some
secondary education.
• Twenty-one percent of women and 25 percent of men age 15-49 are
exposed to at least one source of mass media once a week.
• Only 16 percent of Cambodian women and 13 percent of men are
covered by health insurance.
• Sixty-nine percent of women were employed in the 12 months preceding
the survey, with the majority (57 percent of women) employed in the
agricultural sector.
• Nearly half of working women (44 percent) work in the agricultural sector,
and about three in four of these women are self-employed.
his chapter provides a demographic and socioeconomic profile of respondents interviewed in the
2014 Cambodia Demographic and Health Survey (CDHS). Such background information is
essential to interpret the findings and understand the results presented later in the report. Basic
characteristics of respondents include age, level of education, marital status, religion, and wealth status.
Exposure to mass media and literacy status were examined, and detailed information was collected on
employment status, occupation, and earnings. In addition, the CDHS collected data on knowledge and
attitudes concerning health insurance coverage and use of tobacco.
5.1 CHARACTERISTICS OF SURVEY RESPONDENTS
Background characteristics of the 17,578 women age 15-49 and the 5,190 men age 15-49
interviewed in the 2014 CDHS are shown in Table 5.1. This table is important because it provides
background for interpreting findings presented later in the report.
The distribution of the population of women and men by age reflects recent Cambodian history. It
is notable that 16-18 percent of women and men fall into each of the age groups between 15-19 and 30-34.
Smaller proportions are found in the older age groups. Between 11 and 12 percent of women and men fall
into each of the five-year age groups between 35 and 49. This age distribution of respondents is unusual
and reflects the effects of the Khmer Rouge regime (1975-1979), during which fertility rates declined and
were coupled with higher than normal mortality. Between one and two million people are estimated to
have been killed during the reign of the Khmer Rouge. These events are reflected in the smaller than
expected proportions of women and men in the age groups between 35 and 49.
Approximately 68 percent of women and 66 percent of men are married or living with their
partner. The proportion not currently married varies by gender, with 25 percent of women never married
compared with 32 percent of men. Women are more than three times as likely as men to be divorced,
separated, or widowed (7 percent and 2 percent, respectively).
Access to services and exposure to information pertaining to reproductive health and other aspects
of life are often determined by one’s area of residence. The majority of respondents reside in rural areas,
with only 19 percent of women and 17 percent of men residing in urban areas. About 12 percent of women
and 13 percent of men live in Kampong Cham, and 11 percent of each live in the capital city of Phnom
Penh. Cambodians are predominantly Buddhist (96 percent of women and 95 percent of men). The other
two main religions, Islam and Christianity, are practiced by a very small proportion of respondents (Table
5.1).
T
48 • Respondent Characteristics
Table 5.1 Background characteristics of respondents
Percent distribution of women and men age 15-49 by selected background characteristics, Cambodia 2014
Women Men
Background
characteristic
Weighted
percent
Weighted
number
Unweighted
number
Weighted
percent
Weighted
number
Unweighted
number
Age
15-19 16.5 2,893 3,006 17.8 926 946
20-24 17.2 3,017 3,038 16.1 835 881
25-29 16.1 2,836 2,866 15.7 815 796
30-34 17.3 3,046 2,996 17.5 907 888
35-39 10.5 1,839 1,776 10.7 556 528
40-44 11.6 2,030 1,995 11.5 595 603
45-49 10.9 1,916 1,901 10.7 556 548
Religion
Buddhist 96.0 16,882 16,699 95.4 4,949 4,888
Moslem 1.9 335 338 2.6 133 124
Christian 0.9 157 151 0.9 47 48
Other/missing 1.2 204 390 1.2 61 130
Marital status
Never married 25.2 4,428 4,651 32.0 1,663 1,746
Married 67.2 11,808 11,574 65.3 3,388 3,306
Living together 0.5 91 94 0.3 17 14
Divorced/separated 3.8 664 697 1.8 95 97
Widowed 3.3 588 562 0.5 26 27
Residence
Urban 18.5 3,251 5,667 16.7 869 1,540
Rural 81.5 14,327 11,911 83.3 4,321 3,650
Province
Banteay Meanchey 3.9 689 810 3.7 192 223
Kampong Cham 11.5 2,021 853 12.8 663 300
Kampong Chhnang 3.8 662 899 3.5 182 251
Kampong Speu 6.8 1,196 1,022 6.2 323 269
Kampong Thom 4.8 851 905 4.5 232 261
Kandal 7.6 1,330 875 8.0 413 239
Kratie 2.8 488 874 2.8 143 258
Phnom Penh 11.3 1,994 1,400 10.6 550 391
Prey Veng 6.8 1,188 819 6.6 342 244
Pursat 3.6 631 859 3.5 184 261
Siem Reap 6.5 1,137 943 6.5 337 282
Svay Rieng 3.7 654 822 3.5 183 237
Takeo 6.2 1,082 868 6.4 334 252
Otdar Meanchey 1.7 294 823 1.9 99 277
Battambang/Pailin 7.6 1,333 867 7.8 405 249
Kampot/Kep 4.4 770 880 4.6 241 284
Preah Sihanouk/Koh Kong 2.4 422 1,010 2.3 120 288
Preah Vihear/Stung Treng 2.6 462 1,085 2.2 112 274
Mondul Kiri/Ratanak Kiri 2.1 372 964 2.6 134 350
Education
No education 12.8 2,250 2,233 6.2 324 327
Primary 47.1 8,281 7,826 41.8 2,167 2,026
Secondary and higher 40.1 7,047 7,519 52.0 2,699 2,837
Wealth quintile
Lowest 17.9 3,143 3,050 17.4 901 885
Second 18.9 3,314 3,057 18.4 954 930
Middle 19.2 3,381 2,798 20.0 1,040 867
Fourth 20.6 3,612 3,450 21.7 1,124 1,037
Highest 23.5 4,128 5,223 22.6 1,171 1,471
Total 100.0 17,578 17,578 100.0 5,190 5,190
Note: Education categories refer to the highest level of education attended, whether or not that level was completed.
The majority of Cambodians have some formal schooling, and educational levels of women have
improved within the past 10 years. The percentage of women with no schooling declined from 28 percent
in the 2000 CDHS to 19 percent in the 2005 CDHS, declined further to 16 percent in the 2010 CDHS, and
finished at 13 percent in the 2014 CDHS. Moreover, the percentage of women who had at least some
secondary education increased from 25 percent in 2005, to 35 percent in 2010, and reached 40 percent in
2014. However, Table 5.1 shows there are still notable differences in educational attainment between
women and men. Twice as many women as men have no schooling (13 percent versus 6 percent), and men
are more likely than women to have secondary education or higher (52 percent versus 40 percent).
Respondent Characteristics • 49
5.2 EDUCATIONAL ATTAINMENT AND LITERACY
Tables 5.2.1 and 5.2.2 present a detailed distribution of educational attainment among Cambodian
women and men, according to background characteristics. The general pattern evident in Table 5.2.1
indicates a decrease in the proportion of women with no schooling from the oldest to the youngest cohorts.
Men, with the exception of those in the 40-44 age group, exhibit the same pattern (Table 5.2.2). The data
presented in Tables 5.2.1 and 5.2.2 provide evidence of an increase in educational attainment among the
youngest age cohort. For example, 68 percent of women age 15-19 have attended secondary school, as
compared with only 58 percent of women age 20-24. A similar trend is seen in young men, with 66 percent
of those age 15-19 and 62 percent of those age 20-24 having attended some secondary school.
Table 5.2.1 Educational attainment: Women
Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background
characteristics, Cambodia 2014
Highest level of schooling
Total
Median
years
completed
Number of
women
Background
characteristic
No education
Some
primary
Completed
primary1
Some
secondary
Completed
secondary2
More than
secondary
Age
15-24 4.1 22.6 10.5 50.2 5.4 7.2 100.0 6.9 5,910
15-19 2.8 19.7 9.7 61.8 3.1 2.9 100.0 7.2 2,893
20-24 5.3 25.3 11.3 39.2 7.6 11.3 100.0 6.6 3,017
25-29 11.2 36.2 11.0 29.6 4.5 7.6 100.0 5.2 2,836
30-34 17.8 46.7 6.6 22.2 3.3 3.4 100.0 3.8 3,046
35-39 17.4 53.8 5.8 19.8 2.3 0.9 100.0 3.2 1,839
40-44 17.2 51.0 5.3 22.4 2.3 1.8 100.0 3.3 2,030
45-49 24.9 55.7 2.9 14.0 1.7 0.7 100.0 2.3 1,916
Residence
Urban 5.4 23.5 5.7 39.8 8.9 16.6 100.0 7.5 3,251
Rural 14.5 42.6 8.5 29.8 2.6 1.9 100.0 4.3 14,327
Province
Banteay Meanchey 12.8 46.3 7.1 27.7 4.0 2.1 100.0 4.2 689
Kampong Cham 14.1 43.1 9.9 28.4 2.7 1.8 100.0 4.0 2,021
Kampong Chhnang 8.7 41.1 8.7 33.6 4.3 3.5 100.0 5.0 662
Kampong Speu 11.0 39.2 11.2 35.4 1.9 1.3 100.0 5.0 1,196
Kampong Thom 14.0 46.9 8.8 23.6 3.7 3.0 100.0 3.7 851
Kandal 5.4 42.0 8.5 38.5 2.1 3.6 100.0 5.2 1,330
Kratie 15.6 50.1 7.7 22.1 2.6 1.9 100.0 3.3 488
Phnom Penh 4.1 23.7 5.3 39.6 7.8 19.5 100.0 7.6 1,994
Prey Veng 19.1 42.7 7.6 27.3 2.2 1.0 100.0 3.9 1,188
Pursat 16.3 41.0 10.5 26.5 4.0 1.7 100.0 4.2 631
Siem Reap 25.4 38.4 6.8 22.0 3.9 3.4 100.0 3.3 1,137
Svay Rieng 6.0 50.7 8.1 30.6 2.1 2.5 100.0 4.2 654
Takeo 11.7 32.6 6.1 40.8 5.3 3.5 100.0 5.6 1,082
Otdar Meanchey 26.4 37.2 7.8 24.9 2.8 0.9 100.0 3.3 294
Battambang/Pailin 10.0 35.1 7.9 36.6 5.1 5.3 100.0 5.6 1,333
Kampot/Kep 8.5 39.9 7.4 37.3 3.9 3.0 100.0 5.2 770
Preah Sihanouk/Koh Kong 9.6 38.8 9.6 32.3 4.0 5.6 100.0 5.2 422
Preah Vihear/Stung Treng 23.7 45.1 7.1 19.7 2.2 2.1 100.0 2.8 462
Mondul Kiri/Ratanak Kiri 34.5 32.9 6.0 23.8 1.4 1.3 100.0 2.3 372
Wealth quintile
Lowest 27.9 50.4 7.0 14.0 0.6 0.1 100.0 2.2 3,143
Second 18.1 48.5 8.9 22.9 1.1 0.4 100.0 3.3 3,314
Middle 10.3 46.0 8.0 33.0 1.9 0.8 100.0 4.5 3,381
Fourth 7.1 34.1 9.3 40.2 5.2 4.0 100.0 5.8 3,612
Highest 4.1 21.7 6.9 43.7 8.6 15.1 100.0 7.6 4,128
Total 12.8 39.1 8.0 31.7 3.8 4.6 100.0 4.8 17,578
1 Completed 6th grade at the primary level
2 Completed 12th grade at the secondary level
Urban women have higher levels of education than rural women. Almost two-thirds of urban
women have attended at least some secondary school, as compared with only about one-third of rural
women. Tables 5.2.1 and 5.2.2 show great variation in education across provinces. Mondul Kiri/Ratanak
Kiri has an exceptionally low level of educational attainment among women (35 percent of women having
no formal education) whereas Siem Reap has the lowest level among men (21 percent of men having no
formal education). By contrast, only 4 percent of women and less than 1 percent of men in Phnom Penh
have no schooling. Median number of years of education completed is highest in Phnom Penh (7.6 for
women and 9.9 for men).
50 • Respondent Characteristics
Educational attainment rises dramatically with wealth quintile. Twenty-eight percent of women in
the lowest quintile have no formal education, as compared with 4 percent of women in the highest wealth
quintile. The percentage of women who have attended some secondary school increases from 15 percent in
the lowest wealth quintile to 67 percent in the highest. The pattern of variation in educational attainment by
wealth among men is similar to that among women.
Table 5.2.2 Educational attainment: Men
Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background
characteristics, Cambodia 2014
Highest level of schooling
Total
Median
years
completed
Number of
men
Background
characteristic
No education
Some
primary
Completed
primary1
Some
secondary
Completed
secondary2
More than
secondary
Age
15-24 3.3 24.2 8.2 50.9 5.2 8.2 100.0 7.0 1,760
15-19 2.2 23.6 7.9 59.3 2.8 4.2 100.0 7.0 926
20-24 4.5 25.0 8.6 41.5 7.8 12.6 100.0 7.0 835
25-29 3.9 30.4 9.4 36.6 6.4 13.4 100.0 6.5 815
30-34 8.4 38.4 8.4 30.0 7.0 7.8 100.0 5.3 907
35-39 10.3 45.0 6.9 28.0 5.8 4.0 100.0 4.6 556
40-44 8.1 42.6 6.7 29.3 8.3 5.0 100.0 4.9 595
45-49 9.6 39.5 8.2 34.6 4.9 3.3 100.0 5.1 556
Residence
Urban 1.0 14.9 5.1 42.2 10.0 26.8 100.0 9.0 869
Rural 7.3 37.4 8.7 37.5 5.3 3.7 100.0 5.5 4,321
Province
Banteay Meanchey 7.5 40.0 5.5 38.7 4.2 4.2 100.0 5.3 192
Kampong Cham 5.2 45.5 10.0 30.1 2.5 6.7 100.0 4.9 663
Kampong Chhnang 4.6 41.3 8.9 31.4 7.3 6.5 100.0 5.5 182
Kampong Speu 6.7 24.9 12.4 48.6 5.5 1.9 100.0 6.3 323
Kampong Thom 8.7 42.1 10.6 30.5 3.2 4.9 100.0 4.9 232
Kandal 2.1 39.7 6.8 40.0 6.5 5.0 100.0 5.5 413
Kratie 3.6 45.1 5.2 33.2 8.3 4.5 100.0 5.2 143
Phnom Penh 0.3 11.2 3.7 43.4 10.2 31.2 100.0 9.9 550
Prey Veng 9.2 25.4 9.0 51.6 2.8 2.1 100.0 6.5 342
Pursat 8.0 41.3 12.6 30.6 5.8 1.8 100.0 5.1 184
Siem Reap 20.8 35.5 9.0 20.3 9.8 4.6 100.0 4.2 337
Svay Rieng 1.1 31.6 7.2 48.0 7.8 4.4 100.0 6.7 183
Takeo 4.1 29.9 7.9 45.8 6.9 5.4 100.0 6.9 334
Otdar Meanchey 13.0 38.4 8.7 33.1 6.1 0.8 100.0 4.8 99
Battambang/Pailin 2.3 29.9 9.0 46.3 5.7 6.8 100.0 6.7 405
Kampot/Kep 6.1 33.9 8.0 40.6 8.7 2.7 100.0 6.1 241
Preah Sihanouk/Koh Kong 4.7 29.0 8.1 39.5 8.2 10.5 100.0 6.7 120
Preah Vihear/Stung Treng 11.7 53.1 0.8 26.6 1.5 6.4 100.0 3.7 112
Mondul Kiri/Ratanak Kiri 16.4 36.9 6.3 30.8 3.9 5.7 100.0 4.6 134
Wealth quintile
Lowest 15.7 53.4 8.2 20.5 1.5 0.7 100.0 3.3 901
Second 8.9 47.7 10.8 29.6 1.7 1.2 100.0 4.5 954
Middle 5.7 36.9 9.6 41.2 4.5 2.1 100.0 5.6 1,040
Fourth 2.9 26.3 8.3 49.0 8.2 5.4 100.0 6.9 1,124
Highest 0.6 11.1 4.3 46.3 12.5 25.2 100.0 9.2 1,171
Total 6.2 33.6 8.1 38.3 6.1 7.6 100.0 6.0 5,190
1 Completed 6th grade at the primary level
2 Completed 12th grade at the secondary level
The 2014 CDHS assessed literacy levels among respondents who had never been to school or who
had attended only primary school by asking them to read all or part of a sentence in whatever language
they chose. Those with at least some secondary education were assumed to be literate. Literacy results are
shown in Tables 5.3.1 and 5.3.2.
Table 5.3.1 shows that 76 percent of women are literate, and Table 5.3.2 shows that 84 percent of
men are literate. For women, those in the younger age groups are more likely to be literate than those in the
older age groups. Literacy increases from 62 percent among women age 45-49 to 90 percent among
women age 15-19. For men the negative relationship between literacy and age is less evident. The
percentage of men who are literate is highest at age group 15-19 (89 percent). It decreases gradually to 76
percent among those age 35-39; then it reverses its pattern and is 83 percent among men age 40-49.
Respondent Characteristics • 51
Table 5.3.1 Literacy: Women
Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics,
Cambodia 2014
Secondary
school or
higher
No schooling or primary school
Total
Percentage
literate1
Number of
women
Background
characteristic
Can read a
whole
sentence
Can read
part of a
sentence
Cannot read
at all
No card with
required
language
Blind/
visually
impaired Missing
Age
15-24 62.8 12.6 12.8 11.7 0.0 0.0 0.0 100.0 88.2 5,910
15-19 67.7 11.8 10.2 10.1 0.0 0.1 0.1 100.0 89.8 2,893
20-24 58.1 13.4 15.2 13.3 0.0 0.0 0.0 100.0 86.7 3,017
25-29 41.6 17.1 20.9 20.2 0.0 0.0 0.1 100.0 79.6 2,836
30-34 28.9 18.7 20.9 31.5 0.0 0.0 0.1 100.0 68.5 3,046
35-39 23.0 16.2 26.2 34.6 0.0 0.0 0.0 100.0 65.4 1,839
40-44 26.5 18.7 24.9 29.8 0.0 0.0 0.1 100.0 70.1 2,030
45-49 16.4 16.6 29.1 37.9 0.0 0.0 0.0 100.0 62.1 1,916
Residence
Urban 65.4 14.8 10.3 9.5 0.0 0.0 0.1 100.0 90.5 3,251
Rural 34.3 16.2 22.3 27.1 0.0 0.0 0.1 100.0 72.8 14,327
Province
Banteay Meanchey 33.8 12.1 26.6 27.5 0.0 0.0 0.0 100.0 72.5 689
Kampong Cham 32.9 12.0 29.9 25.2 0.0 0.0 0.0 100.0 74.8 2,021
Kampong Chhnang 41.5 14.0 24.9 19.5 0.0 0.0 0.0 100.0 80.5 662
Kampong Speu 38.5 15.0 18.6 27.8 0.0 0.0 0.0 100.0 72.2 1,196
Kampong Thom 30.3 18.7 30.1 20.9 0.0 0.0 0.0 100.0 79.1 851
Kandal 44.2 27.2 8.1 20.3 0.0 0.0 0.2 100.0 79.5 1,330
Kratie 26.6 28.4 15.0 29.8 0.0 0.0 0.3 100.0 69.9 488
Phnom Penh 66.9 17.2 7.2 8.6 0.0 0.0 0.1 100.0 91.3 1,994
Prey Veng 30.6 15.0 22.3 31.7 0.0 0.1 0.3 100.0 67.9 1,188
Pursat 32.2 4.7 35.4 27.7 0.0 0.0 0.0 100.0 72.3 631
Siem Reap 29.3 16.4 21.4 33.0 0.0 0.0 0.0 100.0 67.0 1,137
Svay Rieng 35.2 19.8 19.2 25.7 0.0 0.2 0.0 100.0 74.2 654
Takeo 49.5 12.3 18.1 20.0 0.0 0.0 0.0 100.0 80.0 1,082
Otdar Meanchey 28.6 2.3 27.7 41.2 0.2 0.0 0.0 100.0 58.6 294
Battambang/Pailin 47.0 22.2 14.9 15.9 0.0 0.0 0.0 100.0 84.1 1,333
Kampot/Kep 44.2 12.2 21.2 22.5 0.0 0.0 0.0 100.0 77.5 770
Preah Sihanouk/Koh Kong 42.0 14.6 27.3 16.0 0.0 0.0 0.1 100.0 83.9 422
Preah Vihear/Stung Treng 24.1 15.7 14.6 45.2 0.4 0.0 0.0 100.0 54.4 462
Mondul Kiri/Ratanak Kiri 26.5 2.1 24.5 46.9 0.0 0.0 0.0 100.0 53.1 372
Wealth quintile
Lowest 14.7 12.5 27.4 45.3 0.0 0.1 0.0 100.0 54.6 3,143
Second 24.4 17.0 24.4 34.0 0.1 0.0 0.0 100.0 65.8 3,314
Middle 35.7 17.8 23.6 22.8 0.0 0.0 0.1 100.0 77.1 3,381
Fourth 49.5 16.6 17.8 16.0 0.0 0.0 0.1 100.0 83.9 3,612
Highest 67.4 15.5 10.0 7.0 0.0 0.0 0.0 100.0 92.9 4,128
Total 40.1 15.9 20.1 23.9 0.0 0.0 0.1 100.0 76.1 17,578
1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence
Ninety-one percent of women residing in urban areas are literate, as compared with 73 percent of
their rural counterparts. Similarly, urban men show higher rates of literacy than rural men (95 percent and
82 percent, respectively). Differences in literacy across provinces are marked, with the highest literacy rate
among women in Phnom Penh (91 percent) and the lowest among women in Mondul Kiri/Ratanak Kiri (53
percent). Among men, literacy is also highest in Phnom Penh (96 percent) and lowest in Preah
Vihear/Stung Treng (76 percent). Literacy levels increase along with wealth status among both women and
men. For example, literacy levels increase from 55 percent among women in the lowest wealth quintile to
93 percent among women in the highest wealth quintile and from 67 percent among men in the lowest
wealth quintile to 98 percent among men in the highest wealth quintile.
Women’s overall literacy rate has continued to increase since the 2000 CDHS (67 percent in 2000
versus 69 percent in 2005, 74 percent in 2010, and 76 percent in 2014). The difference in the literacy rates
among Cambodian men between 2010 (83 percent) and 2014 (84 percent) is very minimal.
52 • Respondent Characteristics
Table 5.3.2 Literacy: Men
Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Cambodia
2014
Secondary
school or
higher
No schooling or primary school
Total
Percentage
literate1
Number of
men
Background
characteristic
Can read a
whole
sentence
Can read
part of a
sentence
Cannot read
at all
No card with
required
language
Blind/
visually
impaired Missing
Age
15-24 64.3 6.1 17.8 11.8 0.1 0.0 0.0 100.0 88.1 1,760
15-19 66.4 6.1 16.4 11.0 0.2 0.0 0.0 100.0 88.8 926
20-24 61.9 6.1 19.3 12.7 0.0 0.0 0.0 100.0 87.3 835
25-29 56.4 11.3 18.9 13.0 0.0 0.4 0.0 100.0 86.6 815
30-34 44.8 13.3 22.5 19.3 0.1 0.0 0.0 100.0 80.6 907
35-39 37.7 16.4 22.3 23.6 0.0 0.0 0.0 100.0 76.4 556
40-44 42.7 13.8 26.2 17.2 0.0 0.0 0.1 100.0 82.6 595
45-49 42.8 15.6 24.7 16.9 0.0 0.0 0.0 100.0 83.1 556
Residence
Urban 78.9 6.7 9.1 5.3 0.0 0.0 0.0 100.0 94.7 869
Rural 46.6 12.1 23.4 17.8 0.1 0.1 0.0 100.0 82.0 4,321
Province
Banteay Meanchey 47.0 1.1 36.2 15.6 0.0 0.0 0.0 100.0 84.4 192
Kampong Cham 39.3 17.4 24.6 18.2 0.0 0.5 0.0 100.0 81.3 663
Kampong Chhnang 45.2 13.0 25.2 16.1 0.0 0.0 0.5 100.0 83.4 182
Kampong Speu 56.0 5.7 17.8 20.5 0.0 0.0 0.0 100.0 79.5 323
Kampong Thom 38.6 23.4 22.3 15.7 0.0 0.0 0.0 100.0 84.3 232
Kandal 51.5 12.3 14.7 21.5 0.0 0.0 0.0 100.0 78.5 413
Kratie 46.1 13.0 24.6 16.3 0.0 0.0 0.0 100.0 83.7 143
Phnom Penh 84.8 4.5 6.3 4.4 0.0 0.0 0.0 100.0 95.6 550
Prey Veng 56.5 7.8 20.5 15.2 0.0 0.0 0.0 100.0 84.8 342
Pursat 38.2 16.1 30.2 15.5 0.0 0.0 0.0 100.0 84.5 184
Siem Reap 34.7 9.8 36.1 19.0 0.5 0.0 0.0 100.0 80.5 337
Svay Rieng 60.1 11.9 14.6 13.3 0.0 0.0 0.0 100.0 86.7 183
Takeo 58.1 10.5 13.6 17.8 0.0 0.0 0.0 100.0 82.2 334
Otdar Meanchey 40.0 3.1 38.9 17.9 0.0 0.0 0.0 100.0 82.1 99
Battambang/Pailin 58.8 22.5 8.2 10.5 0.0 0.0 0.0 100.0 89.5 405
Kampot/Kep 52.0 0.6 29.2 18.3 0.0 0.0 0.0 100.0 81.7 241
Preah Sihanouk/Koh Kong 58.2 20.6 12.5 8.7 0.0 0.0 0.0 100.0 91.3 120
Preah Vihear/Stung Treng 34.5 5.1 35.9 24.5 0.0 0.0 0.0 100.0 75.5 112
Mondul Kiri/Ratanak Kiri 40.4 0.0 39.8 19.4 0.4 0.0 0.0 100.0 80.2 134
Wealth quintile
Lowest 22.8 11.6 33.0 32.6 0.1 0.0 0.0 100.0 67.4 901
Second 32.6 14.0 31.2 22.0 0.2 0.0 0.0 100.0 77.8 954
Middle 47.7 14.2 21.1 17.0 0.0 0.0 0.1 100.0 83.0 1,040
Fourth 62.5 10.8 17.0 9.5 0.0 0.3 0.0 100.0 90.2 1,124
Highest 84.0 6.3 7.1 2.5 0.0 0.0 0.0 100.0 97.5 1,171
Total 52.0 11.2 21.0 15.7 0.0 0.1 0.0 100.0 84.1 5,190
1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence
5.3 ACCESS TO MASS MEDIA
The 2014 CDHS collected information on the exposure of respondents to both broadcast and print
media. This information is important because it provides an indication of the exposure of women to mass
media that can be used to disseminate family planning, health, and other information. Access to mass
media is relatively high in Cambodia. Table 5.4.1 shows that 69 percent of women have some weekly
exposure to mass media. Watching television is the most common way of accessing the media: 61 percent
of women watch television at least once a week. Listening to the radio is also common (32 percent of
women listen at least once a week), with newspapers being the least utilized form of media (8 percent read
a newspaper at least once a week).
There is no strong pattern in access to the three types of media by age. The youngest group of
women (age 15-19) is most likely to access each form of media. However, women in the oldest age group
are not always the least likely to access media. Women age 35-49 are least likely to read a newspaper at
least once a week (5 percent), and women age 35-39 are least likely to listen to the radio (25 percent).
Residence, by contrast, is associated with differences in media exposure. Urban women have
better access to newspaper, television, and radio sources than their rural counterparts. The percentages of
urban women who read newspapers, watch television, and listen to the radio at least once per week are 22
Respondent Characteristics • 53
percent, 86 percent, and 43 percent, respectively. In contrast, rural women are significantly less likely than
urban women to do so (5 percent read newspapers, 55 percent watch television, and 30 percent listen to the
radio).
Media exposure among women varies by province as well. Women residing in Phnom Penh have
the greatest exposure to all three media (17 percent). Women residing in Kratie are least likely to be
exposed to the media, with 65 percent having no weekly access to media.
Table 5.4.1 Exposure to mass media: Women
Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Cambodia 2014
Background
characteristic
Reads a
newspaper at
least once a
week
Watches
television at least
once a week
Listens to the
radio at least
once a week
Accesses all
three media at
least once a
week
Accesses none
of the three
media at least
once a week
Number of
women
Age
15-19 11.4 63.6 41.5 7.0 26.3 2,893
20-24 10.2 63.4 35.4 6.2 28.2 3,017
25-29 8.5 61.3 30.5 4.9 30.7 2,836
30-34 7.1 60.4 26.8 4.5 33.3 3,046
35-39 4.7 56.7 25.2 2.8 37.0 1,839
40-44 5.4 57.6 30.3 3.4 34.8 2,030
45-49 4.5 56.5 34.3 2.9 33.2 1,916
Residence
Urban 21.7 85.5 42.5 13.5 10.7 3,251
Rural 4.7 54.8 30.1 2.8 36.1 14,327
Province
Banteay Meanchey 4.6 74.9 24.9 3.1 19.8 689
Kampong Cham 3.8 53.2 26.2 2.2 36.8 2,021
Kampong Chhnang 6.9 41.4 34.3 4.5 48.5 662
Kampong Speu 3.6 59.7 34.8 1.9 31.3 1,196
Kampong Thom 5.5 58.4 36.3 3.9 33.2 851
Kandal 5.6 87.1 45.4 4.3 10.3 1,330
Kratie 2.9 18.8 24.8 1.4 64.5 488
Phnom Penh 26.9 89.5 49.1 16.9 6.8 1,994
Prey Veng 3.4 68.3 34.4 2.0 24.8 1,188
Pursat 3.5 43.0 22.5 2.0 49.0 631
Siem Reap 6.8 40.5 29.6 3.9 46.4 1,137
Svay Rieng 3.6 64.2 21.7 2.4 30.7 654
Takeo 5.8 65.4 24.4 4.5 32.3 1,082
Otdar Meanchey 5.7 36.4 18.8 2.1 53.3 294
Battambang/Pailin 11.8 76.2 41.3 6.9 15.3 1,333
Kampot/Kep 4.5 27.4 17.7 0.1 58.8 770
Preah Sihanouk/Koh Kong 6.7 71.7 16.3 2.9 24.4 422
Preah Vihear/Stung Treng 2.1 21.8 22.5 0.6 59.8 462
Mondul Kiri/Ratanak Kiri 10.8 29.4 32.2 8.2 53.5 372
Education
No education 0.1 33.4 18.2 0.0 58.2 2,250
Primary 3.0 55.9 27.8 1.7 35.2 8,281
Secondary and higher 16.0 74.5 42.2 10.0 18.3 7,047
Wealth quintile
Lowest 1.3 22.8 19.5 0.5 65.0 3,143
Second 1.8 42.4 25.7 0.8 45.6 3,314
Middle 3.9 62.2 33.1 1.9 28.5 3,381
Fourth 7.8 76.4 36.6 5.0 18.3 3,612
Highest 21.1 88.3 43.0 13.4 8.3 4,128
Total 7.9 60.5 32.3 4.8 31.4 17,578
Media exposure increases with both the educational level and wealth quintile of the respondent.
For example, 88 percent of women in the highest wealth quintile watch television at least once per week,
as compared with 23 percent of women in the lowest wealth quintile. Similarly, 75 percent of women with
secondary education compared with 33 percent of women with no schooling watch television once a week.
In addition, 16 percent of women with at least some secondary school read a newspaper at least once a
week, as compared with 3 percent of women who have attended only primary school.
54 • Respondent Characteristics
Table 5.4.2 Exposure to mass media: Men
Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Cambodia 2014
Background
characteristic
Reads a
newspaper at
least once a
week
Watches
television at least
once a week
Listens to the
radio at least
once a week
Accesses all
three media at
least once a
week
Accesses none
of the three
media at least
once a week
Number of
men
Age
15-19 12.3 65.2 44.7 7.1 23.4 926
20-24 15.5 62.1 46.3 7.8 23.7 835
25-29 16.7 65.9 44.7 11.8 23.3 815
30-34 16.3 62.1 41.4 7.7 26.2 907
35-39 14.7 58.2 43.1 7.1 26.3 556
40-44 14.4 60.9 42.5 9.5 27.0 595
45-49 16.7 56.2 55.3 8.3 22.8 556
Residence
Urban 30.6 74.8 49.8 14.7 11.3 869
Rural 12.1 59.5 44.1 7.2 27.3 4,321
Province
Banteay Meanchey 3.4 70.0 49.0 3.3 19.7 192
Kampong Cham 11.0 58.0 46.8 5.3 26.0 663
Kampong Chhnang 7.4 38.5 24.9 1.9 46.5 182
Kampong Speu 10.2 60.3 49.3 5.1 22.3 323
Kampong Thom 2.9 71.5 48.1 2.3 22.0 232
Kandal 8.4 70.5 33.8 4.4 22.4 413
Kratie 7.6 27.9 30.7 4.2 58.8 143
Phnom Penh 26.7 69.1 44.4 9.6 12.9 550
Prey Veng 2.6 53.8 25.9 0.5 34.1 342
Pursat 5.4 76.4 68.1 5.1 18.1 184
Siem Reap 24.5 31.9 27.2 7.9 46.2 337
Svay Rieng 2.6 50.8 29.3 0.7 36.2 183
Takeo 9.6 84.9 62.9 7.2 5.6 334
Otdar Meanchey 21.0 59.4 52.2 16.0 26.7 99
Battambang/Pailin 38.2 86.7 75.3 32.3 6.1 405
Kampot/Kep 19.9 56.5 42.8 8.6 26.5 241
Preah Sihanouk/Koh Kong 49.0 92.2 61.9 34.9 2.8 120
Preah Vihear/Stung Treng 2.6 35.6 27.7 0.9 45.2 112
Mondul Kiri/Ratanak Kiri 29.2 41.3 42.6 16.1 38.0 134
Education
No education 0.6 35.3 20.6 0.1 54.4 324
Primary 7.8 54.3 39.6 3.5 32.0 2,167
Secondary and higher 22.8 71.5 52.5 13.4 15.1 2,699
Wealth quintile
Lowest 6.1 31.9 28.3 1.3 51.3 901
Second 7.3 47.0 39.1 2.9 34.9 954
Middle 9.3 65.7 49.9 5.9 20.6 1,040
Fourth 16.3 78.8 51.6 10.9 12.9 1,124
Highest 32.8 78.4 52.3 18.5 10.5 1,171
Total 15.2 62.1 45.1 8.5 24.6 5,190
A comparison of Tables 5.4.1 and 5.4.2 shows that women and men have relatively the same
access to all three media at least once per week (5 percent of women versus 9 percent of men). The slight
difference between the levels of exposure can be explained by greater access of men to printed material: 15
percent of men read a newspaper at least once per week, as compared with 8 percent of women.
In general, rates of media utilization remain more or less similar to those in 2010, when two-thirds
of women (68 percent) were exposed to some source of mass media. The differences between media
exposure in the 2010 CDHS and the 2014 CDHS are found among women who read a newspaper at least
once a week (12 percent versus 8 percent, respectively) and women who watch television at least once per
week (58 percent versus 61 percent, respectively). There was some improvement in men’s exposure to
mass media between 2010 and 2014 due to an increase in the percentage of men who watch television. In
2010, 30 percent of men were not exposed to a mass media source on a weekly basis, whereas this
proportion decreased to 25 percent in 2014.
Respondent Characteristics • 55
5.4 EMPLOYMENT
5.4.1 Employment Status
The 2014 CDHS included a number of questions regarding respondents’ employment status,
including whether they worked in the seven days preceding the survey and, if not, whether they worked in
the 12 months before the survey. Employment status results for women and men are presented in Tables
5.5.1 and 5.5.2.
Table 5.5.1 Employment status: Women
Percent distribution of women age 15-49 by employment status, according to background characteristics, Cambodia
2014
Employed in the 12 months
preceding the survey
Not employed in
the 12 months
preceding the
survey Total
Number of
women
Background
characteristic
Currently
employed1
Not currently
employed
Age
15-19 55.2 7.1 37.7 100.0 2,893
20-24 66.8 10.3 22.9 100.0 3,017
25-29 72.1 8.5 19.4 100.0 2,836
30-34 75.4 8.2 16.5 100.0 3,046
35-39 77.6 9.2 13.1 100.0 1,839
40-44 79.0 9.1 11.9 100.0 2,030
45-49 75.7 9.5 14.8 100.0 1,916
Marital status
Never married 66.0 5.8 28.2 100.0 4,428
Married or living together 71.3 10.1 18.6 100.0 11,898
Divorced/separated/
widowed 82.5 7.1 10.5 100.0 1,252
Number of living children
0 67.1 7.2 25.7 100.0 5,698
1-2 71.1 9.4 19.5 100.0 6,622
3-4 74.9 9.0 16.1 100.0 3,893
5+ 72.6 11.5 15.9 100.0 1,365
Residence
Urban 73.1 4.3 22.6 100.0 3,251
Rural 70.2 9.8 20.0 100.0 14,327
Province
Banteay Meanchey 65.5 19.6 14.9 100.0 689
Kampong Cham 71.2 10.4 18.4 100.0 2,021
Kampong Chhnang 88.2 3.7 8.1 100.0 662
Kampong Speu 84.0 4.4 11.6 100.0 1,196
Kampong Thom 79.8 1.2 19.0 100.0 851
Kandal 75.2 5.1 19.7 100.0 1,330
Kratie 74.5 14.3 11.2 100.0 488
Phnom Penh 76.2 3.3 20.5 100.0 1,994
Prey Veng 78.6 5.2 16.2 100.0 1,188
Pursat 56.8 15.9 27.4 100.0 631
Siem Reap 69.4 7.3 23.3 100.0 1,137
Svay Rieng 84.7 5.2 10.1 100.0 654
Takeo 54.8 15.6 29.5 100.0 1,082
Otdar Meanchey 77.8 2.4 19.8 100.0 294
Battambang/Pailin 46.0 8.8 45.1 100.0 1,333
Kampot/Kep 52.5 35.1 12.4 100.0 770
Preah Sihanouk/Koh Kong 69.0 4.3 26.7 100.0 422
Preah Vihear/Stung Treng 70.3 7.1 22.6 100.0 462
Mondul Kiri/Ratanak Kiri 81.5 3.3 15.2 100.0 372
Education
No education 70.4 9.3 20.4 100.0 2,250
Primary 73.0 10.1 16.9 100.0 8,281
Secondary and higher 68.2 7.1 24.7 100.0 7,047
Wealth quintile
Lowest 70.4 12.4 17.2 100.0 3,143
Second 70.9 11.1 18.0 100.0 3,314
Middle 68.5 9.2 22.3 100.0 3,381
Fourth 69.2 9.0 21.7 100.0 3,612
Highest 74.0 3.6 22.4 100.0 4,128
Total 70.7 8.8 20.5 100.0 17,578
1 Currently employed is defined as having done work in the past seven days. Includes persons who did not work in the
past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other
such reason.
56 • Respondent Characteristics
Table 5.5.2 Employment status: Men
Percent distribution of men age 15-49 by employment status, according to background characteristics, Cambodia 2014
Employed in the 12 months
preceding the survey
Not employed in
the 12 months
preceding the
survey Total
Number of
men
Background
characteristic
Currently
employed1
Not currently
employed
Age
15-19 60.9 8.4 30.7 100.0 926
20-24 87.3 5.1 7.6 100.0 835
25-29 93.8 4.3 1.9 100.0 815
30-34 95.8 4.0 0.2 100.0 907
35-39 94.5 5.5 0.0 100.0 556
40-44 95.7 3.7 0.6 100.0 595
45-49 94.5 4.9 0.6 100.0 556
Marital status
Never married 70.9 7.8 21.3 100.0 1,663
Married or living together 95.6 4.0 0.4 100.0 3,405
Divorced/separated/
widowed 92.9 4.0 3.1 100.0 122
Number of living children
0 75.0 7.5 17.5 100.0 2,043
1-2 96.2 3.3 0.5 100.0 1,725
3-4 95.1 4.5 0.4 100.0 1,058
5+ 96.0 3.7 0.3 100.0 364
Residence
Urban 84.1 2.2 13.8 100.0 869
Rural 88.3 5.8 5.8 100.0 4,321
Province
Banteay Meanchey 89.6 8.8 1.6 100.0 192
Kampong Cham 84.0 6.8 9.3 100.0 663
Kampong Chhnang 90.5 1.6 7.8 100.0 182
Kampong Speu 90.3 1.3 8.4 100.0 323
Kampong Thom 98.4 0.5 1.1 100.0 232
Kandal 90.7 0.6 8.8 100.0 413
Kratie 89.7 2.9 7.4 100.0 143
Phnom Penh 81.2 2.9 15.9 100.0 550
Prey Veng 91.2 8.5 0.3 100.0 342
Pursat 86.7 4.7 8.7 100.0 184
Siem Reap 91.6 2.1 6.3 100.0 337
Svay Rieng 88.3 5.0 6.7 100.0 183
Takeo 69.7 26.5 3.8 100.0 334
Otdar Meanchey 91.2 0.0 8.8 100.0 99
Battambang/Pailin 88.6 7.7 3.7 100.0 405
Kampot/Kep 89.0 0.0 11.0 100.0 241
Preah Sihanouk/Koh Kong 88.7 2.8 8.5 100.0 120
Preah Vihear/Stung Treng 95.8 1.4 2.8 100.0 112
Mondul Kiri/Ratanak Kiri 97.6 0.0 2.4 100.0 134
Education
No education 96.1 2.0 2.0 100.0 324
Primary 92.5 5.3 2.2 100.0 2,167
Secondary and higher 82.7 5.5 11.8 100.0 2,699
Wealth quintile
Lowest 90.8 4.5 4.7 100.0 901
Second 91.2 5.1 3.6 100.0 954
Middle 85.6 8.7 5.8 100.0 1,040
Fourth 86.7 5.2 8.1 100.0 1,124
Highest 84.9 2.8 12.3 100.0 1,171
Total 87.6 5.2 7.2 100.0 5,190
1 Currently employed is defined as having done work in the past seven days. Includes persons who did not work in the
past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other
such reason.
At the time of the survey, 71 percent of women were currently employed, and an additional 9
percent were not employed but had worked sometime during the preceding 12 months. The proportion of
women currently employed generally increases with increasing age and peaks at age group 40-44 (79
percent) before decreasing to 76 percent at age 45-49. Women who are divorced, separated, or widowed
are more likely to be employed than other women. Among men, in contrast, those who are married are
more likely to be employed than those who are divorced, separated, or widowed and those who have never
married.
Respondent Characteristics • 57
Urban and rural women are roughly equally likely to be currently employed (73 percent versus 70
percent). However, rural women are almost two and a half times more likely than urban women to have
worked in the past 12 months but not currently (10 percent versus 4 percent). As a result, urban women are
slightly more likely than rural women not to have been employed at all in the 12 months preceding the
survey (23 percent versus 20 percent). Women in Kampong Chhnang are most likely to be currently
employed (88 percent). In contrast, women in Battambang/Pailin are most likely not to have been
employed at any time in the 12 months preceding the survey (45 percent). Women who have attended
secondary school or higher and those in the three highest wealth quintiles are most likely to have not
worked in the 12 months preceding the survey.
The proportion of men currently employed is higher than that of women (88 percent versus 71
percent). Employment status differentials for men are similar to those for women. The proportion of men
currently employed generally increases with age and peaks at age 30-34 (from 61 percent to 96 percent).
From age 35 to 49, the percentage of men currently employed is relatively constant at 95-96 percent. As
with women, urban men are more likely not to have worked in the 12 months preceding the survey, as are
men with a secondary education or higher and those in the highest wealth quintile. The proportion of men
currently employed ranges from a low of 70 percent in Takeo to a high of 98 percent in Kampong Thom
and in Mondul Kiri/Ratanak Kiri. Phnom Penh has the highest percentage of men who are not currently
employed (16 percent), and Takeo has the highest percentage of men who worked at some point in the
previous 12 months (27 percent), but not currently.
The level of female employment in 2014 is similar to that in 2010. However, there is a difference
between the two surveys in the proportions of men employed. In 2010, 81 percent of men in Cambodia
were currently employed, whereas this proportion increased to 88 percent of men in 2014.
5.4.2 Occupation
Respondents who were currently employed or had worked in the 12 months preceding the survey
were further asked to specify their occupation. Tables 5.6.1 and 5.6.2 show data on occupation of
employed women and men, respectively.
Most employed persons are engaged in the agricultural sector, including 44 percent of working
women and 51 percent of working men. About one in four working women are employed in sales and
services (24 percent), along with 13 percent of men. Twenty-two percent of women are employed in
skilled manual labor, and 2 percent are employed in unskilled manual labor. Men are more likely than
women to be employed in skilled manual labor, with 26 percent engaged in this type of occupation. Six
percent of women and 7 percent of men are employed in professional, technical, and managerial fields.
58 • Respondent Characteristics
Table 5.6.1 Occupation: Women
Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics,
Cambodia 2014
Background
characteristic
Professional/
technical/
managerial Clerical
Sales and
services
Skilled
manual
Unskilled
manual Agriculture Missing Total
Number of
women
Age
15-19 2.5 1.4 19.8 33.0 1.8 36.4 5.0 100.0 1,802
20-24 8.4 2.6 22.8 28.6 1.7 34.0 1.9 100.0 2,327
25-29 8.0 2.1 24.4 25.9 1.6 36.8 1.2 100.0 2,286
30-34 5.4 1.1 28.6 22.2 1.6 40.5 0.6 100.0 2,545
35-39 3.4 0.3 26.8 18.8 1.9 48.4 0.4 100.0 1,597
40-44 4.9 0.7 25.3 11.1 1.7 55.5 1.0 100.0 1,788
45-49 4.8 0.5 21.7 6.8 2.1 63.2 1.0 100.0 1,632
Marital status
Never married 8.8 3.0 22.1 29.4 2.2 29.6 4.9 100.0 3,177
Married or living together 4.6 0.8 24.9 19.0 1.3 48.8 0.5 100.0 9,679
Divorced/separated/
widowed 5.1 1.2 26.5 22.7 3.5 39.8 1.3 100.0 1,121
Number of living children
0 8.2 2.7 22.3 29.5 2.2 31.2 3.8 100.0 4,231
1-2 5.8 1.0 26.6 23.1 1.4 41.2 0.7 100.0 5,332
3-4 3.4 0.5 26.0 13.9 1.5 54.2 0.5 100.0 3,267
5+ 1.0 0.1 16.7 8.0 1.9 72.1 0.3 100.0 1,148
Residence
Urban 15.6 4.6 47.5 19.7 5.3 5.2 2.2 100.0 2,514
Rural 3.4 0.6 19.3 22.1 0.9 52.2 1.4 100.0 11,464
Province
Banteay Meanchey 4.1 1.7 31.3 18.8 2.7 40.5 0.9 100.0 586
Kampong Cham 4.0 0.1 22.0 16.3 0.6 54.3 2.6 100.0 1,649
Kampong Chhnang 3.8 0.3 14.7 26.2 0.4 54.1 0.4 100.0 608
Kampong Speu 2.6 0.2 10.3 45.5 0.6 40.8 0.0 100.0 1,057
Kampong Thom 4.0 0.2 20.7 9.9 1.3 63.5 0.3 100.0 690
Kandal 5.9 0.7 20.9 54.5 1.1 16.9 0.0 100.0 1,068
Kratie 3.6 0.3 18.4 3.5 1.0 72.9 0.2 100.0 434
Phnom Penh 16.8 5.1 39.0 27.8 6.0 3.4 1.8 100.0 1,584
Prey Veng 2.9 0.1 24.0 13.1 0.5 54.7 4.8 100.0 996
Pursat 3.4 0.2 22.5 12.9 1.2 58.8 0.9 100.0 458
Siem Reap 5.5 0.7 29.5 9.0 2.5 51.6 1.1 100.0 872
Svay Rieng 3.3 2.3 16.8 25.8 1.5 47.2 3.2 100.0 589
Takeo 4.5 0.4 24.7 35.2 0.6 29.6 4.9 100.0 763
Otdar Meanchey 1.5 1.2 17.4 1.9 0.5 77.0 0.5 100.0 236
Battambang/Pailin 7.9 4.9 39.2 7.9 1.5 37.2 1.5 100.0 731
Kampot/Kep 4.0 0.6 18.3 7.0 1.2 68.8 0.2 100.0 675
Preah Sihanouk/Koh Kong 5.6 2.4 39.8 30.0 4.5 16.8 0.9 100.0 309
Preah Vihear/Stung Treng 3.2 1.0 14.8 1.9 0.3 78.4 0.3 100.0 358
Mondul Kiri/Ratanak Kiri 2.2 0.6 26.2 1.3 1.3 68.3 0.0 100.0 315
Education
No education 0.5 0.2 16.1 10.7 1.6 70.4 0.5 100.0 1,792
Primary 1.3 0.4 20.9 22.8 1.9 52.4 0.4 100.0 6,882
Secondary and higher 12.8 2.9 31.7 23.9 1.6 23.5 3.5 100.0 5,303
Wealth quintile
Lowest 0.6 0.2 5.8 12.7 0.7 79.0 1.1 100.0 2,602
Second 1.1 0.1 11.8 20.5 1.0 64.6 0.9 100.0 2,718
Middle 2.1 0.3 17.4 28.0 0.7 49.3 2.3 100.0 2,628
Fourth 6.5 0.8 31.5 28.3 2.1 29.5 1.3 100.0 2,827
Highest 15.5 4.6 49.6 18.9 3.7 5.5 2.2 100.0 3,202
Total 5.6 1.3 24.4 21.7 1.7 43.7 1.6 100.0 13,978
Residence has an effect on type of occupation. Employed women and men in urban areas are more
likely than those in rural areas to hold jobs in the professional, technical, and managerial; clerical; and
sales and services sectors. In contrast, rural women and men are more likely than those in urban areas to be
engaged in agricultural work. Those with lower levels of education and those in lower wealth quintiles are
also more likely to work in agriculture. For example, 78 percent of employed men with no schooling work
in the field of agriculture, whereas only 36 percent of men with a secondary education or higher work in
agriculture.
Respondent Characteristics • 59
Table 5.6.2 Occupation: Men
Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics,
Cambodia 2014
Background
characteristic
Professional/
technical/
managerial Clerical
Sales and
services
Skilled
manual
Unskilled
manual Agriculture Missing Total
Number of
men
Age
15-19 2.1 0.0 9.2 23.9 1.2 63.2 0.4 100.0 641
20-24 5.8 1.1 11.6 31.6 1.1 47.7 1.0 100.0 772
25-29 9.6 1.7 13.0 27.5 2.3 44.3 1.7 100.0 799
30-34 9.7 2.1 13.4 28.7 1.2 44.5 0.4 100.0 906
35-39 6.1 0.6 11.1 27.8 0.6 53.0 0.9 100.0 556
40-44 8.5 2.0 14.1 20.7 0.1 54.1 0.6 100.0 592
45-49 8.5 1.0 16.7 15.1 0.6 57.9 0.2 100.0 553
Marital status
Never married 6.4 1.0 11.9 27.2 1.1 50.7 1.6 100.0 1,309
Married or living together 7.9 1.4 12.8 24.9 1.1 51.5 0.4 100.0 3,391
Divorced/separated/
widowed 3.9 0.3 15.7 31.3 0.5 46.5 1.7 100.0 118
Number of living children
0 6.9 1.2 12.0 27.8 1.3 49.3 1.5 100.0 1,685
1-2 8.3 1.8 13.1 27.4 1.3 47.7 0.4 100.0 1,717
3-4 7.8 0.8 13.7 23.5 0.8 53.1 0.3 100.0 1,053
5+ 3.8 0.5 10.6 14.5 0.1 70.1 0.5 100.0 363
Residence
Urban 20.1 4.8 28.7 32.7 2.4 8.6 2.6 100.0 749
Rural 5.0 0.6 9.7 24.4 0.8 59.0 0.4 100.0 4,069
Province
Banteay Meanchey 7.5 1.1 10.9 22.6 1.8 55.7 0.5 100.0 189
Kampong Cham 5.0 0.2 10.9 19.3 1.9 62.3 0.4 100.0 602
Kampong Chhnang 7.7 0.0 7.8 20.0 0.6 62.4 1.5 100.0 168
Kampong Speu 4.9 0.5 7.3 30.7 0.7 55.1 0.9 100.0 296
Kampong Thom 5.5 0.2 9.1 18.1 0.2 66.5 0.5 100.0 230
Kandal 6.8 0.4 11.8 39.0 1.8 40.1 0.1 100.0 377
Kratie 6.3 0.6 5.2 17.8 0.9 68.9 0.3 100.0 132
Phnom Penh 21.9 4.9 29.6 35.5 2.2 2.8 3.1 100.0 462
Prey Veng 4.7 0.6 12.1 30.9 0.0 51.8 0.0 100.0 341
Pursat 2.4 1.3 6.9 13.7 0.0 75.2 0.4 100.0 168
Siem Reap 6.0 0.4 10.4 27.3 0.5 54.8 0.6 100.0 316
Svay Rieng 6.1 2.3 16.4 36.2 3.0 35.3 0.6 100.0 171
Takeo 7.1 0.0 13.8 29.5 0.6 48.6 0.6 100.0 321
Otdar Meanchey 5.1 1.1 8.5 7.1 0.0 78.3 0.0 100.0 91
Battambang/Pailin 5.1 3.9 13.7 23.8 0.4 52.2 0.9 100.0 390
Kampot/Kep 6.9 0.9 6.6 19.4 1.6 63.8 0.7 100.0 214
Preah Sihanouk/Koh Kong 10.5 2.5 17.4 36.7 1.7 29.8 1.4 100.0 110
Preah Vihear/Stung Treng 4.1 0.2 7.6 13.6 0.0 74.1 0.4 100.0 109
Mondul Kiri/Ratanak Kiri 5.6 1.4 14.9 8.4 0.0 69.6 0.0 100.0 131
Education
No education 1.7 0.0 4.3 16.1 0.0 78.0 0.0 100.0 318
Primary 2.4 0.0 8.0 23.6 1.3 64.6 0.1 100.0 2,119
Secondary and higher 12.5 2.6 17.9 28.8 1.0 35.6 1.4 100.0 2,380
Wealth quintile
Lowest 1.1 0.3 3.4 17.7 0.2 77.2 0.2 100.0 859
Second 2.5 0.0 3.8 25.0 0.3 68.4 0.0 100.0 919
Middle 3.7 0.4 8.0 24.8 1.0 61.6 0.5 100.0 980
Fourth 8.7 0.6 16.4 27.6 2.1 44.2 0.4 100.0 1,033
Highest 19.1 4.9 28.9 31.9 1.6 11.0 2.6 100.0 1,027
Total 7.4 1.3 12.7 25.7 1.1 51.2 0.8 100.0 4,818
5.4.3 Earnings, Employers, and Continuity of Employment
Table 5.7 shows the percent distribution of employed women by type of earnings and employment
characteristics. Because all of the employment variables in the table are strongly influenced by the sector
in which a woman is employed, data are grouped according to agricultural or nonagricultural work.
60 • Respondent Characteristics
Table 5.7 Type of employment: Women
Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of
earnings, type of employer, and continuity of employment, according to type of employment (agricultural or
nonagricultural), Cambodia 2014
Employment
characteristic Agricultural work
Nonagricultural
work Missing Total
Type of earnings
Cash only 67.5 97.0 46.7 83.3
Cash and in-kind 15.6 1.3 2.3 7.6
In-kind only 8.9 0.0 0.9 3.9
Not paid 8.1 1.6 49.7 5.2
Total 100.0 100.0 100.0 100.0
Type of employer
Employed by family member 13.8 4.6 5.4 8.6
Employed by nonfamily member 13.8 51.8 35.6 34.9
Self-employed 72.5 43.6 58.7 56.4
Total 100.0 100.0 100.0 100.0
Continuity of employment
All year 16.1 85.9 67.9 55.1
Seasonal 81.0 10.0 19.5 41.2
Occasional 2.8 4.1 12.3 3.7
Total 100.0 100.0 100.0 100.0
Number of women employed during
the last 12 months 6,115 7,644 219 13,978
Note: Total includes women with missing information on type of employment who are not shown separately.
One in four women engaged in agricultural work are paid in-kind or through a combination of
cash and in-kind, 68 percent are paid in cash only, and 8 percent are unpaid. Women employed in the
nonagricultural sector are more likely to be paid in cash only (97 percent). Nationally, across all
occupations, 83 percent of employed women are paid in cash and 8 percent are paid in cash and in-kind for
their work. Five percent are not paid at all for their work.
In 2014, 56 percent of employed Cambodian women are self-employed, and 9 percent are
employed by a family member. Thirty-five percent of employed women work for someone outside the
family. Among women working in the agricultural sector, almost three-quarters (73 percent) are working
for themselves, as compared with 44 percent of those in the nonagricultural sector. In addition, the
proportion of women employed by someone outside the family is nearly four times higher among those
working in the nonagricultural sector than among those in the agricultural sector (52 percent versus 14
percent).
Fifty-five percent of employed women work all year, and 41 percent work seasonally. Those who
work occasionally account for only 4 percent. Among women working in the agricultural sector, 81
percent are seasonal workers, as compared with only 10 percent of those working in the nonagricultural
sector. Continuity of employment is more assured for women engaged in nonagricultural work than for
those in agricultural work. For example, 86 percent of women working in the nonagricultural sector work
all year, as compared with 16 percent of women engaged in agricultural work.
5.5 HEALTH INSURANCE
In the 2014 CDHS, women and men age 15-49 were asked whether they were covered by any
health insurance and, if so, which type. The choices were the following: a health equity fund, a maternal
health voucher, community-based insurance, employer-based insurance, and privately purchased
commercial insurance. Tables 5.8.1 and 5.8.2 show health insurance coverage for women and men in
Cambodia.
Respondent Characteristics • 61
Table 5.8.1 Health insurance coverage: Women
Percentage of women age 15-49 with specific types of health insurance coverage, according to background characteristics, Cambodia 2014
Background
characteristic
Health equity
fund
Maternal
health voucher
Communitybased health
insurance
Employerbased
insurance
Privately
purchased
commercial
insurance Other None
Number of
women
Age
15-19 9.3 0.3 0.8 2.8 0.1 0.1 86.7 2,893
20-24 8.6 0.7 0.8 4.3 0.1 0.1 85.9 3,017
25-29 12.5 0.5 0.6 3.1 0.4 0.0 83.0 2,836
30-34 12.4 0.4 1.1 2.9 0.3 0.0 83.4 3,046
35-39 15.5 0.4 1.1 1.0 0.3 0.0 81.9 1,839
40-44 13.1 0.8 1.1 1.1 0.3 0.0 84.5 2,030
45-49 13.3 0.2 1.4 0.8 0.1 0.0 84.5 1,916
Residence
Urban 5.9 0.2 1.0 7.0 0.6 0.0 85.6 3,251
Rural 13.1 0.5 0.9 1.5 0.1 0.0 84.1 14,327
Province
Banteay Meanchey 14.7 0.4 0.0 0.0 0.0 0.0 85.0 689
Kampong Cham 14.6 0.7 1.9 0.5 0.5 0.0 82.9 2,021
Kampong Chhnang 26.0 0.0 0.0 0.0 0.0 0.0 74.0 662
Kampong Speu 1.5 0.0 0.2 3.6 0.0 0.5 94.2 1,196
Kampong Thom 17.6 0.0 2.6 0.0 0.0 0.0 79.8 851
Kandal 1.2 0.0 0.0 0.3 0.0 0.0 98.4 1,330
Kratie 19.3 0.2 0.8 0.0 0.0 0.0 79.8 488
Phnom Penh 3.8 0.0 1.5 16.0 0.8 0.0 78.4 1,994
Prey Veng 9.3 0.0 0.1 0.0 0.0 0.0 90.7 1,188
Pursat 18.2 0.1 0.9 0.1 0.1 0.0 80.9 631
Siem Reap 15.5 0.1 4.8 1.4 0.2 0.0 78.9 1,137
Svay Rieng 13.0 0.5 0.0 2.2 0.0 0.0 84.7 654
Takeo 12.3 3.3 0.3 0.4 0.3 0.0 83.6 1,082
Otdar Meanchey 21.2 0.0 0.6 0.0 0.0 0.0 78.2 294
Battambang/Pailin 25.0 0.1 0.3 0.0 0.0 0.0 74.7 1,333
Kampot/Kep 5.1 1.5 0.0 0.0 0.1 0.0 93.6 770
Preah Sihanouk/Koh Kong 18.3 1.8 0.0 6.6 0.0 0.0 73.6 422
Preah Vihear/Stung Treng 0.8 0.4 0.0 0.0 0.0 0.0 98.8 462
Mondul Kiri/Ratanak Kiri 2.9 0.0 0.0 0.0 0.2 0.2 96.8 372
Education
No education 21.0 0.7 1.1 0.4 0.1 0.0 77.1 2,250
Primary 14.5 0.5 0.9 1.7 0.1 0.0 82.8 8,281
Secondary and higher 5.7 0.4 1.0 4.1 0.4 0.0 88.7 7,047
Wealth quintile
Lowest 24.3 0.4 1.7 0.5 0.1 0.1 73.5 3,143
Second 17.8 0.7 0.6 0.6 0.0 0.0 80.6 3,314
Middle 9.8 0.9 0.9 1.3 0.1 0.1 87.3 3,381
Fourth 6.9 0.2 0.9 2.3 0.2 0.0 89.9 3,612
Highest 3.3 0.2 0.7 6.8 0.6 0.0 88.6 4,128
Total 11.8 0.5 0.9 2.5 0.2 0.0 84.4 17,578
The majority of Cambodians, 84 percent of women and 87 percent of men, do not have health
insurance. These percentages are slightly improved compared with the 2010 CDHS (89 percent and 92
percent, respectively). As for those who are insured, the gross majority (12 percent of women and 9
percent of men) are insured through a health equity fund. One percent of respondents report having
community-based health insurance, and about 3 percent report being covered through employer-based
health insurance, privately purchased commercial health insurance, or, in the case of female respondents,
maternal health vouchers. These data imply that the health insurance system in the country is not
widespread in its reach.
62 • Respondent Characteristics
Table 5.8.2 Health insurance coverage: Men
Percentage of men age 15-49 with specific types of health insurance coverage, according to background characteristics, Cambodia 2014
Background
characteristic
Health equity
fund
Communitybased health
insurance
Employerbased
insurance
Privately
purchased
commercial
insurance Other None
Number of
men
Age
15-19 7.1 0.3 2.1 0.0 0.0 90.8 926
20-24 5.3 0.6 3.6 0.2 0.0 90.3 835
25-29 8.4 1.9 4.6 0.4 0.0 85.1 815
30-34 10.0 0.8 3.6 0.8 0.1 84.8 907
35-39 9.5 3.0 1.5 0.2 0.0 85.8 556
40-44 9.9 1.0 1.6 0.4 0.0 87.0 595
45-49 10.9 0.6 1.7 0.7 0.0 86.0 556
Residence
Urban 4.7 0.7 10.8 1.0 0.0 82.8 869
Rural 9.3 1.2 1.2 0.3 0.0 88.2 4,321
Province
Banteay Meanchey 5.6 0.0 3.9 0.3 0.0 91.4 192
Kampong Cham 11.6 1.0 0.0 0.0 0.0 88.0 663
Kampong Chhnang 24.2 0.0 0.0 0.0 0.0 75.8 182
Kampong Speu 4.3 0.4 1.6 0.1 0.0 93.5 323
Kampong Thom 1.0 0.1 0.2 0.5 0.0 98.2 232
Kandal 0.2 4.0 0.4 0.5 0.0 95.0 413
Kratie 20.5 0.2 0.5 0.1 0.0 78.7 143
Phnom Penh 3.2 0.9 19.0 1.0 0.0 75.8 550
Prey Veng 2.2 0.0 1.0 0.6 0.0 96.3 342
Pursat 14.2 0.4 0.0 0.0 0.0 85.4 184
Siem Reap 15.9 5.1 1.1 0.9 0.3 76.7 337
Svay Rieng 0.1 0.0 2.9 0.5 0.0 96.5 183
Takeo 11.2 2.2 0.8 0.4 0.0 85.7 334
Otdar Meanchey 4.6 0.0 0.0 0.0 0.0 95.4 99
Battambang/Pailin 20.6 0.0 0.0 0.2 0.0 79.1 405
Kampot/Kep 8.5 0.0 0.0 0.0 0.0 91.5 241
Preah Sihanouk/Koh Kong 9.1 1.6 9.6 1.4 0.3 78.9 120
Preah Vihear/Stung Treng 1.1 0.0 0.1 0.0 0.0 98.8 112
Mondul Kiri/Ratanak Kiri 0.9 0.0 0.0 0.0 0.0 99.1 134
Education
No education 13.3 1.6 0.2 0.6 0.0 84.4 324
Primary 12.0 1.6 0.9 0.1 0.0 85.6 2,167
Secondary and higher 5.1 0.6 4.7 0.6 0.0 89.1 2,699
Wealth quintile
Lowest 17.6 1.1 0.1 0.0 0.1 81.5 901
Second 12.6 1.3 0.5 0.2 0.0 85.4 954
Middle 7.5 1.2 0.7 0.1 0.0 90.5 1,040
Fourth 5.2 1.2 2.5 0.6 0.0 90.8 1,124
Highest 2.3 0.7 9.1 0.9 0.0 87.2 1,171
Total 8.5 1.1 2.8 0.4 0.0 87.3 5,190
There are notable differentials in the proportions of women and men with health equity funds
according to background characteristics. Both rural women and rural men are about twice as likely as their
urban counterparts to have a health equity fund. The proportion of those with a health equity fund is higher
among women and men with no education and in the lower wealth quintiles. For example, 24 percent of
women in the lowest wealth quintile are covered through a health equity fund, as compared with only 3
percent of women in the highest wealth quintile. Health equity fund coverage among women varies by
province, ranging from about 1 percent in Preah Vihear/Stung Treng and Kandal to 26 percent in Kampong
Chhnang.
5.6 USE OF TOBACCO
Smoking or other use of tobacco affects one’s health and may adversely affect the health of one’s
children, especially in terms of vulnerability to respiratory illness. In addition, tobacco use during
pregnancy increases a woman’s risk of having a small or low-birth-weight baby. All interviewed
respondents in the 2014 CDHS were asked about their smoking habits. Tables 5.9.1 and 5.9.2 show the
percentage of women and men, respectively, who use various types of tobacco and the percent distribution
of cigarette smokers by number of cigarettes smoked in the preceding 24 hours, according to background
characteristics.
Respondent Characteristics • 63
Table 5.9.1 Use of tobacco: Women
Percentage of women age 15-49 who smoke cigarettes or a pipe or use other tobacco products, according to background characteristics and maternity
status, Cambodia 2014
Uses tobacco
Does not
use
tobacco
Number
of women
Percent distribution of women who smoke cigarettes by
number of cigarettes smoked in the past 24 hours
Total
Number
of cigarette
smokers
Background
characteristic
Cigarettes Pipe
Other
tobacco 0 1-2 3-5 6-9 10+
Don’t
know/
missing
Age
15-19 0.5 0.0 0.3 99.3 2,893 * * * * * * 100.0 14
20-24 0.6 0.0 0.6 98.9 3,017 * * * * * * 100.0 19
25-29 1.6 0.0 1.0 98.0 2,836 0.0 16.0 45.9 5.2 30.8 2.2 100.0 44
30-34 2.0 0.1 2.7 95.9 3,046 0.0 25.8 33.2 4.9 27.1 8.9 100.0 61
35-39 4.6 0.1 5.8 90.9 1,839 0.0 17.2 35.4 12.4 32.4 2.6 100.0 85
40-44 4.8 0.1 10.5 85.7 2,030 0.0 13.3 31.1 10.1 42.5 3.0 100.0 98
45-49 4.7 0.2 13.7 82.6 1,916 0.0 19.9 33.7 11.6 33.3 1.5 100.0 89
Maternity status
Pregnant 1.1 0.0 1.6 97.8 934 * * * * * * 100.0 10
Breastfeeding (not
pregnant) 3.0 0.2 2.6 95.2 2,348 0.0 23.3 41.5 7.6 26.6 1.1 100.0 70
Neither 2.3 0.1 4.5 93.7 14,296 0.0 16.9 34.2 10.1 34.4 4.4 100.0 330
Residence
Urban 0.6 0.0 0.7 98.8 3,251 (0.0) (21.9) (43.3) (4.7) (26.1) (3.9) 100.0 20
Rural 2.7 0.1 4.9 93.1 14,327 0.0 17.9 35.2 10.2 33.0 3.7 100.0 390
Province
Banteay Meanchey 1.1 0.0 3.5 95.6 689 * * * * * * 100.0 7
Kampong Cham 4.6 0.0 5.9 90.5 2,021 (0.0) (17.8) (24.5) (10.4) (43.5) (3.8) 100.0 93
Kampong Chhnang 0.0 0.0 3.6 96.4 662 * * * * * * 0.0 0
Kampong Speu 0.5 0.0 1.6 97.9 1,196 * * * * * * 100.0 6
Kampong Thom 1.3 0.0 3.6 95.6 851 * * * * * * 100.0 11
Kandal 0.3 0.0 2.5 97.4 1,330 * * * * * * 100.0 4
Kratie 12.4 0.0 7.9 81.4 488 0.0 32.6 32.5 9.2 25.7 0.0 100.0 60
Phnom Penh 0.5 0.0 0.7 98.8 1,994 * * * * * * 100.0 10
Prey Veng 0.8 0.0 8.4 91.1 1,188 * * * * * * 100.0 10
Pursat 2.0 0.0 7.8 90.5 631 * * * * * * 100.0 12
Siem Reap 1.4 0.1 4.2 94.4 1,137 * * * * * * 100.0 16
Svay Rieng 0.0 0.0 8.3 91.7 654 * * * * * * 0.0 0
Takeo 1.1 0.0 1.8 97.8 1,082 * * * * * * 100.0 12
Otdar Meanchey 1.5 0.0 3.3 95.7 294 * * * * * * 100.0 4
Battambang/Pailin 2.4 0.0 1.8 96.0 1,333 * * * * * * 100.0 32
Kampot/Kep 0.9 0.0 1.6 97.7 770 * * * * * * 100.0 7
Preah Sihanouk/
Koh Kong 0.8 0.0 0.6 98.7 422 * * * * * * 100.0 3
Preah Vihear/
Stung Treng 14.4 0.0 12.4 77.0 462 0.0 24.6 50.3 4.0 17.8 3.2 100.0 67
Mondul Kiri/
Ratanak Kiri 14.9 3.3 11.3 82.1 372 0.0 13.1 53.3 9.3 24.3 0.0 100.0 55
Education
No education 8.2 0.4 11.3 83.4 2,250 0.0 21.6 37.9 11.9 27.6 0.9 100.0 185
Primary 2.4 0.1 5.1 92.9 8,281 0.0 15.9 37.7 9.4 30.9 6.2 100.0 200
Secondary and
higher 0.4 0.0 0.6 99.1 7,047 * * * * * * 100.0 25
Wealth quintile
Lowest 6.1 0.3 9.7 85.5 3,143 0.0 19.6 35.3 13.5 31.1 0.5 100.0 192
Second 3.2 0.1 5.4 92.6 3,314 0.0 19.4 34.8 9.0 33.5 3.4 100.0 106
Middle 2.1 0.0 3.9 94.4 3,381 0.0 13.8 38.4 4.8 35.9 7.0 100.0 71
Fourth 0.9 0.0 2.5 96.8 3,612 (0.0) (11.5) (29.2) (5.3) (38.6) (15.4) 100.0 33
Highest 0.2 0.0 0.4 99.4 4,128 * * * * * * 100.0 8
Total 2.3 0.1 4.1 94.2 17,578 0.0 18.1 35.6 9.9 32.7 3.7 100.0 410
Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has
been suppressed.
Overall, 6 percent of women in Cambodia use some form of tobacco, a slight decrease from selfreported tobacco use among women in the 2010 CDHS. Two percent smoke cigarettes and 4 percent use a
form of tobacco other than cigarettes or a pipe (some women use more than one form of tobacco). Only 2
percent of pregnant women and 5 percent of women who are breastfeeding use tobacco. Tobacco use is
much higher among men, with 32 percent of Cambodian men reporting that they smoke cigarettes and 5
percent reporting that they use other forms of tobacco.
Tobacco use varies greatly by background characteristics. Older women and men are much more
likely to use tobacco than are younger women and men. Cigarette smoking increases from less than 1
64 • Respondent Characteristics
percent among women age 15-19 to 5 percent among women 35-49. Similarly, reported cigarette smoking
in men increases from 8 percent among those age 15-19 to 53 percent among those in the oldest age cohort.
Use of tobacco other than cigarettes also increases with age among both women and men.
Table 5.9.2 Use of tobacco: Men
Percentage of men age 15-49 who smoke cigarettes or a pipe or use other tobacco products and the percent distribution of cigarette smokers by number of
cigarettes smoked in preceding 24 hours, according to background characteristics, Cambodia 2014
Uses tobacco
Does not
use
tobacco
Number
of men
Percent distribution of men who smoke cigarettes by
number of cigarettes smoked in the past 24 hours
Total
Number
of cigarette
smokers
Background
characteristic
Cigarettes Pipe
Other
tobacco 0 1-2 3-5 6-9 10+
Don’t
know/
missing
Age
15-19 8.2 0.1 1.1 91.8 926 0.0 20.2 27.2 14.1 38.4 0.0 100.0 76
20-24 23.7 0.0 2.9 76.1 835 0.0 6.7 15.9 8.2 69.2 0.0 100.0 198
25-29 25.0 0.0 3.2 74.6 815 0.1 2.4 12.0 7.7 77.8 0.0 100.0 204
30-34 36.8 0.1 6.8 62.1 907 0.6 3.0 15.5 8.2 72.7 0.0 100.0 334
35-39 45.5 0.1 6.3 53.0 556 0.0 2.5 7.2 4.2 86.1 0.0 100.0 253
40-44 48.7 0.1 7.1 49.2 595 0.0 3.6 7.7 7.7 81.0 0.0 100.0 290
45-49 53.4 0.0 10.5 45.1 556 0.0 1.1 10.7 7.3 80.6 0.3 100.0 297
Residence
Urban 21.6 0.0 1.5 78.4 869 0.1 9.7 17.5 8.8 63.9 0.0 100.0 187
Rural 33.9 0.1 5.7 65.1 4,321 0.1 3.1 11.5 7.4 77.8 0.1 100.0 1,466
Province
Banteay Meanchey 34.7 0.0 0.7 64.7 192 0.0 1.8 10.2 3.0 85.0 0.0 100.0 67
Kampong Cham 37.9 0.0 2.1 61.1 663 0.0 1.6 4.3 8.8 85.3 0.0 100.0 251
Kampong Chhnang 25.4 0.0 10.7 66.6 182 0.0 2.2 18.3 5.8 73.7 0.0 100.0 46
Kampong Speu 30.9 0.0 0.0 69.1 323 0.0 11.2 14.2 7.0 67.6 0.0 100.0 100
Kampong Thom 34.8 0.0 2.4 63.4 232 0.0 0.0 4.8 11.3 83.9 0.0 100.0 81
Kandal 22.4 0.0 1.6 76.5 413 0.0 0.0 36.3 4.7 59.0 0.0 100.0 93
Kratie 37.5 0.0 0.0 62.5 143 0.0 5.5 12.1 9.8 72.6 0.0 100.0 54
Phnom Penh 17.9 0.0 2.6 82.1 550 2.2 18.3 21.7 7.2 50.7 0.0 100.0 99
Prey Veng 31.6 0.0 31.6 67.8 342 0.0 0.0 19.1 7.2 73.7 0.0 100.0 108
Pursat 30.3 0.0 2.1 69.7 184 0.0 9.1 7.1 12.8 69.6 1.3 100.0 56
Siem Reap 40.6 0.0 0.3 59.1 337 0.0 3.5 13.3 2.9 80.3 0.0 100.0 137
Svay Rieng 29.6 0.0 3.4 68.1 183 0.0 6.7 12.2 5.7 75.4 0.0 100.0 54
Takeo 30.3 0.0 1.0 68.7 334 0.1 1.6 6.9 7.6 83.8 0.0 100.0 101
Otdar Meanchey 41.2 0.0 0.4 58.4 99 0.0 1.7 5.8 8.6 83.9 0.0 100.0 41
Battambang/Pailin 31.4 0.0 0.0 68.6 405 0.0 0.0 3.8 8.8 87.4 0.0 100.0 127
Kampot/Kep 37.0 0.0 4.2 63.0 241 0.0 4.5 12.5 5.0 78.0 0.0 100.0 89
Preah Sihanouk/
Koh Kong 37.9 0.0 0.0 62.1 120 0.0 4.7 7.5 12.8 75.0 0.0 100.0 46
Preah Vihear/
Stung Treng 44.7 0.0 8.3 55.3 112 0.0 6.3 17.0 15.2 61.5 0.0 100.0 50
Mondul Kiri/
Ratanak Kiri 40.2 1.7 40.1 58.4 134 0.0 0.7 15.9 5.0 78.4 0.0 100.0 54
Education
No education 59.4 0.2 16.3 38.0 324 0.0 4.8 7.5 4.6 83.1 0.0 100.0 193
Primary 41.8 0.1 5.8 56.9 2,167 0.0 2.0 9.7 8.3 79.9 0.1 100.0 906
Secondary and
higher 20.5 0.0 2.9 79.2 2,699 0.4 6.6 17.7 7.3 68.0 0.0 100.0 554
Wealth quintile
Lowest 46.9 0.1 9.6 50.7 901 0.0 1.9 11.8 10.5 75.8 0.0 100.0 422
Second 36.4 0.1 6.7 62.4 954 0.0 2.5 8.7 8.6 80.2 0.0 100.0 348
Middle 34.1 0.1 6.0 65.2 1,040 0.0 3.6 7.4 5.3 83.7 0.0 100.0 355
Fourth 27.2 0.0 2.6 72.6 1,124 0.7 4.5 13.8 5.4 75.3 0.2 100.0 306
Highest 19.0 0.0 1.4 80.9 1,171 0.1 9.2 23.4 6.8 60.5 0.0 100.0 223
Total 31.8 0.0 5.0 67.3 5,190 0.1 3.9 12.2 7.5 76.2 0.0 100.0 1,653
Women and men in rural areas, those with less education, and those in the lower wealth quintiles
are more likely to use tobacco. Only 1 percent of women in urban areas use tobacco, as compared with 7
percent of women in rural areas. Likewise, almost 22 percent of urban men report using tobacco, as
compared with 35 percent of their rural counterparts. Tobacco use ranges from less than 1 percent among
women with a secondary education or higher and those in the highest wealth quintile to 17 percent among
women with no education and 14 percent among those in the lowest wealth quintile. Men show a pattern
similar to that of women. Tobacco use rates are highest among women in Preah Vihear/Stung Treng, where
23 percent of women use tobacco, in the form of cigarettes (14 percent) or other form of tobacco (12
percent), and in Mondul Kiri/Ratanak Kiri (18 percent), where the proportion of women using cigarettes is
15 percent and that using other forms of tobacco is 11 percent). Among men, tobacco use is highest in
Respondent Characteristics • 65
Preah Vihear/Stung Treng (45 percent), where high proportions of men report smoking cigarettes (45
percent). Using other forms of tobacco is highest among men in Mondul Kiri/Ratanak Kiri (40 percent).
Respondents who reported smoking cigarettes were asked to recall the number of cigarettes
smoked in the past 24 hours. The differentials in smoking frequency among female smokers are very small
due to the small number of women in Cambodia who smoke. However, Table 5.9.1 shows that 36 percent
of women who smoke cigarettes report smoking 3-5 cigarettes per day, and 33 percent report smoking 10
or more cigarettes per day. Proportions among women are much lower than those among men, as can be
seen in Table 4.9.2. Seventy-six percent of male smokers reported smoking 10 or more cigarettes in the
past 24 hours. This proportion is much higher among men living in Battambang/Pailin, where 87 percent
report smoking 10 or more cigarettes in the past 24 hours.
Fertility • 67
FERTILITY 6
Key Findings
• The total fertility rate in Cambodia for the three years preceding the
survey is 2.7 children per woman. Rural women have almost one child
more than urban women.
• Fertility declined by 0.4 children per woman between 2005 and 2010,
from 3.4 children to 3.0 children per woman, and slightly decreased
further to 2.7 children in 2014.
• One-tenth of women age 25-49 gave birth by age 18 and 28 percent by
age 20. The median age at first birth is 22.4 years.
• Thirty-seven percent of births occur within three years of a previous birth;
13 percent occur within 24 months.
• Twelve percent of young women age 15-19 are already mothers or
pregnant with their first child.
ertility is an important component of population dynamics and plays a large role in changing the
size and structure of the population of a given area. In Cambodia, population size and structure were
severely affected during the reign of the Khmer Rouge (1975-1979), in terms of both excess
mortality and reduced fertility. The CDHS generates detailed information on fertility and fertility patterns
over time that will be useful for the formulation of policies and the design of programs.
Current fertility levels, trends and differentials in fertility, cumulative fertility, birth intervals, age
at first birth, and adolescent fertility are examined in this chapter. The fertility indicators presented in this
chapter are based on information obtained from women age 15-49. All women who were interviewed in
the 2014 CDHS were asked to report the total number of daughters and sons they had given birth to in their
lifetime. To encourage complete reporting, women were asked separately about children still living at
home, those living elsewhere, and those who had died. A complete birth history was then obtained,
including information on the sex, date of birth,1 and survival status of each child and the age at death for
deceased children.
6.1 CURRENT FERTILITY LEVELS AND DIFFERENTIALS
The current level of fertility refers to live births in the three-year period preceding the survey. This
information was obtained from birth history data and is presented in Table 6.1. The summary measures
include age-specific fertility rates (ASFRs),2 total fertility rates (TFRs) for women age 15-49, the general
fertility rate (GFR), and the crude birth rate (CBR). The ASFRs represent the number of live births per
1,000 women in the age group. The TFR is a common measure of current fertility and is defined as the
total number of births a woman would have by the end of her childbearing years if she were to pass
through those years bearing children at the currently observed age-specific fertility rates. The GFR is
1 During data collection, interviewers recorded Gregorian month and year of birth. However, when the respondent
knew only the Khmer month and year of birth, the interviewer used a chart specially designed for the CDHS to
convert Khmer dates into Gregorian dates.
2 Numerators of the three-year ASFRs are calculated by summing the number of live births that occurred in the period
1-36 months preceding the survey (determined by the date of the interview and the date of birth of the child) and
classifying them by age (in 5-year groups) of the mother at the time of the birth (determined by the mother’s birth
date). The denominators of the rates are the number of woman-years lived in each of the specified 5-year age groups
during the 1-36 months preceding the survey.
F
68 • Fertility
defined as the annual number of births per 1,000 women age 15-44. The CBR is the total number of births
occurring in a given year per 1,000 population.
The total fertility rate in Cambodia for the three years preceding the survey indicates that if
fertility rates were to remain constant at the level prevailing during the period 2012-2014, a Cambodian
woman would bear 2.7 children during her lifetime. The average Cambodian woman will give birth to 1.1
children by age 253 and 1.9 children by age 30. The TFR in urban areas is 2.1 births per woman, almost
one child lower than the rate in rural areas (2.9 births per woman). An examination of age-specific rates by
urban-rural residence indicates that the age pattern of fertility is quite different in urban and rural areas.
Fertility rates are higher in nearly every age group for rural women than for urban women. Among women
age 15-19, fertility rates are quite low in both urban and rural areas (21 and 66 per 1,000 women,
respectively). Among rural women, rates quickly increase to reach their maximum at age 20-24 (179 per
1,000) and remain quite high at age 25-29 (156 per 1,000) before declining regularly above age 29. Among
urban women, fertility rates increase from 21 per 1,000 at age 15-19 to 101 per 1,000 at age 20-24 and
reach a maximum of 135 per 1,000 at age 25-29. They then decline regularly, similar to rates among rural
women.
The CBR, also presented in Table 6.1, is 22.0 per 1,000 population. The GFR, the average annual
number of births per 1,000 women age 15-44 for the three years prior to the survey, is 98. As with the
TFR, the GFR and CBR vary by urban-rural residence. The GFR for rural women is 103 births per 1,000
women, which is about 36 percent higher than that for urban women (76 births per 1,000 women). Also,
the CBR in rural areas (22.4 per 1,000 population) is approximately 10 percent higher than the CBR in
urban areas (20.2 per 1,000 population).
Table 6.1 Current fertility
Age-specific and total fertility rates, the general
fertility rate, and the crude birth rate for the three
years preceding the survey, by residence,
Cambodia 2014
Residence
Total Age group Urban Rural
15-19 21 66 57
20-24 101 179 162
25-29 135 156 152
30-34 92 104 102
35-39 56 50 51
40-44 11 18 17
45-49 3 5 4
TFR (15-49) 2.1 2.9 2.7
GFR 76 103 98
CBR 20.2 22.4 22.0
Notes: Age-specific fertility rates are per 1,000
women. Rates for age group 45-49 may be
slightly biased due to truncation. Rates are for the
period 1-36 months prior to the interview.
TFR: Total fertility rate, expressed per woman
GFR: General fertility rate, expressed per 1,000
women age 15-44
CBR: Crude birth rate, expressed per 1,000
population
Table 6.2 presents differentials in fertility by urban-rural residence, province, education, and
wealth quintile. There are large differences in fertility levels across provinces. Fertility is lowest in the
capital city of Phnom Penh, at 2.0 children per woman, and highest in Preah Vihear/Stung Treng and
Kratie, at 3.6 children per woman. Among the remaining provinces, total fertility ranges from 2.4 to 3.3.
Fertility is well known to be inversely related to level of education around the world, and Cambodian
women demonstrate this universal pattern. A woman with no education (TFR of 3.3) has 0.2 children more
3 Calculated as the age-specific fertility rate for women age 15-19 plus the age-specific fertility rate for women age
20-24, multiplied by 5 (to take into account the five-year age group) and divided by 1,000.
Fertility • 69
than a woman with a primary school education (TFR of 3.1) and one child more than a woman with a
secondary education or higher (TFR of 2.3). Fertility is also very closely associated with wealth. The
disparity in fertility between the poorest women, who have the most children (3.8), and the richest women,
who have the fewest (2.2), is 1.6 children per woman.
Table 6.2 Fertility by background characteristics
Total fertility rate for the three years preceding the survey, percentage of
women age 15-49 currently pregnant, and mean number of children ever
born to women age 40-49, by background characteristics, Cambodia 2014
Background
characteristic
Total fertility
rate
Percentage of
women age
15-49 currently
pregnant
Mean number
of children
ever born to
women age
40-49
Residence
Urban 2.1 4.9 3.0
Rural 2.9 5.4 4.0
Province
Banteay Meanchey 2.8 5.2 4.0
Kampong Cham 3.3 3.5 3.9
Kampong Chhnang 2.4 5.4 4.2
Kampong Speu 2.4 6.3 4.1
Kampong Thom 2.9 5.8 4.4
Kandal 2.5 5.7 3.9
Kratie 3.6 7.3 4.5
Phnom Penh 2.0 4.6 2.8
Prey Veng 3.0 4.9 3.5
Pursat 3.1 5.9 4.0
Siem Reap 2.7 5.2 3.9
Svay Rieng 2.5 5.7 3.4
Takeo 2.4 3.9 3.7
Otdar Meanchey 3.0 8.5 4.6
Battambang/Pailin 2.9 5.5 3.8
Kampot/Kep 2.5 4.9 3.9
Preah Sihanouk/Koh Kong 2.7 5.8 4.1
Preah Vihear/Stung Treng 3.6 9.5 5.2
Mondul Kiri/Ratanak Kiri 3.3 6.9 4.8
Education
No education 3.3 4.5 4.3
Primary 3.1 5.3 4.0
Secondary and higher 2.3 5.6 3.1
Wealth quintile
Lowest 3.8 5.2 4.4
Second 2.8 6.4 4.3
Middle 2.8 4.9 3.9
Fourth 2.4 5.2 3.7
Highest 2.2 4.9 3.0
Total 2.7 5.3 3.9
Note: Total fertility rates are for the period 1-36 months prior to the interview.
Table 6.2 includes another indicator of current fertility, the percentage of women who reported
being pregnant at the time of the survey. This percentage may be underreported because women may not
be aware of a pregnancy, especially at the very early stages, and some women who are early in their
pregnancy may not want to reveal that they are pregnant. Five percent of women reported that they were
pregnant at the time of the survey. The proportion of pregnant women in urban areas and rural areas is
about the same. Kampong Cham and Takeo had the lowest proportion of pregnant women (4 percent), and
Preah Vihear/Stung Treng (10 percent) and Otdar/Meanchey (9 percent) had the highest. The proportion of
women who are currently pregnant rises slightly as education increases. There is no clear relationship
between current pregnancy and wealth quintile.
70 • Fertility
6.2 FERTILITY TRENDS
The 2014 CDHS data can be used to assess trends in fertility in Cambodia in several ways.
6.2.1 Comparison of Current and Cumulative Fertility Levels
Table 6.2 shows the mean number of live births among women age 40 to 49. This figure is an
indicator of completed, or cumulative, fertility. Unlike the TFR, which measures the current or recent
fertility of women age 15 to 49, cumulative fertility shows the past fertility of women surveyed at the end
of their childbearing years. In a population whose fertility does not change, the level of cumulative fertility
more or less coincides with the TFR. But TFRs that are lower than the mean number of children ever born
to women at the end of their childbearing years indicate a downward trend in fertility.
In Cambodia, women age 40-49 have given birth to an average of 3.9 children. This is higher than
the TFR (2.7). The difference, although small (1.2), suggests a substantial decline in fertility. Data from
previous CDHS surveys show a difference between the two rates of 1.4 children in 2000, 1.5 children in
2005, and 1.2 children in 2010.
Fertility results by background characteristics show cumulative fertility rates above the TFR for
all categories, indicating that fertility is declining among all women. However, the difference between
cumulative fertility (number of children ever born) and the TFR is greatest in Kampong Chhnang (1.8
children).
6.2.2 Retrospective Data
Fertility trends can be investigated using
retrospective data from the birth histories collected within
the 2014 CDHS. Table 6.3.1 and Figure 6.1 show agespecific fertility rates (ASFRs) for successive five-year
periods preceding the 2014 CDHS. Numerators of the rates
are classified by five-year segments of time preceding the
survey and the mother’s age at the time of birth. Because
women age 50 and over were not interviewed in the survey,
the rates for older age groups become progressively more
truncated for periods more distant from the survey date. For
example, rates cannot be calculated for women age 35-39 for
the period 15-19 years before the survey because these
women would have been over age 50 at the time of the
survey and were not interviewed.
Table 6.3.1 Trends in age-specific fertility rates
Age-specific fertility rates for five-year periods preceding
the survey, by mother’s age at the time of the birth,
Cambodia 2014
Mother’s
age at birth
Number of years preceding survey
0-4 5-9 10-14 15-19
15-19 56 50 61 65
20-24 159 165 184 212
25-29 149 177 193 219
30-34 105 123 142 [187]
35-39 51 79 [109]
40-44 18 [48]
45-49 [4]
Note: Age-specific fertility rates are per 1,000 women.
Estimates in brackets are truncated. Rates exclude the
month of the interview.
Fertility • 71
Figure 6.1 Age-specific fertility rates for five-year periods preceding the survey
Age-specific fertility rates calculated over time provide further evidence of a substantial decline in
fertility at all ages. Among young women age 15-19, the ASFR declined from 65 per 1,000 15-19 years
before the survey to 50 per 1,000 5-9 years before the survey and then slightly increased to 56 per 1,000
during the most recent period (0-4 years before the survey). Fertility rates have also progressively declined
over time among women age 20-49 at the birth of their child. For instance, among mothers age 20-24 when
they gave birth, the ASFR fell from 212 per 1,000 15-19 years before the survey to 159 per 1,000 0-4 years
before the survey. A similar pattern was observed among women in the other age groups. The data further
show that the decline in fertility rates has slowed slightly in recent years.
6.2.3 Comparison with Previous CDHS
Another way to assess fertility trends is to compare current
estimates with earlier surveys. Table 6.3.2 and Figure 6.2 show the
ASFRs for the 2005, 2010, and 2014 CDHSs. The current TFR of
2.7 attests to a decline in fertility, from 3.4 children per woman
reported in the 2005 CDHS. As mentioned, the decline in fertility
has slowed slightly in recent years: the TFR decreased by 0.6
children per woman between 2000 and 2005 (data not shown), by
0.4 between 2005 and 2010, and by 0.3 between 2010 and 2014.
Although fertility declined in both urban and rural areas, the change
in the TFR between the 2010 CDHS and the 2014 CDHS occurred
predominantly as a result of declining fertility among rural women.
The TFR decreased by 0.4 children among rural women and by 0.1
children among urban women.
0
50
100
150
200
250
15-19 20-24 25-29 30-34 35-39 40-44 45-49
Births per 1,000
women
Woman’s age
0-4 years
5-9 years
10-14 years
15-19 years
CDHS 2014
Table 6.3.2 Trends in fertility
Age-specific and total fertility rates (TFR) for the
three years preceding the survey, Cambodia
2005, 2010, and 2014
Age group
CDHS
20051
CDHS
20102
CDHS
2014
15-19 47 46 57
20-24 175 173 162
25-29 180 167 152
30-34 142 121 102
35-39 91 71 51
40-44 41 28 28
45-49 5 4 5
Total 3.4 3.0 2.7
Note: Age-specific fertility rates are per 1,000
women.
1 NIPH, NIS, and ORC Macro, 2006
2 NIS, DGH, and ICF Macro, 2011
72 • Fertility
Figure 6.2 Trends in age-specific fertility rates, Cambodia 2005, 2010, and 2014
Declines in ASFRs between 2010 and 2014 have occurred among women age 20-24 and older.
The age groups in which women have demonstrated the largest decreases in fertility are 25-29, 30-34, and
35-39, with women in these age groups showing a decrease of 15-20 births per 1,000 women. In contrast,
there has been a rise in teenage fertility in Cambodia over the past few years, with age-specific fertility
rates among young women age 15-19 increasing from 46 children per 1,000 women in 2010 to 57 children
per 1,000 women in 2014.
6.3 CHILDREN EVER BORN AND LIVING
Data on the number of children ever born reflect the accumulation of births over the past 30 years
and therefore have limited relevance to current fertility levels, particularly when a country has experienced
a decline in fertility. Nevertheless, information on children ever born (or parity) is useful in looking at how
average family size varies across age groups and in assessing the level of primary infertility, the inability to
bear children. A comparison of the differences in the mean number of children ever born and surviving
reflects the cumulative effects of mortality levels during the period in which women have been bearing
children.
Table 6.4 shows the percent distribution of all women and currently married women by the
number of children ever born, the mean number of children ever born, and the mean number of children
living. More than 9 in 10 women age 15-19 (93 percent) have never given birth. However, this proportion
declines quickly to 23 percent among women age 25-29 and to 9 percent or less among women age 35 and
above. On average, Cambodian women have attained a parity of 4.1 children by the end of their
reproductive years. This is 1.4 children more than the total fertility rate, a difference brought about by
sustained declines in fertility.
0
20
40
60
80
100
120
140
160
180
200
15-19 20-24 25-29 30-34 35-39 40-44 45-49
Births per 1,000
women
Woman’s age
CDHS 2005
CDHS 2010
CDHS 2014
CDHS 2014
Fertility • 73
Table 6.4 Children ever born and living
Percent distribution of all women and currently married women age 15-49 by number of children ever born, mean number of children ever born, and
mean number of living children, according to age group, Cambodia 2014
Number of children ever born
Total
Number
of women
Mean
number of
children
ever born
Mean
number of
living
children Age 0 1 2 3 4 5 6 7 8 9 10+
ALL WOMEN
15-19 92.7 6.7 0.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 2,893 0.08 0.08
20-24 50.6 34.7 13.1 1.4 0.3 0.0 0.0 0.0 0.0 0.0 0.0 100.0 3,017 0.66 0.64
25-29 23.0 28.9 33.3 11.5 2.7 0.6 0.1 0.1 0.0 0.0 0.0 100.0 2,836 1.44 1.39
30-34 11.1 14.7 34.8 23.9 10.3 3.7 1.1 0.2 0.1 0.1 0.0 100.0 3,046 2.25 2.14
35-39 8.7 7.4 21.9 24.0 20.4 9.7 4.0 2.9 0.7 0.3 0.0 100.0 1,839 3.06 2.81
40-44 7.1 6.0 16.3 21.4 19.7 13.2 9.2 4.1 1.3 0.8 0.9 100.0 2,030 3.59 3.23
45-49 6.8 6.4 10.9 16.4 18.6 14.6 12.1 6.1 4.4 1.7 2.2 100.0 1,916 4.13 3.57
Total 32.0 16.4 19.1 13.0 8.7 4.9 3.0 1.5 0.7 0.3 0.3 100.0 17,578 1.93 1.77
CURRENTLY MARRIED WOMEN
15-19 56.8 39.5 3.6 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 450 0.47 0.46
20-24 22.3 54.4 20.8 2.1 0.3 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,833 1.04 1.00
25-29 9.1 32.4 40.4 14.0 3.4 0.7 0.1 0.1 0.0 0.0 0.0 100.0 2,249 1.73 1.67
30-34 3.3 14.3 38.6 26.7 11.5 4.1 1.3 0.2 0.1 0.1 0.0 100.0 2,625 2.48 2.36
35-39 3.4 5.5 22.9 25.7 22.7 10.9 4.4 3.3 0.8 0.3 0.0 100.0 1,573 3.33 3.06
40-44 2.3 3.9 16.4 23.0 21.3 14.4 10.3 4.9 1.5 0.8 1.1 100.0 1,673 3.90 3.52
45-49 2.4 4.4 10.0 17.3 19.0 16.4 13.7 7.5 5.1 1.8 2.5 100.0 1,495 4.53 3.91
Total 9.1 21.0 26.1 17.7 11.6 6.6 4.0 2.1 1.0 0.4 0.5 100.0 11,898 2.61 2.40
The same pattern is observed for currently married women, except that the mean number of
children ever born is higher for currently married women (2.6 children) than for all women (1.9 children).
The difference between all women and currently married women in mean number of children ever born is
due to the substantial proportion of young and unmarried women in the all-women category who exhibit
lower fertility. For example, only 7 percent of teenage women overall have given birth to a child, whereas
43 percent of currently married teenage women have begun childbearing.
As would be expected, the mean number of children ever born and the mean number of children
surviving rise monotonically as age increases. A comparison of the mean number of children ever born
with the mean number of living children reveals the experience of child loss among Cambodian women.
By the end of their reproductive years (age 45-49), married women in Cambodia have given birth, on
average, to 4.5 children, with 3.9 surviving.
Voluntary childlessness is not common in Cambodia, and currently married women with no
children are likely to be those who are unable to bear children (primary infertility). Whereas 57 percent of
currently married adolescent women are childless, this proportion decreases to 9 percent among currently
married women age 25-29 and continues to decline with increasing age. The percentage of childless
women among currently married women at the end of the reproductive period (age 45-49) shows that
primary infertility among currently married women is low (2 percent).
6.4 BIRTH INTERVALS
Longer birth intervals contribute to improved health status of both mother and child (Rutstein,
2005). Infants born within two years of the birth of a previous child experience a higher risk of health
problems. Table 6.5 shows the distribution of second- and higher-order births that occurred in the five
years preceding the survey by the number of months since the previous birth, according to background
characteristics.
74 • Fertility
Table 6.5 Birth intervals
Percent distribution of non-first births in the five years preceding the survey by number of months since preceding
birth, and median number of months since preceding birth, according to background characteristics, Cambodia
2014
Background
characteristic
Months since preceding birth
Total
Number
of nonfirst births
Median
number of
months
since
preceding
birth 7-17 18-23 24-35 36-47 48-59 60+
Age
15-19 * * * * * * 100.0 17 *
20-29 6.8 12.2 28.6 23.7 13.2 15.3 100.0 1,807 37.1
30-39 4.0 5.5 20.8 17.4 15.2 37.1 100.0 2,233 49.6
40-49 4.3 3.1 16.2 11.7 11.1 53.6 100.0 374 63.6
Sex of preceding birth
Male 5.5 8.0 20.9 20.8 13.7 31.1 100.0 2,306 44.5
Female 4.9 8.2 26.5 18.3 14.4 27.7 100.0 2,124 42.7
Survival of preceding birth
Living 4.2 7.9 23.2 20.1 14.2 30.4 100.0 4,189 44.5
Dead 22.5 12.4 31.2 9.8 11.1 13.1 100.0 242 30.6
Birth order
2-3 5.1 8.3 23.8 20.8 14.4 27.6 100.0 3,274 43.4
4-6 4.0 7.7 22.0 15.9 13.2 37.1 100.0 971 48.3
7+ 13.8 5.8 29.7 17.4 11.2 22.2 100.0 186 36.3
Residence
Urban 5.1 8.2 21.1 18.9 12.8 33.9 100.0 616 45.7
Rural 5.2 8.1 24.0 19.7 14.2 28.8 100.0 3,815 43.5
Province
Banteay Meanchey 7.2 8.4 15.7 14.9 14.5 39.3 100.0 129 50.5
Kampong Cham 5.2 5.1 24.6 21.5 14.3 29.3 100.0 637 44.9
Kampong Chhnang 4.1 9.6 25.6 18.0 18.5 24.1 100.0 153 41.6
Kampong Speu 3.8 9.2 23.4 22.8 13.4 27.4 100.0 265 43.9
Kampong Thom 5.7 5.8 23.3 17.3 16.5 31.3 100.0 217 45.7
Kandal 5.7 7.2 26.3 21.1 13.4 26.3 100.0 339 42.9
Kratie 2.5 11.8 30.0 18.0 11.2 26.6 100.0 177 37.8
Phnom Penh 4.1 7.8 22.0 17.8 12.9 35.3 100.0 370 46.5
Prey Veng 4.3 6.2 24.4 15.2 13.4 36.5 100.0 284 47.9
Pursat 2.9 8.1 29.2 19.0 19.1 21.6 100.0 191 41.3
Siem Reap 7.6 13.5 25.1 18.8 11.1 23.9 100.0 341 38.6
Svay Rieng 2.4 5.2 14.7 22.2 19.0 36.5 100.0 140 51.1
Takeo 5.4 10.4 19.9 16.9 17.8 29.6 100.0 228 44.6
Otdar Meanchey 3.0 8.7 21.0 19.8 16.6 30.9 100.0 86 45.7
Battambang/Pailin 7.7 5.4 18.7 26.9 12.2 29.2 100.0 313 43.5
Kampot/Kep 2.8 8.0 25.6 16.8 12.1 34.7 100.0 156 46.2
Preah Sihanouk/Koh Kong 6.3 8.3 21.8 17.2 14.8 31.7 100.0 106 46.2
Preah Vihear/Stung Treng 8.8 9.7 23.9 22.9 10.4 24.3 100.0 152 38.7
Mondul Kiri/Ratanak Kiri 6.2 13.6 28.3 15.0 11.4 25.5 100.0 148 36.9
Education
No education 6.1 8.2 26.3 15.8 13.0 30.5 100.0 791 41.4
Primary 5.4 7.9 22.7 19.2 14.0 30.8 100.0 2,518 44.5
Secondary and higher 4.0 8.5 23.7 23.1 14.9 25.8 100.0 1,122 43.4
Wealth quintile
Lowest 7.1 8.6 27.2 20.4 14.4 22.4 100.0 1,214 38.7
Second 3.9 8.4 25.3 17.0 14.4 31.0 100.0 930 44.4
Middle 4.7 9.0 23.2 20.3 12.5 30.3 100.0 772 43.4
Fourth 4.8 8.3 19.4 18.8 16.2 32.6 100.0 681 47.0
Highest 4.5 6.1 20.5 21.2 12.8 35.0 100.0 834 47.1
Total 5.2 8.1 23.6 19.6 14.0 29.5 100.0 4,431 43.8
Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding
pregnancy that ended in a live birth. An asterisk indicates that a figure is based on fewer than 25 unweighted cases
and has been suppressed.
In 2014, 13 percent of non-first births in Cambodia occurred less than 24 months after the
preceding birth (as compared with 16 percent in 2010 and 18 percent in 2005), with 5 percent occurring
less than 18 months after the preceding birth. Sixty-three percent of women gave birth at least 36 months
after the previous birth, an improvement over the figure from the 2010 CDHS (58 percent). The overall
median birth interval was 43.8 months. This means that half of the births in Cambodia occur within 43.8
months of the previous birth, and half occur after an interval of 43.8 months or longer.
Fertility • 75
The data also indicate that median birth intervals increase as age increases, from 37.1 months
among women age 20-29 to 63.6 months among women age 40 and above. Birth intervals do not vary
appreciably by sex of the preceding child or urban-rural residence. However, birth intervals vary markedly
by the survival status of the preceding birth: 23 percent of births occur within an 18-month interval when
the preceding child has died, as compared with 4 percent when the child is still alive. The median birth
interval is 44.5 months if the previous child is living but falls to 30.6 months if the preceding child died.
Median birth intervals are shortest in Kratie (37.8 months) and Mondul Kiri/Ratanak Kiri (36.9 months)
and significantly longer in Banteay Meanchey (50.5 months) and Svay Rieng (51.1 months). Mothers with
more education have slightly longer birth intervals: those with no education have a median birth interval of
41.4 months, whereas those with a primary education have a median birth interval of 44.5 months and
those with a secondary education or higher have a median birth interval of 43.4 months. The median birth
interval is shortest among women in the lowest wealth quintile (38.7 months) and longest among those in
the highest wealth quintile (47.1 months).
6.5 AGE AT FIRST BIRTH
Early age at childbearing has a detrimental effect on the health of both mother and child. It also
frequently leads to a longer reproductive span and a higher level of fertility. Table 6.6 shows the
percentage of women age 15-49 who have given birth by exact ages, the percentage who have never given
birth, and the median age at first birth, according to current age. The youngest cohort of women for whom
median age at first birth can be calculated is 25-29 years. The medians age for women in the 15-19 and 2024 age groups cannot be determined because fewer than half of these women had a birth before reaching
the lowest age of the age group.
Table 6.6 Age at first birth
Percentage of women age 15-49 who gave birth by exact ages, percentage who have never given birth, and
median age at first birth, according to current age, Cambodia 2014
Percentage who gave birth by exact age
Percentage
who have
never given
birth
Number of
women
Median age
at first birth Current age 15 18 20 22 25
15-19 0.2 na na na na 92.7 2,893 a
20-24 0.4 7.0 24.1 na na 50.6 3,017 a
25-29 0.5 6.9 21.9 41.1 65.4 23.0 2,836 22.9
30-34 0.5 10.3 26.4 44.5 66.0 11.1 3,046 22.7
35-39 0.8 13.3 33.3 51.9 73.6 8.7 1,839 21.8
40-44 0.9 11.7 32.0 53.4 75.5 7.1 2,030 21.7
45-49 1.6 12.6 27.7 46.5 69.2 6.8 1,916 22.4
25-49 0.8 10.5 27.6 46.7 69.2 12.2 11,668 22.4
na = Not applicable due to censoring
a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age
group
Whereas less than 1 percent of women in the 25-49 age group had given birth by age 15, 11
percent had given birth by age 18 and 28 percent by age 20. The percentage who had given birth by age 18
does not vary much between ages 30 and 49, but it is slightly lower among the youngest cohorts (7
percent), implying a trend toward postponement of childbearing. Median age at first birth ranged from 21.7
to 22.9 years across the age groups, with no discernible pattern of variation.
Table 6.7 presents the median age at first birth by background characteristics and age at the time
of the survey. The median age at first birth (22.4 for all women age 25-49) is higher in urban areas than in
rural areas, with a difference of 1.5 years among women age 25-49. Phnom Penh has the highest median
age at first birth (23.9), and Mondul Kiri/Ratanak Kiri has the lowest (20.9). There is a positive
relationship between educational attainment and median age at first birth. Women with no formal
education have a lower median age at first birth (21.3) than women with a primary education (22.0) and
those with a secondary education or higher (23.7). There is no clear pattern in median age at first birth by
wealth quintile.
76 • Fertility
Table 6.7 Median age at first birth
Median age at first birth among women age 25-49, according to background characteristics, Cambodia
2014
Background
characteristic
Age
Women
age
25-49 25-29 30-34 35-39 40-44 45-49
Residence
Urban a 24.2 22.1 22.4 22.9 23.6
Rural 22.5 22.4 21.8 21.6 22.3 22.1
Province
Banteay Meanchey 22.5 22.8 20.9 21.4 21.9 22.0
Kampong Cham 22.4 21.8 21.9 21.6 22.4 22.0
Kampong Chhnang 24.1 22.6 22.8 22.7 22.5 22.9
Kampong Speu 21.9 21.8 20.0 21.4 22.9 21.6
Kampong Thom 22.8 22.4 22.3 20.8 22.2 22.2
Kandal 22.9 23.8 23.7 21.9 23.7 23.2
Kratie 21.6 23.1 21.0 21.6 22.6 22.0
Phnom Penh a 24.6 22.3 22.5 23.1 23.9
Prey Veng 22.5 22.4 21.0 20.9 21.6 21.7
Pursat 23.4 21.8 21.3 22.3 24.2 22.6
Siem Reap 21.6 22.2 21.8 22.3 23.1 22.2
Svay Rieng 22.7 22.0 21.8 21.4 22.9 22.1
Takeo 23.5 22.6 23.0 21.1 21.6 22.6
Otdar Meanchey 21.9 22.7 21.7 20.6 21.4 21.8
Battambang/Pailin 23.6 23.3 21.9 22.0 21.4 22.5
Kampot/Kep 21.6 21.6 20.9 21.8 22.1 21.7
Preah Sihanouk/Koh Kong 23.4 21.9 20.5 21.2 21.8 22.0
Preah Vihear/Stung Treng 22.3 21.6 21.1 21.5 21.3 21.6
Mondul Kiri/Ratanak Kiri 21.4 20.4 21.2 20.6 21.1 20.9
Education
No education 21.4 21.7 20.9 21.1 21.5 21.3
Primary 22.0 22.3 21.8 21.6 22.2 22.0
Secondary and higher 24.6 24.3 22.3 22.3 23.7 23.7
Wealth quintile
Lowest 22.0 22.0 21.7 22.0 23.4 22.2
Second 21.5 22.2 21.6 21.6 21.9 21.7
Middle 22.6 21.9 21.6 21.3 22.0 21.9
Fourth 23.6 22.8 21.7 21.2 22.2 22.4
Highest a 23.8 22.5 22.5 22.6 23.5
Total 22.9 22.7 21.8 21.7 22.4 22.4
a = Omitted because less than 50 percent of the women had a birth before reaching the beginning of the
age group
6.6 TEENAGE PREGNANCY AND MOTHERHOOD
Teenage fertility is a major health concern because teenage mothers and their children are at high
risk of illness and death. Childbearing during the teenage years can have dire social consequences as well,
curtailing the educational and employment opportunities of women. Early initiation into childbearing is
also often associated with higher lifetime levels of fertility. Table 6.8 presents the proportion of women
age 15-19 (teenagers) who are mothers or pregnant with their first child, by background characteristics.
Approximately 1 in 8 women (12 percent) age 15-19 have become mothers or are currently
pregnant with their first child. The percentage of women who have begun childbearing at age 15-19
provides further evidence of a sharp increase in teenage fertility in recent years. The level of teenage
fertility was relatively stable from 2000 to 2010 at 8 percent.
The percentage of women who have begun childbearing increases with age, from less than 1
percent among women age 15 to 31 percent among women age 19. Six percent of urban women begin
childbearing in their teens, as do 13 percent of rural women. The level of teenage fertility is strongly
associated with education. More than one-third of teenagers (37 percent) who have never been to school
have begun childbearing, as compared with 18 percent who have a primary school education and 8 percent
who have a secondary education or higher. The level of teenage fertility is also strongly associated with
wealth: 18 percent of the poorest teenagers have begun childbearing, as compared with only 7 percent of
the richest. The percentage of teenagers who have begun childbearing varies greatly among provinces, with
the lowest in Battambang/Pailin (4 percent) and the highest in Mondul Kiri/Ratanak Kiri (34 percent).
Fertility • 77
Table 6.8 Teenage pregnancy and motherhood
Percentage of women age 15-19 who have had a live birth or who are pregnant with their first child, and
percentage who have begun childbearing, by background characteristics, Cambodia 2014
Percentage of women age 15-19 who: Percentage who
have begun
childbearing
Number of
women
Background
characteristic
Have had a live
birth
Are pregnant with
first child
Age
15 0.2 0.4 0.6 640
16 1.4 2.4 3.8 556
17 3.5 4.4 7.9 577
18 10.0 8.4 18.4 577
19 23.2 8.2 31.3 542
Residence
Urban 4.3 1.9 6.2 532
Rural 8.0 5.2 13.3 2,361
Province
Banteay Meanchey 16.5 2.5 18.9 113
Kampong Cham 13.1 2.9 16.1 327
Kampong Chhnang 6.3 2.9 9.1 129
Kampong Speu 2.0 6.2 8.2 202
Kampong Thom 4.1 4.4 8.6 156
Kandal 8.8 3.1 11.9 225
Kratie 14.5 5.0 19.5 80
Phnom Penh 3.8 2.1 5.9 316
Prey Veng 6.7 4.2 10.9 141
Pursat 3.8 4.8 8.6 100
Siem Reap 4.8 10.5 15.3 191
Svay Rieng 6.5 4.4 10.9 73
Takeo 2.5 5.2 7.8 193
Otdar Meanchey 11.0 5.8 16.8 50
Battambang/Pailin 3.1 1.2 4.3 217
Kampot/Kep 7.3 4.3 11.6 114
Preah Sihanouk/Koh Kong 7.5 5.5 12.9 88
Preah Vihear/Stung Treng 12.1 13.1 25.1 102
Mondul Kiri/Ratanak Kiri 23.2 10.6 33.8 75
Education
No education 25.5 11.6 37.1 82
Primary 11.8 6.7 18.4 852
Secondary and higher 4.7 3.5 8.1 1,959
Wealth quintile
Lowest 11.2 7.0 18.1 458
Second 9.8 5.1 14.9 552
Middle 7.5 6.2 13.8 578
Fourth 4.9 3.7 8.6 630
Highest 4.9 2.2 7.1 675
Total 7.3 4.6 12.0 2,893
Practice of Abortion • 79
PRACTICE OF ABORTION 7
Key Findings
• Twelve percent of women have had at least one abortion in their lifetime,
and 7 percent have had an abortion in the past five years.
• Among those who have had an abortion in the past five years, 53 percent
have had it within the first two months of pregnancy.
• Forty-four percent of abortions take place in a private health facility and
40 percent occur in the respondent’s or someone else’s home.
• Sixty-one percent of abortions were assisted by a health care
professional. However, 30 percent of women did not receive any
assistance.
n many countries in the developing world, there are very few data on the practice of abortion. It is
illegal in a number of countries, often has negative social connotations, and is often considered against
religious principles. The practice of abortion was legalized in Cambodia in 1997. According to the
1997 law, abortions can be conducted only by medical doctors, medical practitioners, or midwives
authorized by the Ministry of Health and can be carried out only in a hospital, health center, health clinic,
or maternity ward. In addition, abortions can be legally conducted only before the 12th week of pregnancy
unless one of a number of specific conditions that permit later abortions is met (The World Law Guide,
accessed on May 23, 2011).
In order to better understand the practice of abortion in Cambodia, questions on the practice were
integrated into the reproductive section of the CDHS Woman’s Questionnaire. The results in this chapter
present an estimation of the frequency of abortion in the past five years. Information was collected on the
person who performed the abortion, the pregnancy duration, the place where the abortion took place, and
the persons who assisted with the abortion. Pregnancy outside of marriage is not socially acceptable in
Cambodia, and thus it is likely that not all women who have had an abortion will be willing to report
having done so. As a result, abortion statistics are likely underestimates of the true level of abortion.
7.1 NUMBER OF LIFETIME INDUCED ABORTIONS
Table 7.1 presents the percent distribution of all women age 15 to 49 by the number of induced
abortions they have had over their lifetime according to background characteristics. In Cambodia, 12
percent of women age 15 to 49 reported having had one or more abortions in their lifetime.
There is a reverse U-shaped association between abortion and age. The percentage of women who
have had at least one abortion increases sharply from less than 1 percent at age 15-19 to a peak of 21
percent at age 35-39 before declining to 20 percent at age 40-44 and 16 percent at age 45-49. The
likelihood that a woman has had an abortion increases with number of living children. Less than 1 percent
of women with no children and 9 percent of women with one child reported ever having had an abortion.
Sixteen percent of women with two children and 22-24 percent of women with three to four children have
had at least one abortion. The proportion declines to 20 percent among women with five or more children.
The practice of abortion varies slightly by urban-rural residence (17 percent in urban areas versus
11 percent in rural areas). The percentage of women who have had an abortion varies across provinces as
well. The highest percentages are observed among women living in Phnom Penh (19 percent) and Banteay
Meanchey (18 percent). By contrast, only 3 percent of women in Mondul Kiri/Ratanak Kiri reported
having had an abortion. Less than 1 in 10 women (9 percent) with a secondary education or higher reported
ever having had an abortion, as compared with 15 percent of women with a primary education and 12
percent of women with no education. The practice of abortion occurs mostly among ever-married women.
I
80 • Practice of Abortion
Table 7.1 Number of induced abortions
Percent distribution of women by number of induced abortions during their lifetime, according to background characteristics,
Cambodia 2014
Background
characteristic
Number of abortions
Total
Number of
women None 1 2 3 4+ Missing
Age
15-19 99.2 0.6 0.2 0.0 0.0 0.0 100.0 2,893
20-24 94.6 4.8 0.4 0.1 0.1 0.0 100.0 3,017
25-29 87.4 10.3 1.6 0.5 0.1 0.1 100.0 2,836
30-34 82.6 12.6 3.2 0.7 0.6 0.2 100.0 3,046
35-39 78.8 14.3 4.4 1.1 1.4 0.0 100.0 1,839
40-44 80.4 12.3 3.3 2.5 1.6 0.0 100.0 2,030
45-49 84.0 9.4 3.3 1.5 1.8 0.0 100.0 1,916
Number of living
children
0 99.0 0.8 0.1 0.0 0.0 0.0 100.0 5,235
1 90.4 7.8 1.1 0.3 0.2 0.1 100.0 3,236
2 83.5 12.4 2.7 0.9 0.4 0.1 100.0 3,726
3 78.0 14.3 4.8 1.4 1.5 0.0 100.0 2,477
4 76.1 17.0 3.5 2.0 1.4 0.1 100.0 1,519
5 79.6 12.6 3.9 1.8 2.0 0.1 100.0 773
6+ 80.3 10.5 3.6 2.6 2.9 0.0 100.0 611
Residence
Urban 82.5 10.3 3.8 1.6 1.7 0.0 100.0 3,251
Rural 88.8 8.3 1.7 0.6 0.4 0.1 100.0 14,327
Province
Banteay Meanchey 82.3 12.9 2.5 0.8 1.3 0.2 100.0 689
Kampong Cham 87.7 9.8 1.3 0.7 0.6 0.0 100.0 2,021
Kampong Chhnang 90.5 7.2 1.4 0.5 0.3 0.0 100.0 662
Kampong Speu 91.5 6.3 1.2 0.5 0.5 0.0 100.0 1,196
Kampong Thom 93.2 5.0 1.2 0.3 0.3 0.0 100.0 851
Kandal 86.0 10.7 2.0 1.1 0.0 0.2 100.0 1,330
Kratie 89.0 8.2 1.6 0.4 0.8 0.0 100.0 488
Phnom Penh 80.6 10.6 5.0 1.8 2.0 0.0 100.0 1,994
Prey Veng 94.2 4.7 0.6 0.2 0.3 0.0 100.0 1,188
Pursat 93.8 5.2 0.7 0.0 0.4 0.0 100.0 631
Siem Reap 85.5 10.2 2.5 1.0 0.6 0.2 100.0 1,137
Svay Rieng 88.1 8.0 2.4 1.0 0.4 0.0 100.0 654
Takeo 87.8 7.9 3.0 1.0 0.3 0.0 100.0 1,082
Otdar Meanchey 92.8 6.0 0.9 0.1 0.0 0.0 100.0 294
Battambang/Pailin 83.9 10.6 3.0 1.2 1.2 0.0 100.0 1,333
Kampot/Kep 85.5 12.2 1.5 0.6 0.1 0.0 100.0 770
Preah Sihanouk/Koh
Kong 83.5 11.7 2.0 1.4 1.4 0.0 100.0 422
Preah Vihear/Stung
Treng 91.8 6.5 0.8 0.1 0.4 0.4 100.0 462
Mondul Kiri/Ratanak
Kiri 97.3 2.2 0.4 0.0 0.0 0.1 100.0 372
Education
No education 87.6 8.5 2.3 0.8 0.7 0.0 100.0 2,250
Primary 84.9 10.9 2.3 1.0 0.9 0.1 100.0 8,281
Secondary and
higher 91.0 6.2 1.8 0.6 0.4 0.0 100.0 7,047
Marital status
Never married 99.8 0.2 0.0 0.0 0.0 0.0 100.0 4,428
Ever married 83.6 11.6 2.8 1.1 0.9 0.1 99.9 13,150
Total 87.7 8.7 2.1 0.8 0.7 0.1 100.0 17,578
Practice of Abortion • 81
Figure 7.1 presents the distribution of women who report having at least one abortion in their
lifetime according to the number of abortions they have had. The majority of women who have had an
abortion have had only one (74 percent). Seventeen percent of women who have had an abortion report
having had two abortions, and 10 percent of women who have had an abortion report having had three or
more induced abortions.
Figure 7.1 Distribution of women who have had an abortion by number of abortions
7.2 PRACTICE OF ABORTION IN THE PAST FIVE YEARS
In order to obtain information on the recent practice of abortion, detailed questions concerning
abortion were asked to those women who had had an abortion since 2009. In Table 7.2 and subsequent
tables, education of the respondent has been grouped into two categories, no schooling and primary
education or higher, due to the relatively small number of cases.
Table 7.2 shows that 7 percent of women had an induced abortion in the five years before the
survey. This represents an increase from the figure reported in the 2010 CDHS (5 percent).
7.2.1 Pregnancy Duration at the Time of Abortion
Table 7.2 also shows the percentage of women who reported having an abortion in the past five
years by their pregnancy duration at the time of abortion. Slightly more than half of these women (53
percent) aborted their pregnancy within the first two months of pregnancy, and 46 percent had the abortion
between the second and fourth months of pregnancy.
Women with three or four living children were more likely than other women to have had an
abortion (11 percent), and approximately half of these women (53 percent) had their abortion within the
first two months of pregnancy. Sixty-nine percent of women with five or more living children had their
abortion after the second month of pregnancy. The percentage of women who recently had an abortion also
varies by urban-rural residence; urban women are more likely to have had a recent abortion than rural
women (10 percent versus 6 percent). Although the likelihood of having a recent abortion did not vary by
level of education, there were differences according to education in the duration of pregnancy at the time
of the abortion. Women with a primary education or higher were more likely than women with no
schooling to have had their abortion within the first two months of pregnancy (55 percent versus 42
percent). In contrast, the percentage of women with no schooling who had their abortion after the second
month of pregnancy is higher than that among women with at least a primary education (58 percent versus
45 percent).
One - 74%
Two - 17%
Three - 6%
Four or more - 4%
CDHS 2014
82 • Practice of Abortion
Table 7.2 Pregnancy duration at the time of abortion
Percentage of women who had at least one induced abortion and percent distribution of the last termination that was an abortion
during the past five years by pregnancy duration at the time of the abortion, according to background characteristics, Cambodia 2014
Background
characteristic
Percentage
with at least
one abortion
since January
2009
Number of
women
Pregnancy duration at the time of last abortion
Total
Number of
women whose
last
termination
was an
abortion <2 months 2-4 months 5+ months
Current age
15-24 3.1 5,910 55.1 44.0 0.9 100.0 166
25-34 10.2 5,882 54.7 43.4 1.9 100.0 532
35-49 7.5 5,786 49.6 49.7 0.7 100.0 373
Number of living
children1
0-2 5.5 12,198 56.6 41.7 1.7 100.0 598
3-4 10.7 3,996 52.8 46.1 1.1 100.0 377
5+ 8.2 1,384 30.8 69.2 0.0 100.0 95
Residence
Urban 9.7 3,251 61.5 36.8 1.6 100.0 282
Rural 6.3 14,327 50.0 48.8 1.2 100.0 789
Education
No education 6.9 2,250 41.6 57.4 1.0 100.0 136
Primary and higher 6.9 15,328 54.7 44.0 1.4 100.0 934
Total 6.9 17,578 53.0 45.7 1.3 100.0 1,070
1 Including current pregnancy
7.2.2 Place of Abortion
Women who had an abortion in the five years before the survey were asked where the most recent
abortion took place (Table 7.3). The proportion of women who had their abortion in a health facility (60
percent) was similar to the figure reported in the 2010 CDHS (57 percent). Of facility-based abortions, the
majority occur in a private facility. Thirty-two percent of abortions took place in the respondent’s home,
and 8 percent took place in someone else’s home. These figures show that abortions are more likely to
have taken place in a health facility than at home.
Among women who had an abortion in the five years before the survey, the percentage who had
an abortion in a health facility is slightly higher among those in urban areas than among those in rural areas
(64 percent and 58 percent, respectively). However, the percentage of women who had an abortion in a
health facility does not differ markedly by education (58 percent among those with no schooling versus 60
percent among those with at least a primary education).
Table 7.3 Place of abortion
Percent distribution of the last termination that was an abortion during the five years before the survey by place of abortion,
according to background characteristics, Cambodia 2014
Place of abortion
Total
Number of
women
whose last
termination was
an abortion
Background
characteristic
Public health
facility
Private health
facility
Respondent
home Other home
Current age
15-34 13.4 44.8 35.4 6.4 100.0 697
35-49 19.4 43.2 26.3 11.2 100.0 373
Pregnancy duration
at the time of last
abortion
<2 months 12.6 45.5 36.8 5.1 100.0 567
2-4 months 18.7 42.7 27.2 11.3 100.0 489
5+ months 20.0 49.0 20.5 10.5 100.0 14
Residence
Urban 18.2 45.5 29.1 7.2 100.0 282
Rural 14.5 43.8 33.3 8.4 100.0 789
Education
No education 18.5 39.3 34.6 7.5 100.0 136
Primary and higher 15.0 45.0 31.9 8.1 100.0 934
Total 15.5 44.3 32.2 8.0 100.0 1,070
Practice of Abortion • 83
7.2.3 Persons Who Helped with the Abortion
Women who had an abortion in the five years before the survey were asked to identify the type of
person or persons who assisted their last abortion. If more than one person assisted with the abortion, only
the most qualified person is reported in Table 7.4. The proportion of women receiving help from a
qualified health care provider (doctor, nurse, midwife, and/or other health worker) has continued to decline
over recent years, from 79 percent in 2005 to 67 percent in 2010 and only 61 percent in 2014. In contrast,
the percentage of women who report having no help from anyone has increased in the past few years (from
8 percent in 2005 to 22 percent in 2010 and 30 percent in 2014). Approximately 8 percent of women
received help from a relative or friend and 1 percent from a traditional birth attendant, Kru Khmer, or
pharmacist.
Women age 15-34 were less likely to seek assistance from a qualified provider than older women
(59 percent versus 67 percent). Moreover, women who had their abortion at the early stage of pregnancy
(before 2 months) were more likely to have had no help than were those who were 2-4 months pregnant at
the time of their abortion (37 percent versus 23 percent). More late-stage abortions (2-4 months) involved
assistance from a health professional (67 percent) than early-stage abortions (before 2 months). There were
no substantial variations in assistance at abortion by urban-rural residence. The percentage of women who
received help from a relative or friend during their last abortion differed by education (13 percent among
women with no schooling versus 7 percent among women with a primary education or higher).
Table 7.4 Persons who helped with abortion
Percent distribution of the last termination that was an abortion during the five years before the survey by the most qualified person
who helped with the abortion, according to background characteristics, Cambodia 2014
Person who helped with last abortion
Total
Number of
women whose
last termination
was an abortion
Background
characteristic
Doctor/nurse/
midwife/other
health worker
Traditional birth
attendant/
Kru Khmer/
pharmacist
Relative/friend/
other No one
Current age
15-34 58.5 0.6 8.6 32.3 100.0 697
35-49 67.0 1.5 5.8 25.8 100.0 373
Pregnancy duration
at the time of last
abortion
<2 months 56.5 1.3 5.1 37.2 100.0 567
2-4 months 66.6 0.4 10.3 22.6 100.0 489
5+ months * * * * 100.0 14
Residence
Urban 63.4 0.9 5.7 30.0 100.0 282
Rural 60.7 0.9 8.3 30.1 100.0 789
Education
No education 56.6 0.0 13.0 30.4 100.0 136
Primary and higher 62.1 1.0 6.8 30.0 100.0 934
Total 61.4 0.9 7.6 30.1 100.0 1,070
Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and had been suppressed.
7.2.4 Method Used for the Abortion
Women who had an abortion in the five years before the survey were asked about the methods
they used to induce the last abortion. The percentages shown in Table 7.5 can sum to more than 100
percent because women could list more than one method.
Three in five women (60 percent) who had an abortion in the five years before the survey used a
surgical method to induce abortion, whereas 47 percent used a medical method. The majority of women
(57 percent) used vacuum aspiration, a surgical method. Oral pill/tablet was the second most popular
method, used by 42 percent of women. Only 6 percent of women used the curettage method, and only 4
percent used the dilatation and evacuation method.
84 • Practice of Abortion
There were no substantial differences in the method of abortion according to women’s residence
or level of education. However, there were slight variations by age and duration of pregnancy. Women age
35-49 were more likely to use a surgical method than women age 15-24 and 25-34 (64 percent versus 54
percent and 59 percent, respectively). In contrast, the proportion of younger women (15-24 and 25-39) who
used a medical method for their last abortion was slightly higher than the proportion among their older
counterparts (35-49) (55 percent and 50 percent, respectively, versus 42 percent). Women who had their
abortions at a later stage of pregnancy (2-4 months) were more likely than those who had their abortions at
an early stage of pregnancy (before 2 months) to use a surgical method (65 percent versus 56 percent). In
contrast, medical methods were used more often during the early stage of pregnancy (51 percent) than
during the late stage of pregnancy (42 percent).
Table 7.5 Method used for the abortion
Among women who had an abortion during the five years before the survey, the percentage who used different methods to induce the abortion, according to background
characteristics, Cambodia 2014
Background
characteristic
Any
surgical
method
Surgical methods
Any
medical
method
Medical methods
Traditional
methods
Other
methods
Number of
women
whose last
termination
was an
abortion
Vacuum
aspiration Curettage
Dilatation
and
evacuation
Oral
pill/tablet
Vaginal pill/
tablet Injectable Intrauterine
Current age
15-24 53.7 50.1 5.9 3.0 54.6 50.8 12.3 3.4 0.0 0.0 0.0 166
25-34 58.8 55.4 6.3 4.3 47.9 43.3 9.9 3.3 0.5 0.0 1.0 532
35-49 64.3 62.2 5.1 2.5 42.3 37.0 8.0 6.0 0.5 0.1 2.6 373
Pregnancy duration
at the time of last
abortion
<2 months 56.2 54.9 2.8 2.2 50.8 46.9 9.2 3.9 0.0 0.0 0.7 567
2-4 months 65.1 60.8 9.2 4.6 42.2 37.4 10.3 3.6 1.0 0.1 1.8 489
5+ months * * * * * * * * * * * 14
Residence
Urban 61.7 57.6 6.3 4.7 43.2 37.5 6.3 2.6 1.5 0.0 0.7 282
Rural 59.3 56.7 5.7 3.1 48.4 43.9 10.8 4.8 0.1 0.1 1.7 789
Education
No education 61.5 58.6 8.0 1.9 53.3 48.4 6.9 9.4 0.0 0.0 0.0 136
Primary and higher 59.7 56.7 5.5 3.7 46.1 41.4 10.0 3.5 0.5 0.1 1.6 934
Total 59.9 57.0 5.8 3.5 47.0 42.3 9.6 4.2 0.4 0.1 1.4 1,070
Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and had been suppressed.
Family Planning • 85
FAMILY PLANNING 8
Key Findings
• Awareness of at least one method of contraception is universal in
Cambodia.
• More than half (56 percent) of currently married women are using a
method of contraception, with most women using a modern method
(39 percent).
• The daily pill remains the most commonly used method of contraception
among currently married women (18 percent).
• Use of modern methods of family planning has consistently increased
over the past decade, from 19 percent of currently married women in
2000 to 39 percent in 2014.
• The government sector remains the major provider of contraceptive
methods for nearly half of the users of modern methods (47 percent).
• Nearly 9 in 10 women (88 percent) who use the rhythm method know
correctly when the fertile period occurs.
his chapter presents information from the 2014 CDHS on contraceptive knowledge, attitudes, and
behavior. Comparisons are also made, where appropriate, with findings from the 2010 CDHS to
evaluate trends over the past four years.
8.1 KNOWLEDGE OF CONTRACEPTIVE METHODS
Acquiring knowledge about family planning is an
important step toward gaining access to and using a suitable
contraceptive method in a timely and effective manner.
Individuals who have adequate information about the available
methods of contraception are better able to make choices about
planning their families. Thus, one of the main objectives of the
2014 CDHS was to assess the level of knowledge of family
planning methods among women of reproductive age. To collect
data on knowledge of contraception, the interviewer described
each method and probed for whether the respondent recognized it.
Information was collected on several modern
contraceptive methods: female and male sterilization, daily and
monthly pills, intrauterine devices (IUDs), injectables, implants,
male and female condoms, the lactational amenorrhea method
(LAM), and emergency contraception. Information was also
collected on two traditional methods: rhythm (or periodic
abstinence) and withdrawal. In addition, provision was made in
the questionnaire to record any other methods named
spontaneously by the respondents.
Table 8.1 presents information about knowledge of
contraceptive methods among all women and currently married
women age 15-49. Knowledge of any contraceptive method and
T
Table 8.1 Knowledge of contraceptive methods
Percentage of all women and currently married
women who know any contraceptive method, by
specific method, Cambodia 2014
Method All women
Currently
married
women
Any method 99.2 99.8
Any modern method 99.2 99.8
Female sterilization 90.5 94.1
Male sterilization 69.2 74.7
Daily pill 97.7 99.1
Monthly pill 48.9 54.1
IUD 96.9 98.5
Injectables 97.0 98.9
Implants 93.5 96.3
Male condom 95.0 97.0
Female condom 22.8 23.3
Lactational
amenorrhea (LAM) 27.1 31.5
Emergency
contraception 16.4 17.0
Any traditional method 70.3 82.9
Rhythm 48.2 55.8
Withdrawal 62.3 76.2
Other 0.6 0.7
Mean number of
methods known by
respondents 15-49 8.7 9.2
Number of
respondents 17,578 11,898
86 • Family Planning
any modern method is nearly universal among both all women and currently married women in Cambodia.
Knowledge of traditional methods is lower; 70 percent of all women and 83 percent of currently married
women know at least one traditional method. Nearly all of the modern methods are widely known to both
all women and currently married women. Over 90 percent of all women and currently married women
have heard of female sterilization, the daily pill, IUDs, injectables, implants, and male condoms. However,
only 69 percent of women overall and 75 percent of currently married women know about male
sterilization. Knowledge of female condoms, LAM, and emergency contraception remains very low among
both all women and currently married women. About half of women know about monthly pills (also
known as Chinese pills).
The mean number of methods known, a rough
indicator of the breadth of knowledge of family planning
methods, is high in Cambodia. Breadth of contraceptive
knowledge is slightly higher among currently married
women (9.2 methods) than all women (8.7 methods).
Knowledge of at least one contraceptive method
among all women increased from 92 percent in 2000 to
99 percent in 2005 and has remained at this level over
the past nine years. Some of the greatest increases in
knowledge in the past four years were in knowledge of
male sterilization, implants, and emergency
contraception. Knowledge of male sterilization increased
from 59 percent to 69 percent among all women and
from 65 percent to 75 percent among married women.
Knowledge of implants increased from 88 percent to 94
percent among all women and from 91 percent to 96
percent among married women. Finally, knowledge of
emergency contraception increased from 10 percent
among all women and 11 percent among currently
married women to 16 percent among all women and 17
percent among currently married women. However, there
has been a decrease in the percentage of women
reporting that they know about monthly pills. Knowledge
of any traditional method has increased over the same
period, especially knowledge of withdrawal.
With practically all currently married women
knowing at least one method of contraception, there is
very little variation in knowledge by background
characteristics (Table 8.2). Knowledge of any method of
contraception is slightly lower in Mondul Kiri/Ratanak
Kiri, where 97 percent of married women are aware of
any method or any modern method of contraception.
8.2 CURRENT USE OF CONTRACEPTIVE
METHODS
The level of current use of contraceptive
methods is one of the indicators most frequently used to
assess the success of family planning program activities.
It is also widely used as a measure in analyzing the
Table 8.2 Knowledge of contraceptive methods by background
characteristics
Percentage of currently married women age 15-49 who have
heard of at least one contraceptive method and who have
heard of at least one modern method by background
characteristics, Cambodia 2014
Background
characteristic
Heard of
any method
Heard of
any modern
method1 Number
Age
15-19 98.8 98.8 450
20-24 99.8 99.8 1,833
25-29 99.9 99.8 2,249
30-34 100.0 100.0 2,625
35-39 100.0 100.0 1,573
40-44 99.9 99.9 1,673
45-49 99.5 99.5 1,495
Residence
Urban 99.9 99.9 1,818
Rural 99.8 99.8 10,080
Province
Banteay Meanchey 99.8 99.8 503
Kampong Cham 99.7 99.7 1,490
Kampong Chhnang 100.0 100.0 396
Kampong Speu 99.7 99.7 843
Kampong Thom 100.0 100.0 572
Kandal 100.0 100.0 870
Kratie 99.8 99.8 359
Phnom Penh 100.0 100.0 1,084
Prey Veng 100.0 100.0 889
Pursat 100.0 100.0 425
Siem Reap 100.0 100.0 765
Svay Rieng 100.0 100.0 483
Takeo 99.8 99.8 677
Otdar Meanchey 100.0 100.0 218
Battambang/Pailin 99.8 99.8 890
Kampot/Kep 100.0 100.0 574
Preah Sihanouk/
Koh Kong 99.8 99.8 266
Preah Vihear/
Stung Treng 99.7 99.3 314
Mondul Kiri/
Ratanak Kiri 97.3 97.3 281
Education
No education 99.3 99.3 1,774
Primary 99.9 99.9 6,399
Secondary and
higher 99.9 99.9 3,431
Wealth quintile
Lowest 99.7 99.6 2,294
Second 99.7 99.7 2,404
Middle 99.8 99.8 2,365
Fourth 99.9 99.9 2,393
Highest 100.0 100.0 2,443
Total 99.8 99.8 11,898
1 Female sterilization, male sterilization, daily pills, monthly
pills, IUD, injectables, implants, male condom, female condom,
diaphragm, foam or jelly, lactational amenorrhea method
(LAM), and emergency contraception
Family Planning • 87
determinants of fertility. This section focuses on the levels of and differentials in current use of family
planning in Cambodia.
Current contraceptive use among all women and currently married women is presented in Table
8.3 by age group. Fifty-six percent of married women are currently using a method of family planning.
This includes 39 percent who are using a modern method and 18 percent who are using a traditional
method. The most widely used method is the daily pill (18 percent), followed by withdrawal (15 percent)
and injectables (9 percent).
Table 8.3 Current use of contraception by age
Percent distribution of all women and currently married women age 15-49 by contraceptive method currently used, according to age, Cambodia 2014
Any
method
Any
modern
method
Modern method Any
traditional
method
Traditional method
Not
currently using Total
Number
of womenAge
Female
sterilization
Male
sterilization
Daily
pill
Monthly
pill IUD
Injectables
Implants
Male
condom
Female
condom LAM Rhythm
Withdrawal
Folk
method
ALL WOMEN
15-19 4.6 3.2 0.0 0.0 1.1 0.0 0.3 1.2 0.3 0.1 0.0 0.0 1.4 0.1 1.4 0.0 95.4 100.0 2,893
20-24 29.7 21.4 0.0 0.0 9.9 0.0 2.4 6.2 1.5 1.1 0.0 0.1 8.3 0.9 7.4 0.0 70.3 100.0 3,017
25-29 49.2 34.9 0.8 0.0 17.7 0.1 4.1 7.8 2.2 2.1 0.0 0.1 14.3 1.8 12.3 0.1 50.8 100.0 2,836
30-34 58.8 41.1 2.6 0.0 18.8 0.2 4.8 9.4 2.3 2.8 0.0 0.1 17.7 3.0 14.7 0.0 41.1 100.0 3,046
35-39 57.8 40.9 5.7 0.3 16.8 0.1 5.2 8.7 2.0 2.1 0.0 0.1 16.9 3.0 13.8 0.1 41.9 100.0 1,839
40-44 49.6 32.0 5.4 0.2 13.4 0.1 3.0 7.1 1.4 1.4 0.0 0.0 17.5 4.5 13.0 0.0 50.4 100.0 2,030
45-49 25.1 15.1 3.7 0.0 5.7 0.3 1.4 3.1 0.1 0.8 0.0 0.0 10.0 2.0 7.8 0.2 74.9 100.0 1,916
Total 38.5 26.6 2.2 0.1 11.9 0.1 3.0 6.2 1.5 1.5 0.0 0.0 11.9 2.0 9.8 0.1 61.5 100.0 17,578
CURRENTLY MARRIED WOMEN
15-19 29.1 20.2 0.0 0.0 7.2 0.0 2.2 8.0 2.1 0.7 0.0 0.0 8.9 0.4 8.5 0.0 70.9 100.0 450
20-24 47.8 34.4 0.1 0.0 16.4 0.1 3.9 10.1 2.5 1.2 0.0 0.2 13.4 1.2 12.2 0.0 52.2 100.0 1,833
25-29 61.6 43.8 0.9 0.0 22.3 0.1 5.2 9.8 2.8 2.5 0.0 0.1 17.9 2.3 15.4 0.2 38.4 100.0 2,249
30-34 67.9 47.4 2.9 0.0 21.8 0.2 5.5 10.9 2.7 3.3 0.0 0.1 20.5 3.5 17.0 0.0 32.0 100.0 2,625
35-39 66.9 47.1 6.2 0.4 19.5 0.1 6.0 9.9 2.4 2.5 0.0 0.1 19.7 3.5 16.1 0.1 32.8 100.0 1,573
40-44 59.6 38.4 6.2 0.2 16.1 0.2 3.7 8.6 1.7 1.7 0.0 0.0 21.3 5.5 15.8 0.0 40.4 100.0 1,673
45-49 31.3 18.6 4.2 0.0 7.1 0.4 1.8 4.0 0.1 0.9 0.0 0.0 12.7 2.6 10.0 0.1 68.7 100.0 1,495
Total 56.3 38.8 3.0 0.1 17.6 0.2 4.4 9.1 2.2 2.1 0.0 0.1 17.5 3.0 14.5 0.1 43.7 100.0 11,898
Note: If more than one method is used, only the most effective method is considered in this tabulation.
LAM = Lactational amenorrhea method
Use of modern contraceptive methods among currently married women varies by age, rising
sharply from 20 percent among women age 15-19 to a peak of 47 percent among women age 30-39 before
dropping quickly to 19 percent among women age 45-49. There are also differences by age in the methods
used by women. For example, among currently married women, the daily pill is the most commonly used
method in all age groups other than 15-19, with slightly more women in this group using withdrawal and
injectables than the daily pill. As expected, most of the women who have been sterilized are age 35 or
older.
As shown in Table 8.4.1, there are marked differences in use of contraceptives by women’s
background characteristics. Among those currently married, urban women are more likely than rural
women to be using any method of contraception (60 percent versus 56 percent) and any traditional method
(27 percent versus 16 percent). Meanwhile, rural women are more likely to use modern methods than
urban women (40 percent versus 33 percent), particularly injectables (10 percent versus 3 percent) and
daily pills (18 percent versus 13 percent). However, urban women are more likely to use male condoms
than rural women (5 percent versus 2 percent). There is also substantial variation in current use by
province. Current use of any method among married women is highest in Kampong Speu (65 percent);
Phnom Penh (63 percent); Banteay Meanchey, Kandal, and Preah Sihanouk/Koh Kong (61 percent each);
and Takeo (60 percent). It is lowest in Preah Vihear/Stung Treng (42 percent).
Contraceptive use is associated with the number of living children a woman has; use of any
method is highest among married women with three to four children (66 percent) and lowest among
women with no children (12 percent). Current contraceptive use increases with increasing education. Fiftytwo percent of married women with no schooling are currently using any method of contraception, as
compared with 58 percent of married women with a secondary education or higher. Use of contraception
rises in an irregular pattern with increasing wealth; the percentage of currently married women using
88 • Family Planning
contraception ranges from 53 percent in the lowest wealth quintile to 62 percent in the highest quintile,
with a slight drop at the middle quintile.
Table 8.4.1 Current use of contraception by background characteristics
Percent distribution of currently married women age 15-49 by contraceptive method currently used, according to background characteristics, Cambodia 2014
Any
method
Any
modern
method
Modern method Any
traditional
method
Traditional method
Not
currently using Total
Number
of women
Background
characteristic
Female
sterilization
Male
sterilization
Daily
pill
Monthly
pill IUD
Injectables
Implants
Male
condom
Female
condom LAM Rhythm
Withdrawal Other
Number of living
children
0 11.8 4.3 0.2 0.0 2.5 0.0 0.2 0.7 0.4 0.4 0.0 0.0 7.5 0.9 6.5 0.0 88.2 100.0 1,128
1-2 60.4 42.3 1.3 0.1 20.6 0.2 5.0 10.1 2.5 2.5 0.0 0.1 18.0 2.9 15.1 0.1 39.6 100.0 5,942
3-4 65.7 45.2 5.4 0.1 18.8 0.2 5.1 10.3 2.7 2.4 0.0 0.1 20.5 4.1 16.4 0.0 34.1 100.0 3,572
5+ 49.9 34.6 6.9 0.1 13.1 0.1 3.6 8.9 0.7 1.0 0.0 0.0 15.4 1.9 13.1 0.3 50.1 100.0 1,257
Residence
Urban 59.8 32.8 3.7 0.1 13.3 0.3 5.0 2.9 2.3 5.1 0.0 0.0 27.0 7.0 19.9 0.1 40.2 100.0 1,818
Rural 55.6 39.8 2.9 0.1 18.3 0.1 4.3 10.3 2.1 1.6 0.0 0.1 15.8 2.2 13.5 0.1 44.3 100.0 10,080
Province
Banteay Meanchey 61.4 51.0 4.7 0.1 22.9 0.3 3.6 14.7 2.4 2.2 0.0 0.0 10.4 0.8 9.5 0.0 38.6 100.0 503
Kampong Cham 44.3 27.3 2.3 0.0 11.4 0.1 3.6 5.4 2.7 1.8 0.0 0.0 17.0 3.8 13.2 0.0 55.3 100.0 1,490
Kampong Chhnang 56.0 33.5 2.3 0.0 14.7 0.0 5.8 7.7 1.4 1.7 0.0 0.0 22.5 2.0 20.5 0.0 44.0 100.0 396
Kampong Speu 65.4 41.2 4.5 0.2 25.2 0.0 3.4 5.2 0.3 2.3 0.0 0.2 24.3 0.7 23.6 0.0 34.6 100.0 843
Kampong Thom 58.4 44.1 3.8 0.0 15.5 0.2 5.8 14.9 3.1 0.7 0.0 0.0 14.3 4.7 9.6 0.0 41.6 100.0 572
Kandal 61.0 40.4 2.0 0.1 19.5 0.0 4.5 12.2 0.5 1.6 0.0 0.0 20.6 0.8 19.8 0.0 39.0 100.0 870
Kratie 47.9 30.7 2.5 0.0 11.6 0.0 5.0 8.8 1.7 1.0 0.0 0.0 17.2 2.3 14.4 0.5 52.1 100.0 359
Phnom Penh 63.0 28.5 2.7 0.0 11.8 0.5 5.1 1.5 1.3 5.6 0.0 0.0 34.5 7.9 26.4 0.2 36.7 100.0 1,084
Prey Veng 55.4 41.3 2.5 0.2 19.4 0.0 3.7 11.6 2.7 1.2 0.0 0.0 14.1 1.5 12.5 0.0 44.6 100.0 889
Pursat 51.0 40.1 1.6 0.3 18.8 0.3 5.6 11.1 0.7 1.7 0.0 0.0 11.0 1.5 9.5 0.0 49.0 100.0 425
Siem Reap 59.0 46.5 4.2 0.2 19.5 0.0 5.3 10.2 3.3 3.8 0.0 0.0 12.6 2.4 10.2 0.0 41.0 100.0 765
Svay Rieng 57.9 40.7 3.0 0.0 19.7 0.2 3.9 9.3 2.2 1.7 0.0 0.6 17.2 2.6 14.6 0.0 42.1 100.0 483
Takeo 60.1 48.2 4.8 0.2 19.6 1.0 6.8 10.6 3.3 1.7 0.0 0.2 12.0 4.0 7.9 0.0 39.9 100.0 677
Otdar Meanchey 56.6 49.7 3.6 0.0 24.4 0.0 3.2 15.6 1.5 1.3 0.0 0.1 6.9 0.3 6.4 0.2 43.4 100.0 218
Battambang/Pailin 58.3 40.6 4.2 0.1 19.2 0.0 4.7 8.2 2.6 1.5 0.0 0.0 17.7 4.0 13.2 0.4 41.7 100.0 890
Kampot/Kep 53.8 38.3 1.4 0.0 16.3 0.2 4.9 10.7 3.0 1.7 0.0 0.2 15.5 2.3 13.2 0.0 46.2 100.0 574
Preah Sihanouk/
Koh Kong 60.6 41.5 2.7 0.0 18.8 0.4 5.4 6.5 5.5 2.0 0.0 0.1 19.1 3.4 15.5 0.1 39.4 100.0 266
Preah Vihear/
Stung Treng 42.0 34.9 1.2 0.0 17.8 0.0 0.9 13.2 0.3 1.4 0.0 0.0 7.1 1.4 5.7 0.0 58.0 100.0 314
Mondul Kiri/
Ratanak Kiri 50.0 42.7 2.5 0.0 18.5 0.0 1.3 16.3 3.6 0.5 0.0 0.0 7.3 3.1 4.0 0.2 50.0 100.0 281
Education
No education 52.0 39.9 4.2 0.0 17.8 0.4 2.7 12.2 1.4 1.2 0.0 0.0 12.1 1.1 10.9 0.2 48.0 100.0 1,774
Primary 56.4 39.7 2.9 0.1 18.5 0.1 4.5 9.6 2.2 1.7 0.0 0.0 16.7 2.0 14.7 0.1 43.5 100.0 6,399
Secondary and
higher 58.1 36.7 2.8 0.1 15.8 0.1 5.1 6.9 2.5 3.2 0.0 0.1 21.4 5.6 15.8 0.0 41.9 100.0 3,726
Wealth quintile
Lowest 52.6 39.4 2.0 0.0 18.9 0.1 3.9 11.9 1.8 0.7 0.0 0.0 13.2 1.1 12.0 0.1 47.3 100.0 2,294
Second 55.4 42.4 2.6 0.1 20.1 0.2 4.4 11.5 1.6 1.8 0.0 0.1 13.0 1.4 11.6 0.0 44.6 100.0 2,404
Middle 53.5 38.2 3.2 0.0 18.6 0.1 3.2 9.3 2.3 1.5 0.0 0.0 15.3 1.9 13.2 0.2 46.4 100.0 2,365
Fourth 57.7 39.2 3.2 0.2 18.1 0.3 4.4 8.6 2.7 1.6 0.0 0.1 18.5 3.0 15.5 0.0 42.3 100.0 2,393
Highest 61.7 34.5 4.1 0.1 12.3 0.2 6.1 4.5 2.4 4.8 0.0 0.0 27.2 7.3 19.8 0.1 38.2 100.0 2,443
Total 56.3 38.8 3.0 0.1 17.6 0.2 4.4 9.1 2.2 2.1 0.0 0.1 17.5 3.0 14.5 0.1 43.7 100.0 11,898
Note: If more than one method is used, only the most effective method is considered in this tabulation.
LAM = Lactational amenorrhea method
Current use of contraceptive method among women in Cambodia continues to increase from the
levels reported in the first CDHS in 2000. Since the 2010 CDHS, the proportion of currently married
women who are using any method of contraception has increased from 51 percent to 56 percent (Table
8.4.2). The proportion of currently married women using any modern method has increased from 35
percent to 39 percent, and the proportion using any traditional method has increased from 16 percent to 18
percent. In the case of individual methods, the largest increases have been achieved among currently
married women using pills (16 percent in 2010 to 18 percent in 2014) and withdrawal (12 percent to 15
percent).
Family Planning • 89
Table 8.4.2 Trends in current use of contraception
Percent distribution of currently married women age 15-49 by contraceptive
method currently used, according to CDHS 2000, CDHS 2005, CDHS 2010, and
2014 CDHS
Method CDHS 2000 CDHS 2005 CDHS 2010 CDHS 2014
Any method 23.8 40.0 50.5 56.3
Any modern method 18.5 27.2 34.9 38.8
Female sterilization 1.5 1.7 2.4 3.0
Daily/monthly pill 7.2 12.6 15.7 17.8
IUD 1.3 1.8 3.1 4.4
Injectables 7.4 7.9 10.4 9.1
Male condom 0.9 2.9 2.7 2.1
Implant 0.1 0.2 0.4 2.2
Other modern 0.1 0.1 0.1 0.4
Any traditional method 5.3 12.8 15.7 17.5
Rhythm 2.7 4.5 3.9 3.0
Withdrawal 2.3 8.3 11.7 14.5
Other traditional 0.1 0.1 0.1 0.1
Not currently using 76.2 60.0 49.5 43.7
Total 100.0 100.0 100.0 100.0
Number of women 9,071 10,087 11,626 11,898
8.3 USE OF SOCIAL MARKETING BRANDS
Current users of daily pills and condoms were asked for the brand name of the pills and condoms
they last used. This information is useful in monitoring the success of social marketing programs that
promote a specific brand.
Socially marketed contraceptive brands are prevalent in Cambodia. Almost all pill and condom
users are using a socially marketed product (95 percent of pill users and 88 percent of condom users). Just
over half of daily pill users (52 percent) use the “Srey Pich” brand of pills, and 43 percent use “OK” brand
pills. About half of condom users (51 percent) use OK condoms and 37 percent use “Number 1” brand
condoms (Table 8.5). Srey Pich pills are more popular among rural women than among urban women (54
percent versus 32 percent among pill users). OK pills, OK condoms, and Number 1 condoms are equally
popular among urban and rural women. There are large differences by province in use of the two brands of
pills; however, the small number of pill users in some provinces indicates that caution should be exercised
in interpreting these results.
90 • Family Planning
Table 8.5 Use of social marketing brand pills and condoms
Percentage of daily pill and condom users age 15-49 using specific social marketing brands, by background characteristics,
Cambodia 2014
Among pill users Among condom users1
Background
characteristic
Percentage
using Srey Pich
pill
Percentage
using OK pill
Number of
women using the
daily pill
Percentage
using Number 1
Percentage
using OK
condom
Number of
women using
condoms
Residence
Urban 31.8 43.0 247 37.4 50.0 96
Rural 54.2 43.2 1,850 36.1 51.8 144
Province
Banteay Meanchey 46.8 46.0 114 * * 10
Kampong Cham 31.8 65.2 166 * * 24
Kampong Chhnang 73.5 25.5 57 * * 5
Kampong Speu 80.9 18.2 211 * * 18
Kampong Thom 33.9 62.6 90 * * 5
Kandal 48.6 49.0 169 * * 14
Kratie 41.1 57.8 41 * * 4
Phnom Penh 35.2 33.7 133 (34.6) (53.1) 62
Prey Veng 51.1 46.7 173 * * 10
Pursat 57.7 39.0 81 * * 7
Siem Reap 43.9 47.8 152 (39.1) (54.8) 29
Svay Rieng 48.1 51.9 96 * * 8
Takeo 68.0 27.4 139 * * 11
Otdar Meanchey 45.7 50.4 53 * * 3
Battambang/Pailin 51.8 43.8 171 * * 11
Kampot/Kep 52.7 47.1 94 * * 8
Preah Sihanouk/
Koh Kong 50.8 37.8 50 * * 5
Preah Vihear/
Stung Treng 57.6 41.4 56 * * 4
Mondul Kiri/
Ratanak Kiri 46.1 45.1 50 * * 1
Education
No education 45.0 53.2 317 * * 18
Primary 53.4 43.8 1,189 38.8 49.6 107
Secondary and
higher 51.3 36.4 591 34.6 50.7 115
Wealth quintile
Lowest 52.1 47.1 434 * * 14
Second 55.1 43.2 483 (34.5) (51.8) 36
Middle 60.4 37.9 441 (49.0) (51.0) 35
Fourth 51.0 46.4 437 (46.4) (43.0) 39
Highest 33.1 40.5 303 33.5) 51.2 115
Total 51.6 43.2 2,097 36.6 51.1 240
Note: Table excludes pill and condom users who do not know the brand name. Condom use is based on women’s reports. Figures
in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted
cases and has been suppressed.
1 Among condom users not also using the pill
8.4 KNOWLEDGE OF FERTILE PERIOD
The successful use of natural family planning methods depends largely on an understanding of
when during the menstrual cycle a woman is most likely to conceive. All women in the survey were asked
about their knowledge of the fertile period. Specifically, they were asked whether there are certain days
between two menstrual periods when a woman is more likely to become pregnant if she has sexual
intercourse. Those who said yes were further asked whether this time is just before the period begins,
during the period, right after the period ends, or halfway between the two periods.
Table 8.6 shows that 64 percent of women do not know when a woman’s fertile period is, and
only 21 percent correctly state that the fertile time in a woman’s menstrual cycle is halfway between two
periods. Knowledge of the fertile period is much higher among women who are users of the rhythm
method, 88 percent of whom accurately know the timing of the fertile period. However, 8 percent of
rhythm method users report that they don’t know when the fertile period is, and an additional 3 percent
believe it is right after a woman’s period has ended. Thus, slightly more than one-tenth of users of the
rhythm method are at risk of unwanted pregnancy.
Family Planning • 91
Table 8.6 Knowledge of fertile period
Percent distribution of women age 15-49 by knowledge of the fertile period during
the ovulatory cycle, according to current use of the rhythm method, Cambodia 2014
Perceived fertile period
Users of rhythm
method
Nonusers of
rhythm method All women
Just before her menstrual
period begins 0.5 1.2 1.2
During her menstrual period 0.0 0.5 0.5
Right after her menstrual
period has ended 3.4 6.8 6.7
Halfway between two
menstrual periods 87.7 19.1 20.5
No specific time 0.9 7.3 7.2
Don’t know 7.5 65.1 63.9
Missing 0.0 0.0 0.0
Total 100.0 100.0 100.0
Number of women 357 17,221 17,578
8.5 TIMING OF STERILIZATION
Given the effectiveness of female sterilization as a means of preventing pregnancies, family
planning programs should emphasize dissemination of information about this method. Trends in the use of
sterilization are of interest, especially trends in women’s age at the time of the operation.
In Cambodia, 3 percent of married women of reproductive age rely on sterilization as their method
of contraception. Table 8.7 shows the distribution of sterilized women age 15-49 by age group at the time
of sterilization and median age at sterilization. The data are disaggregated according to number of years
since the operation. Thirty-four percent of women who have been sterilized had the operation at age 30-34,
with 24 percent each having the operation at age 25-29 and age 35-39. The median age at sterilization is
31.9, a figure that has not varied substantially over time.
Table 8.7 Timing of sterilization
Percent distribution of sterilized women age 15-49 by age at the time of sterilization and median age at sterilization, according
to the number of years since the operation, Cambodia 2014
Years since
operation
Age at time of sterilization
Total
Number of
women
Median
age1 <25 25-29 30-34 35-39 40-44 45-49
<2 2.4 20.0 34.7 26.9 13.1 3.0 100.0 56 33.7
2-3 5.6 12.9 39.3 28.6 13.5 0.0 100.0 70 32.8
4-5 4.3 27.5 31.5 25.1 11.6 0.0 100.0 88 30.8
6-7 4.9 25.2 29.9 27.1 12.9 0.0 100.0 75 33.1
8-9 (13.5) (30.8) (20.1) (29.6) (5.9) (0.0) 100.0 29 (30.4)
10+ 17.3 28.8 43.0 11.0 0.0 0.0 100.0 70 a
Total 7.4 23.8 34.3 24.1 9.9 0.4 100.0 387 31.9
Note: Figures in parentheses are based on 25-49 unweighted cases.
a = Not calculated due to censoring
1 Median age at sterilization is calculated only for women sterilized before age 40 to avoid problems of censoring.
8.6 SOURCE OF FAMILY PLANNING METHODS
Data on sources of modern contraceptives are important for family planning program managers
and service providers. Women who reported using a modern method of contraception at the time of the
survey were asked where they last obtained the method, and interviewers recorded the name and location
of the source. To ensure accuracy in reporting, supervisors and editors verified the type of source from the
written response.
Table 8.8 shows that users of modern contraceptives obtain their methods from the public sector
more than from the private medical sector (47 percent versus 39 percent). Thirty-nine percent of all
modern contraceptive users obtain their methods from public health centers, and 20 percent obtain their
methods from a private pharmacy. Approximately 12 percent of women who use contraception obtain their
methods from private clinics, 8 percent from a community distributor, and 4 percent from a shop.
92 • Family Planning
Table 8.8 Source of modern contraception methods
Percent distribution of users of modern contraceptive methods age 15-49 by most recent source of method, according to method,
Cambodia 2014
Source
Female
sterilization Daily pill IUD Injectables Implants Male condom Total1
Public sector 75.6 35.0 53.0 64.9 48.5 17.3 47.2
National hospital (PP) 12.2 0.0 0.7 0.0 0.0 0.0 1.1
Provincial hospital (RH) 36.6 0.1 2.6 0.5 3.2 0.1 3.8
District hospital (RH) 21.5 0.3 5.3 0.5 2.0 1.2 2.9
Health center 4.5 34.2 44.1 62.5 42.0 15.6 38.7
Health post 0.0 0.4 0.0 0.8 0.0 0.0 0.3
Military hospital 0.0 0.0 0.0 0.0 0.0 0.5 0.0
Other public sector 0.7 0.1 0.3 0.7 1.3 0.0 0.4
Private medical sector 22.3 42.1 34.7 32.5 48.0 64.9 39.0
Private hospital 5.8 2.0 0.7 3.2 4.2 1.3 2.5
Private clinic 16.2 5.2 26.1 12.1 34.1 3.1 11.7
Pharmacy 0.3 32.8 0.0 8.1 0.2 58.7 20.3
Other private medical
sector 0.0 2.2 7.9 9.0 9.4 1.7 4.6
Other sources 0.0 22.8 0.6 2.4 1.5 17.8 12.0
Shop 0.0 6.6 0.0 0.1 0.0 13.4 3.8
Community distributor 0.0 16.0 0.6 2.3 1.5 2.9 8.0
Friend/relative 0.0 0.2 0.0 0.1 0.0 1.5 0.2
Other 1.5 0.0 0.2 0.1 0.7 0.0 0.2
Missing 0.6 0.1 11.5 0.2 1.4 0.0 1.5
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number of women 387 2,098 530 1,094 257 266 4,663
Note: Total includes 10 users of male sterilization and 21 users of monthly pills.
1 Includes other modern methods but excludes lactational amenorrhea method (LAM)
PP = Phnom Penh
RH = Referral hospital
There is notable variation in source of method by type of contraceptive. Users of daily pills most
often obtain them from a public health center (34 percent), a pharmacy (33 percent), or a community
distributor (16 percent). The public sector is the largest source of IUDs. More than half of women (53
percent) who use an IUD obtained it from the public sector, primarily a health center (44 percent). An
additional 35 percent obtained their IUD from a private medical source. The public sector is also the most
common source of contraception among women who use injectables (65 percent). Similar proportions of
implant users obtain their methods from public (49 percent) and private (48 percent) sources. Two-thirds of
condom users obtain their method from a private source, predominantly pharmacies. Finally, provincial
hospitals and district hospitals are the most commonly cited sources of female sterilization.
Since the 2010 CDHS, there have been changes in the most commonly cited sources of
contraceptive methods. In 2010, users of daily pills and male condoms were less likely to obtain them from
a pharmacy and more likely to obtain them from the public sector than in 2014. Female sterilization was
more commonly done in a private hospital or private clinic in 2014 than in 2010.
8.7 INFORMED CHOICE
Current users of modern methods who are well informed about the side effects and problems
associated with different methods and who know of a range of method options are in a better position to
make an informed choice about the method they would like to use. Current users of various modern
contraceptive methods were asked whether, at the time they were initiating their use of a particular method,
they were informed about the possible side effects or problems they might have with the method and what
to do if they experienced side effects. Table 8.9 shows the percentage of current users of modern methods
who were informed about side effects or problems with the method used, informed about what to do if they
experienced side effects, and informed of other methods they could use, according to the type of method
they are currently using and initial source of the method.
Family Planning • 93
Table 8.9 Informed choice
Among current users of modern methods age 15-49 who started the last episode of use within the five years
preceding the survey, the percentage who were informed about possible side effects or problems of that
method, the percentage who were informed about what to do if they experienced side effects, and the
percentage who were informed about other methods they could use, by method and initial source, Cambodia
2014
Among women who started last episode of modern contraceptive method within
five years preceding the survey:
Method/source
Percentage who
were informed
about side effects
or problems of
method used
Percentage who
were informed
about what to do if
side effects
experienced
Percentage who
were informed by a
health or family
planning worker of
other methods that
could be used
Number of
women
Method
Female sterilization 88.4 75.5 80.7 166
Daily pill 73.3 68.9 75.1 1,548
IUD 97.3 96.3 91.0 446
Injectables 84.3 78.8 83.0 874
Implants 94.4 92.6 88.6 251
Initial source of method1
Public sector 91.9 88.6 87.9 1,797
National hospital (PP) (88.7) (73.9) (84.7) 28
Provincial hospital (RH) 88.3 82.1 80.6 92
District hospital (RH) 95.4 89.9 90.3 81
Health center 92.1 89.2 88.3 1,573
Health post (77.0) (77.0) (67.4) 13
Other public sector * * * 10
Private sector 70.5 65.5 72.1 1,162
Private hospital 79.0 79.0 85.2 71
Private clinic 87.9 83.9 83.6 431
Pharmacy 54.1 48.8 61.0 435
Other private medical
sector 66.3 58.4 67.2 225
Other sources 66.4 57.3 72.2 320
Shop 41.8 36.3 57.8 82
Community distributor 75.6 65.5 77.3 225
Friend/relative * * * 13
Other * * * 5
Total 81.9 77.4 80.7 3,284
Note: Table includes users of only the methods listed individually. Figures in parentheses are based on 25-49
unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has
been suppressed.
1 Source at start of current episode of use
Overall, 82 percent of contraceptive users were informed about side effects of their method when
they initiated their current use of that method. More than three-quarters (77 percent) of women were
informed about what to do if they experienced side effects, and 81 percent were informed by a health or
family planning worker about other methods they could use.
Findings on informed choice varied by method. Users of IUDs and implants were most likely to
have received all three types of information relating to informed choice. Unfortunately, users of the most
commonly used method—pills—were least likely to be informed; 73 percent of users of the daily pill were
informed of side effects, and 69 percent were told about what to do in the event of side effects. Users of
pills (75 percent) were also least likely to be informed of other methods.
8.8 FUTURE USE OF CONTRACEPTION
Intention to use a method of contraception is an important indicator of the potential demand for
family planning services. Currently married women who were not using contraception at the time of the
survey were asked about their intention to use family planning methods in the future. The results are
presented in Table 8.10.
94 • Family Planning
Table 8.10 Future use of contraception
Percent distribution of currently married women age 15-49 who are not using a
contraceptive method by intention to use in the future, according to number of living
children, Cambodia 2014
Number of living children1
Total Intention 0 1 2 3 4+
Intends to use 56.4 72.5 61.2 46.8 29.2 54.4
Unsure 7.6 3.5 4.7 5.0 5.5 4.9
Does not intend to use 36.0 24.1 33.8 48.2 65.1 40.6
Missing 0.0 0.0 0.3 0.1 0.2 0.1
Total 100.0 100.0 100.0 100.0 100.0 100.0
Number of women 540 1,472 1,215 775 1,195 5,198
1 Includes current pregnancy
Fifty-four percent of currently married women who were not using any contraception at the time
of the survey reported that they intend to use a family planning method sometime in the future,
approximately the same percentage as in 2010 (53 percent). Forty-one percent do not intend to use any
method, and 5 percent are unsure of their intention. The proportion of women who intend to use
contraception in the future varied by number of living children, increasing from 56 percent among those
with no living children to a peak of 73 percent among those with one child. These women are most likely
interested in spacing subsequent births.
8.9 EXPOSURE TO FAMILY PLANNING MESSAGES
The media can be a major source of family planning messages. Information about public exposure
to messages on a particular type of media allows policymakers to ensure the use of the most effective
means of communication for various target groups in the population. To assess the effectiveness of
electronic and print sources in disseminating family planning information, women interviewed in the 2014
CDHS were asked whether they had heard or seen family planning messages on the radio or television or
read a family planning message in a newspaper or magazine in the months leading up to the survey. The
results are shown in Table 8.11.
Media messages about family planning were largely accessed through television and radio, with
lesser access through the print media. For example, 51 percent of women had recently heard about family
planning on television and 38 percent had recently heard about it on the radio. By contrast, only 17 percent
of women obtained such information from newspapers or magazines. There has been a significant decline
in access to family planning messages since 2010. In 2014, 40 percent of women were not exposed to a
family planning message through any of these three media sources in the months preceding the survey, as
compared with only 25 percent of women in 2010. Access to family planning messages declined for all
three types of mass media.
Significant variation was observed in exposure to family planning messages by background
characteristics. Younger women were more likely to be exposed to family planning messages than older
women, and women in rural areas had less exposure to information on family planning through the media
than women in urban areas. For example, 43 percent of rural women had not seen or heard family planning
messages in any of the three types of media, as compared with 30 percent of urban women. Educational
attainment and wealth quintile were both associated with access to family planning messages in the media.
For example, only 5 percent of women with no schooling were exposed to a family planning message in a
newspaper or magazine, as compared with 28 percent of women with a secondary education or higher. In
addition, the proportion of women who had not seen or heard family planning messages in any of the three
types of media decreased steadily from 59 percent among those in the lowest wealth quintile to 28 percent
among those in the highest wealth quintile.
Family Planning • 95
Table 8.11 Exposure to family planning messages
Percentage of women age 15-49 who heard or saw a family planning message on radio, on television, or in a
newspaper or magazine in the past few months, according to background characteristics, Cambodia 2014
Background
characteristic Radio Television
Newspaper/
magazine
None of these
three media
sources
Number of
women
Age
15-19 40.1 51.1 18.5 39.2 2,893
20-24 38.6 53.6 21.7 37.8 3,017
25-29 39.8 52.8 18.8 37.3 2,836
30-34 37.2 52.0 16.3 40.3 3,046
35-39 33.2 48.3 13.4 45.0 1,839
40-44 36.0 48.6 14.6 43.6 2,030
45-49 40.0 49.4 13.1 42.5 1,916
Residence
Urban 36.0 63.7 28.2 30.2 3,251
Rural 38.5 48.4 14.6 42.6 14,327
Province
Banteay Meanchey 25.4 45.7 11.1 49.9 689
Kampong Cham 22.4 29.6 5.6 60.3 2,021
Kampong Chhnang 64.0 67.7 33.6 19.1 662
Kampong Speu 32.2 49.2 4.2 44.2 1,196
Kampong Thom 48.6 60.2 12.8 29.4 851
Kandal 43.8 67.3 17.9 28.3 1,330
Kratie 29.2 19.6 6.8 63.0 488
Phnom Penh 35.6 65.6 32.1 27.0 1,994
Prey Veng 82.3 88.7 47.0 10.1 1,188
Pursat 32.9 37.2 8.4 52.5 631
Siem Reap 40.6 41.6 16.5 44.1 1,137
Svay Rieng 44.1 62.1 23.8 33.6 654
Takeo 41.3 67.9 19.3 29.7 1,082
Otdar Meanchey 19.2 28.1 11.1 60.3 294
Battambang/Pailin 19.7 34.8 9.3 57.6 1,333
Kampot/Kep 38.1 45.6 6.0 41.3 770
Preah Sihanouk/
Koh Kong 33.5 60.1 16.0 35.6 422
Preah Vihear/
Stung Treng 28.4 18.7 5.6 62.3 462
Mondul Kiri/
Ratanak Kiri 38.1 25.7 18.7 55.2 372
Education
No education 28.3 33.1 5.1 58.7 2,250
Primary 36.2 47.2 11.2 44.0 8,281
Secondary and
higher 43.4 61.6 28.0 30.1 7,047
Wealth quintile
Lowest 32.5 27.7 8.4 59.2 3,143
Second 36.9 42.1 11.5 47.5 3,314
Middle 42.0 53.2 14.2 38.5 3,381
Fourth 41.2 61.6 17.5 33.0 3,612
Highest 37.3 65.7 30.5 28.2 4,128
Total 38.1 51.2 17.1 40.3 17,578
Exposure to family planning messages through the media was highest in Prey Veng and lowest in
Kratie and Preah Vihear/Stung Treng.
8.10 CONTACT OF NONUSERS WITH FAMILY PLANNING PROVIDERS
Family planning services are important for the improvement of mother and child health. Thus, it is
crucial that every opportunity to meet a woman’s family planning needs be fully exploited. In reality,
however, health care providers miss these opportunities. Information on missed opportunities was gathered
in the survey by asking women who were not currently using a modern contraceptive method whether they
had visited a health facility in the 12 months preceding the survey. Those who visited a health facility were
asked whether anyone at the facility had discussed family planning with them during any of their visits.
Women were also asked whether they had been visited by a fieldworker who talked with them about
family planning in the 12 months preceding the survey.
Results showed that three-quarters of nonusers did not have any contact with health care providers
or fieldworkers with whom family planning was discussed (Table 8.12). Only 18 percent of nonusers
96 • Family Planning
reported being visited by fieldworkers who discussed family planning issues. Thirty-nine percent of
nonusers visited a health facility during the 12 months preceding the survey, but the majority of these
women did not discuss family planning with any health care provider (25 percent). Younger nonusers,
those in urban areas, and those in Mondul Kiri/Ratanak Kiri are particularly disadvantaged. There have not
been any improvements in maximizing opportunities to meet a woman’s family planning needs over the
past four years. Levels of missed opportunities among nonusers remain high and have actually increased
somewhat during this period.
Table 8.12 Contact of nonusers with family planning providers
Among all women age 15-49 who are not currently using any contraception, the percentage who during the past 12 months
were visited by a fieldworker who discussed family planning, the percentage who visited a health facility and discussed family
planning, the percentage who visited a health facility but did not discuss family planning, and the percentage who did not
discuss family planning either with a fieldworker or at a health facility, by background characteristics, Cambodia 2014
Percentage of
women who were
visited by
fieldworker who
discussed family
planning
Percentage of women who visited a
health facility in the past 12 months
and who:
Percentage of
women who did not
discuss family
planning either with
fieldworker or at a
health facility
Number of
women
Background
characteristic
Discussed family
planning
Did not discuss
family planning
Age
15-19 12.0 6.2 18.6 86.0 2,760
20-24 15.8 15.2 29.9 75.9 2,121
25-29 21.8 20.6 28.3 68.5 1,441
30-34 22.4 22.6 28.8 65.8 1,252
35-39 21.1 17.0 28.5 70.6 771
40-44 20.3 14.2 24.3 72.9 1,024
45-49 22.5 9.7 23.4 74.7 1,436
Residence
Urban 7.1 10.2 32.7 84.9 2,124
Rural 20.8 14.7 23.4 73.2 8,681
Province
Banteay Meanchey 13.9 10.3 25.7 79.3 379
Kampong Cham 15.0 11.8 35.1 77.3 1,353
Kampong Chhnang 66.8 56.4 20.9 28.8 440
Kampong Speu 19.7 9.1 24.5 76.6 643
Kampong Thom 7.8 8.0 17.4 87.6 513
Kandal 10.7 4.2 24.8 85.8 798
Kratie 7.3 11.0 25.0 83.7 317
Phnom Penh 4.3 10.8 44.1 86.0 1,279
Prey Veng 21.1 13.5 4.0 76.2 695
Pursat 11.8 7.4 13.2 84.2 411
Siem Reap 17.0 15.3 29.8 72.9 673
Svay Rieng 10.8 11.8 24.9 81.4 373
Takeo 38.5 25.6 13.6 57.1 672
Otdar Meanchey 15.8 7.7 6.5 81.5 171
Battambang/Pailin 26.7 16.1 25.8 66.4 807
Kampot/Kep 16.4 13.0 15.6 75.3 461
Preah Sihanouk/
Koh Kong 15.6 11.4 12.2 76.6 260
Preah Vihear/
Stung Treng 28.1 17.2 37.0 62.3 330
Mondul Kiri/
Ratanak Kiri 7.0 2.1 25.7 91.6 231
Education
No education 22.8 14.4 23.4 71.6 1,316
Primary 19.7 14.8 25.5 73.4 4,632
Secondary and
higher 15.4 12.6 25.4 78.5 4,857
Wealth quintile
Lowest 22.4 15.2 24.8 71.9 1,923
Second 20.7 16.4 19.6 72.5 1,973
Middle 21.1 14.4 22.9 73.2 2,109
Fourth 20.2 13.1 24.0 74.1 2,220
Highest 8.7 10.9 32.7 83.5 2,579
Total 18.1 13.8 25.2 75.5 10,805
Other Proximate Determinants of Fertility • 97
OTHER PROXIMATE DETERMINANTS
OF FERTILITY 9
Key Findings
• The median age at marriage among men age 25-49 is 23 years, two
years older than the median age among women (21 years).
• The percentage of women who were first married by age 15 declines from
7 percent among women currently age 45-49 to 1 percent among women
age 15-19.
• Among Cambodian women, the median age at first sex is about the same
as the median age at first marriage. In contrast, men typically initiate
sexual intercourse one full year before their first marriage.
• Overall, although it is illegal, 3 percent of married women in Cambodia
are in a polygamous union.
his chapter examines the principal factors, other than contraception, that affect a woman’s chances
of becoming pregnant. These factors include marriage (including consensual unions), postpartum
amenorrhea, abstinence from sexual relations, and termination of exposure to pregnancy. Marriage
and sexual relations relate to childbearing; postpartum amenorrhea and abstinence affect the intervals
between births; and menopause marks the end of childbearing. This chapter also takes an in-depth look at
more direct measures of timing and level of exposure to the risk of pregnancy: age at first sexual
intercourse and frequency of intercourse. Marriage is an important fertility indicator because, for most
women in Cambodia, it marks the beginning of regular exposure to the risk of pregnancy. Populations in
which the age at first marriage is low also tend to experience early childbearing and high fertility.
Measures of the onset of menopause are important because the probability of becoming pregnant decreases
as women approach the end of their reproductive years and increasing proportions become infecund.
Collectively, the above-mentioned factors determine the duration and pace of reproductive activity and
hence are important in understanding fertility.
9.1 MARITAL STATUS
Table 9.1 shows the distribution of all women and men age 15-49 by current marital status. The
data indicate that, on average, 25 percent of Cambodian women of reproductive age have never been
married, and 68 percent are currently married or cohabiting as if married. Four percent of women of
reproductive age are divorced or separated, and 3 percent are widows. A higher proportion of men age 1549 have never been married (32 percent), and, because men tend to marry later than women, fewer men
than women in the youngest age groups have ever been married. Almost no men in the two oldest age
groups have never been married.
T
98 • Other Proximate Determinants of Fertility
Table 9.1 Current marital status
Percent distribution of women and men age 15-49 by current marital status, according to age, Cambodia 2014
Marital status
Total
Percentage
of respondents
currently in
union
Number of
respondentsAge
Never
married Married
Living
together Divorced Separated Widowed
WOMEN
15-19 83.4 15.4 0.2 0.6 0.3 0.1 100.0 15.6 2,893
20-24 35.8 59.9 0.8 1.9 0.3 1.2 100.0 60.8 3,017
25-29 15.0 78.7 0.6 4.1 0.3 1.3 100.0 79.3 2,836
30-34 7.6 85.7 0.5 3.5 0.3 2.5 100.0 86.2 3,046
35-39 5.1 84.9 0.6 4.7 0.4 4.3 100.0 85.5 1,839
40-44 5.0 81.9 0.5 5.2 0.4 7.0 100.0 82.4 2,030
45-49 4.2 77.6 0.4 6.1 0.5 11.2 100.0 78.0 1,916
Total 25.2 67.2 0.5 3.4 0.3 3.3 100.0 67.7 17,578
MEN
15-19 96.8 2.9 0.1 0.0 0.2 0.0 100.0 3.0 926
20-24 59.4 36.1 0.8 1.5 1.8 0.4 100.0 36.9 835
25-29 24.6 72.0 0.6 2.7 0.1 0.0 100.0 72.6 815
30-34 5.5 91.6 0.1 2.3 0.3 0.2 100.0 91.7 907
35-39 2.5 95.2 0.1 2.1 0.0 0.1 100.0 95.2 556
40-44 1.1 96.1 0.0 0.9 0.1 1.8 100.0 96.1 595
45-49 0.0 97.4 0.5 0.3 0.0 1.7 100.0 98.0 556
Total 32.0 65.3 0.3 1.4 0.4 0.5 100.0 65.6 5,190
Table 9.1 also shows that the proportion of women who have never married decreases with age to
a low of 4 percent among those age 45-49. This reflects the near universality of marriage in Cambodian
society. Consequently, the proportion of women currently married or cohabiting as if married increases
with age up to age 30-39 (86 percent) and declines thereafter due to increasing levels of widowhood.
Widowhood also increases with age among men, but not to the same extent as among women. Only 2
percent of men age 45-49 are widowed, as compared with 11 percent of women. This is likely due to
men’s greater propensity to remarry after having been widowed.
9.2 POLYGAMY
The survey asked currently married women (in formal or informal union) whether their partners
had other wives. Table 9.2 shows the percent distribution of married women by number of co-wives,
according to background characteristics. Polygamy is not very common in Cambodia. However, although
it is illegal, it affects 3 percent of women in union.
The proportion of women in a polygamous marriage increases with age, from less than 2 percent
at age 15-19 to 5 percent at age 45-49. Although the prevalence of polygamy does not differ by residence,
there is substantial variation by province. The percentage of currently married women with co-wives is
highest in Kampot/Kep (9 percent) and lowest in Kampong Thom, Kratie, Otdar Meanchey,
Battambang/Pailin, Preah Vihear/Stung Treng, and Mondul Kiri/Ratanak Kiri (less than 1 percent).
Women’s level of education is related to the prevalence of this practice: the percentage of married women
with co-wives is twice as high among those with no education (4 percent) as among those with a secondary
education or higher (2 percent). The proportion of women with co-wives varies little by wealth quintile,
from 2 percent to 3 percent.
Other Proximate Determinants of Fertility • 99
Table 9.2 Number of women’s co-wives
Percent distribution of currently married women age 15-49 by number of co-wives, according to
background characteristics, Cambodia 2014
Background
characteristic
Number of co-wives
Total
Number of
women 0 1 2+ Missing
Age
15-19 95.0 0.6 1.2 3.2 100.0 450
20-24 94.8 1.7 0.3 3.2 100.0 1,833
25-29 96.1 1.3 0.3 2.3 100.0 2,249
30-34 94.7 2.0 0.6 2.8 100.0 2,625
35-39 92.7 3.4 0.5 3.3 100.0 1,573
40-44 93.6 2.9 0.3 3.2 100.0 1,673
45-49 92.8 4.0 0.9 2.4 100.0 1,495
Residence
Urban 94.1 2.6 0.3 3.0 100.0 1,818
Rural 94.4 2.3 0.5 2.8 100.0 10,080
Province
Banteay Meanchey 92.9 5.2 1.4 0.6 100.0 503
Kampong Cham 89.0 5.3 1.3 4.4 100.0 1,490
Kampong Chhnang 97.0 2.2 0.2 0.6 100.0 396
Kampong Speu 97.3 1.2 0.0 1.5 100.0 843
Kampong Thom 96.2 0.0 0.3 3.5 100.0 572
Kandal 85.6 1.5 0.5 12.4 100.0 870
Kratie 98.6 0.4 0.2 0.8 100.0 359
Phnom Penh 94.3 2.5 0.0 3.2 100.0 1,084
Prey Veng 96.8 2.3 0.0 0.8 100.0 889
Pursat 94.3 2.1 1.1 2.5 100.0 425
Siem Reap 94.7 2.4 0.1 2.8 100.0 765
Svay Rieng 93.3 1.0 0.6 5.1 100.0 483
Takeo 98.1 1.1 0.0 0.8 100.0 677
Otdar Meanchey 98.7 0.4 0.0 0.9 100.0 218
Battambang/Pailin 98.5 0.3 0.2 1.0 100.0 890
Kampot/Kep 89.4 7.2 2.0 1.5 100.0 574
Preah Sihanouk/
Koh Kong 96.7 2.2 0.2 0.9 100.0 266
Preah Vihear/
Stung Treng 99.3 0.5 0.0 0.2 100.0 314
Mondul Kiri/
Ratanak Kiri 99.9 0.1 0.0 0.0 100.0 281
Education
No education 93.6 3.1 0.8 2.5 100.0 1,774
Primary 93.9 2.6 0.6 2.8 100.0 6,399
Secondary and
higher 95.4 1.5 0.1 3.1 100.0 3,726
Wealth quintile
Lowest 94.6 2.5 0.9 2.0 100.0 2,294
Second 94.9 2.2 0.5 2.5 100.0 2,404
Middle 94.2 1.9 0.3 3.6 100.0 2,365
Fourth 94.0 2.7 0.4 2.9 100.0 2,393
Highest 94.0 2.4 0.3 3.3 100.0 2,443
Total 94.3 2.3 0.5 2.9 100.0 11,898
9.3 AGE AT FIRST UNION
In many societies, age at first marriage marks the point in a woman’s life when childbearing
becomes socially acceptable. Women who marry early will on average have a longer exposure to the risk
of pregnancy. Therefore, early age at first marriage would imply early age at childbearing and a higher
societal level of fertility. Information on age at first marriage was obtained by asking all ever-married
respondents the month and year they started living with their first spouse or, if they could not remember
the month and year, the age at which they started living with their first spouse. This information is
presented in Table 9.3.
100 • Other Proximate Determinants of Fertility
Table 9.3 Age at first marriage
Percentage of women and men age 15-49 who were first married by specific exact ages and median age at first
marriage, according to current age, Cambodia 2014
Current
age
Percentage first married by exact age:
Percentage
never
married
Number of
respondents
Median age
at first
marriage 15 18 20 22 25
WOMEN
15-19 1.4 na na na na 83.4 2,893 a
20-24 1.9 18.5 40.8 na na 35.8 3,017 a
25-29 2.7 18.6 38.7 55.9 76.4 15.0 2,836 21.2
30-34 3.7 24.5 43.9 59.8 76.5 7.6 3,046 20.7
35-39 5.4 29.5 48.8 67.3 79.8 5.1 1,839 20.1
40-44 5.1 30.3 51.7 68.6 81.9 5.0 2,030 19.8
45-49 6.6 28.2 45.6 62.8 79.7 4.2 1,916 20.5
25-49 4.4 25.4 45.1 62.1 78.5 8.0 11,668 20.5
MEN
15-19 0.0 na na na na 96.8 926 a
20-24 0.0 3.6 16.1 na na 59.4 835 a
25-29 0.0 3.9 13.6 31.9 57.4 24.6 815 24.1
30-34 0.2 10.8 23.7 41.5 67.6 5.5 907 22.9
35-39 0.1 10.3 23.2 42.5 68.5 2.5 556 22.7
40-44 0.2 7.8 23.4 46.2 72.5 1.1 595 22.4
45-49 0.7 10.8 27.0 43.5 66.1 0.0 556 22.6
25-49 0.2 8.5 21.7 40.5 65.9 7.9 3,430 23.0
Note: The age at first marriage is defined as the age at which the respondent began living with her/his first
spouse/partner.
na = Not applicable due to censoring
a = Omitted because less than 50 percent of the respondents married for the first time before reaching the beginning
of the age group
The median age at first marriage among women in Cambodia has increased marginally over the
past two decades and is now just under 21 years. Men have a slightly older median age at first marriage of
23 years. The proportion of women married by age 15 has declined in recent years, dropping from 7
percent among women age 45-49 to 1 percent among women age 15-19. Almost half (45 percent) of
Cambodian women age 25-49 are married by age 20, and 79 percent are married by age 25. Less than 1
percent of all Cambodian men age 25-49 are married by the age of 15, and only 9 percent are married by
age 18. This finding contrasts fairly sharply with the proportion of women married by age 18 (25 percent).
Other Proximate Determinants of Fertility • 101
Table 9.4.1 Median age at first marriage: Women
Median age at first marriage among women by five-year age groups, age 25-49, according to
background characteristics, Cambodia 2014
Background
characteristic
Age Women age
25-49 25-29 30-34 35-39 40-44 45-49
Residence
Urban 23.6 22.2 20.1 20.5 21.2 21.7
Rural 20.8 20.5 20.1 19.7 20.3 20.3
Province
Banteay Meanchey 20.9 21.6 19.5 19.7 20.3 20.5
Kampong Cham 21.0 20.1 20.8 20.1 20.5 20.5
Kampong Chhnang 22.3 20.4 20.9 20.4 20.4 20.8
Kampong Speu 19.9 19.9 18.4 19.8 21.0 19.8
Kampong Thom 21.1 20.3 20.6 19.2 20.2 20.2
Kandal 21.4 22.4 21.6 20.0 22.0 21.5
Kratie 19.7 21.1 19.0 19.4 20.4 19.9
Phnom Penh 24.3 22.9 20.5 20.6 21.3 22.1
Prey Veng 20.7 19.8 19.1 19.5 19.4 19.8
Pursat 21.7 20.3 20.0 20.3 21.4 21.1
Siem Reap 20.0 20.6 20.5 20.3 21.1 20.5
Svay Rieng 20.9 19.8 19.0 19.7 20.6 20.0
Takeo 22.4 20.6 21.0 18.8 20.1 20.8
Otdar Meanchey 20.5 20.1 20.1 18.9 20.1 20.1
Battambang/Pailin 22.1 21.4 19.9 20.2 19.7 20.7
Kampot/Kep 19.7 19.4 19.4 19.9 20.2 19.8
Preah Sihanouk/
Koh Kong 21.4 19.9 18.7 19.3 20.2 20.1
Preah Vihear/Stung
Treng 20.8 20.0 19.3 20.0 19.2 20.0
Mondul Kiri/
Ratanak Kiri 19.4 19.0 19.0 19.4 19.7 19.3
Education
No education 19.7 19.9 19.4 19.4 19.7 19.7
Primary 20.3 20.2 20.1 19.7 20.2 20.1
Secondary and
higher 22.7 22.4 20.7 20.4 22.1 21.9
Wealth quintile
Lowest 20.0 20.2 20.3 20.2 20.9 20.3
Second 19.8 20.4 19.9 19.8 19.9 20.0
Middle 21.0 19.9 20.2 19.6 20.2 20.2
Fourth 22.1 20.6 19.8 19.4 20.2 20.4
Highest 23.0 21.8 20.6 20.4 20.8 21.6
Total 21.2 20.7 20.1 19.8 20.5 20.5
Note: The age at first marriage is defined as the age at which the respondent began living with her/his
first spouse/partner.
Table 9.4.1 shows the median age at first marriage among women age 25-49 by current age and
selected background characteristics. Table 9.4.2 shows the same information among men age 25-49. The
median age at first marriage among urban women (22) is older than that among rural women (20). Men
demonstrate greater urban-rural differences in median age at marriage than do women. Less than half of
urban men are married by age 25, whereas half of rural men are married by age 23. Median age at first
marriage among women varies by almost three years across provinces, ranging from 19 in Mondul
Kiri/Ratanak Kiri to 22 in Phnom Penh and Kandal. One consistent difference in age at first marriage
among Cambodian women of all ages is by education. Women who have attained a high school education
or higher tend to marry two years later than women with no education. Men with a high school education
or higher tend to marry more than three years later than their counterparts with no education. Among
women, there is little difference in median age at marriage in the lowest four wealth quintiles; however,
women in the highest wealth quintile marry at least one year later than their less wealthy counterparts.
Among men, the median age at first marriage increases incrementally with increasing wealth.
102 • Other Proximate Determinants of Fertility
Table 9.4.2 Median age at first marriage: Men
Median age at first marriage among men by five-year age groups, age 25-49, according to background
characteristics, Cambodia 2014
Background
characteristic
Age Men age
25-49 25-29 30-34 35-39 40-44 45-49
Residence
Urban a 26.0 24.9 24.2 24.3 a
Rural 23.6 22.4 22.5 22.1 22.3 22.6
Province
Banteay Meanchey 22.7 23.6 22.2 23.2 21.5 22.8
Kampong Cham 24.0 22.2 22.7 22.7 20.7 22.9
Kampong Chhnang a 21.3 21.6 22.7 23.2 22.9
Kampong Speu 23.3 22.4 21.9 21.1 22.4 22.4
Kampong Thom 23.7 23.0 22.9 21.4 23.0 23.0
Kandal 23.5 21.9 23.5 23.5 24.1 22.8
Kratie 24.1 23.7 23.8 22.4 27.3 23.9
Phnom Penh a 25.8 24.2 24.2 24.3 a
Prey Veng 22.9 23.0 22.8 21.2 22.2 22.4
Pursat a 24.1 23.9 22.5 26.5 24.7
Siem Reap 23.3 23.5 22.5 21.3 22.7 22.7
Svay Rieng 22.5 21.5 20.4 20.4 17.9 21.1
Takeo 24.6 22.7 22.8 22.0 21.7 22.5
Otdar Meanchey 22.8 23.2 23.3 23.7 23.3 23.1
Battambang/Pailin 24.1 24.2 23.6 22.6 22.9 23.7
Kampot/Kep 23.6 21.6 20.4 20.4 20.9 21.1
Preah Sihanouk/
Koh Kong a 23.7 24.8 23.2 22.8 24.3
Preah Vihear/
Stung Treng 21.8 23.4 23.5 22.6 20.8 22.5
Mondul Kiri/
Ratanak Kiri 21.9 23.4 23.0 22.2 23.6 22.6
Education
No education 21.3 20.9 21.5 20.6 21.0 21.0
Primary 23.0 21.7 21.9 22.4 21.4 22.1
Secondary and
higher a 24.8 24.6 23.2 24.2 24.5
Wealth quintile
Lowest 21.7 20.9 21.2 21.5 25.0 21.7
Second 23.0 21.8 22.2 22.4 22.4 22.3
Middle 24.1 22.5 22.8 21.4 20.9 22.5
Fourth 23.8 23.5 22.6 22.6 21.9 23.0
Highest a 25.5 24.9 24.0 24.7 a
Total 24.1 22.9 22.7 22.4 22.6 23.0
Note: The age at first marriage is defined as the age at which the respondent began living with her/his
first spouse/partner.
a = Omitted because less than 50 percent of men married for the first time before reaching the
beginning of the age group
9.4 AGE AT FIRST SEXUAL INTERCOURSE
Age at first marriage is commonly used as a proxy for the onset of women’s exposure to sexual
intercourse and risk of pregnancy and sexually transmitted infections. However, because some men and
women are sexually active before marriage, it is also important to measure the impact of age at first sexual
intercourse on fertility. The 2014 CDHS asked women and men how old they were when they first
engaged in sexual intercourse. The results are presented in Tables 9.5, 9.6.1, and 9.6.2.
A comparison of the percentage of women who had first sexual intercourse by specific ages
(Table 9.5) with the percentage of women first married by those ages (Table 9.3) shows very little
variation, implying that women rarely engage in sexual activity prior to marriage. The median age at first
intercourse is slightly older than the median age at first marriage among women age 25-49 (20.7 years
versus 20.5 years). Eight percent of women age 25-49 have never had intercourse.
Other Proximate Determinants of Fertility • 103
Table 9.5 Age at first sexual intercourse
Percentage of women and men age 15-49 who had first sexual intercourse by specific exact ages, percentage who
never had intercourse, and median age at first intercourse, according to current age, Cambodia 2014
Current
age
Percentage who had first sexual intercourse by exact age:
Percentage
who never
had
intercourse Number
Median age
at first
intercourse 15 18 20 22 25
WOMEN
15-19 1.4 na na na na 82.9 2,893 a
20-24 1.6 17.4 40.2 na na 35.2 3,017 a
25-29 2.3 17.8 37.2 55.1 74.6 14.7 2,836 21.4
30-34 3.2 22.5 42.3 58.0 74.1 7.5 3,046 20.9
35-39 5.0 28.9 47.8 65.0 76.4 5.0 1,839 20.3
40-44 4.8 29.5 51.2 67.7 80.4 4.8 2,030 19.9
45-49 6.2 27.4 44.5 62.3 77.8 4.1 1,916 20.6
25-49 4.0 24.4 43.8 60.8 76.3 7.8 11,668 20.7
MEN
15-19 0.3 na na na na 92.5 926 a
20-24 0.4 4.4 24.4 na na 45.4 835 a
25-29 0.1 6.0 22.8 45.7 71.3 12.1 815 22.4
30-34 0.3 13.0 30.3 50.7 73.1 1.9 907 21.9
35-39 0.1 10.5 33.4 51.6 73.6 1.0 556 21.8
40-44 0.2 8.9 28.3 51.2 75.1 0.7 595 21.9
45-49 1.0 11.3 33.4 49.8 71.0 0.0 556 22.0
25-49 0.3 9.9 29.2 49.6 72.8 3.7 3,430 22.0
na = Not applicable due to censoring
a = Omitted because less than 50 percent of the respondents had intercourse for the first time before reaching the
beginning of the age group
A comparison of the percentage of men who had first sexual intercourse by specific ages (Table
9.5) with the percentage of men first married by those ages (Table 9.3) shows some variation, indicating
that men are more likely to engage in sexual activity prior to marriage than women. The percentage of men
age 25-49 never having had intercourse is 4 percent, half the proportion of men never having married (8
percent). Half of men have had sexual experience by age 22, while only 41 percent have married by that
age. Among men, the median age at first intercourse is one year younger than the median age at first
marriage (22.0 years versus 23.0 years).
Table 9.6.1 shows differentials in the median age at first sexual intercourse by background
characteristics for women, and Table 9.6.2 shows these differentials for men. Among women (Table 9.6.1),
there is a one-year difference in age at first sexual intercourse between urban and rural residents (22 and
21, respectively). There is little variation by province with the exception of a notably older median age at
first intercourse among women in Phnom Penh (22 years). There is also a two-year difference between
those who have a secondary education or higher (22 years) and those who have less education (20 years)
and at least a one-year difference between those in the highest wealth quintile (22) and those in the lower
four quintiles (20-21 years). Among men (Table 9.6.2), there is a one-year difference in median age at first
sexual intercourse between urban and rural residents (23 and 22 years, respectively). There is a difference
of two years between those who have a secondary education or higher (23 years) and those who have less
education (21 years). Also, there is a difference of one to two years in the median age at first sex between
men in the wealthiest quintile (23 years) and men in the other quintiles (21-22 years).
104 • Other Proximate Determinants of Fertility
Table 9.6.1 Median age at first intercourse: Women
Median age at first sexual intercourse among women by five-year age groups, age 25-49, according to
background characteristics, Cambodia 2014
Background
characteristic
Age Women age
25-49 25-29 30-34 35-39 40-44 45-49
Residence
Urban 23.7 22.2 20.2 20.6 21.3 21.8
Rural 20.9 20.7 20.3 19.8 20.5 20.5
Province
Banteay Meanchey 21.2 21.3 19.5 19.7 20.4 20.6
Kampong Cham 21.5 20.9 21.2 20.3 20.9 21.0
Kampong Chhnang 22.9 21.1 21.5 20.5 20.8 21.3
Kampong Speu 19.9 20.0 18.5 19.7 21.1 19.8
Kampong Thom 21.1 20.5 20.7 19.2 20.0 20.2
Kandal 21.5 22.4 21.6 20.1 21.6 21.4
Kratie 19.6 21.1 18.9 19.1 20.4 19.8
Phnom Penh 24.4 22.8 20.3 20.6 21.4 22.0
Prey Veng 20.7 19.7 19.3 19.3 19.7 19.8
Pursat 21.8 20.6 20.0 20.4 21.8 21.2
Siem Reap 20.2 20.6 20.9 20.4 21.0 20.6
Svay Rieng 20.9 19.9 18.9 19.5 20.8 20.1
Takeo 22.5 21.0 21.7 18.9 20.7 21.3
Otdar Meanchey 20.8 20.9 21.0 20.5 20.6 20.7
Battambang/Pailin 22.1 21.4 20.1 20.4 19.5 20.7
Kampot/Kep 19.8 19.7 19.2 19.8 20.2 19.8
Preah Sihanouk/
Koh Kong 21.8 20.5 19.1 19.6 20.3 20.4
Preah Vihear/
Stung Treng 20.9 19.9 19.2 19.1 19.1 19.8
Mondul Kiri/
Ratanak Kiri 19.6 19.2 19.3 19.4 19.2 19.4
Education
No education 20.0 20.4 19.9 19.5 19.7 19.9
Primary 20.4 20.4 20.1 19.7 20.3 20.2
Secondary and
higher 22.8 22.5 20.8 20.5 22.2 22.0
Wealth quintile
Lowest 20.3 20.4 20.4 20.3 21.1 20.5
Second 19.9 20.6 20.0 19.8 20.2 20.1
Middle 21.3 20.2 20.3 19.5 20.2 20.3
Fourth 22.2 20.8 19.9 19.6 20.4 20.6
Highest 23.0 21.9 20.7 20.5 20.9 21.6
Total 21.4 20.9 20.3 19.9 20.6 20.7
Other Proximate Determinants of Fertility • 105
Table 9.6.2 Median age at first intercourse: Men
Median age at first sexual intercourse among men by five-year age groups, age 25-49, according to
background characteristics, Cambodia 2014
Background
characteristic
Age Men age
25-49 25-29 30-34 35-39 40-44 45-49
Residence
Urban 22.4 23.1 22.4 23.2 23.1 22.8
Rural 22.4 21.6 21.7 21.6 21.8 21.9
Province
Banteay Meanchey 22.0 22.5 20.7 22.5 21.5 22.0
Kampong Cham 22.4 20.8 20.7 22.0 19.8 21.1
Kampong Chhnang 24.2 21.1 18.9 21.2 20.8 21.5
Kampong Speu 21.4 22.0 20.7 20.7 22.5 21.7
Kampong Thom 23.4 22.9 22.9 21.1 22.8 22.8
Kandal 22.1 20.7 22.8 23.6 21.8 22.1
Kratie 23.2 23.4 23.0 22.0 26.0 23.4
Phnom Penh 22.3 22.7 21.5 23.1 22.9 22.6
Prey Veng 22.6 21.5 22.8 20.8 22.3 22.2
Pursat 22.5 20.5 23.0 20.8 24.5 22.6
Siem Reap 23.0 23.6 21.7 21.3 22.8 22.5
Svay Rieng 21.7 20.4 20.3 19.6 17.9 20.7
Takeo 22.9 22.3 21.3 21.5 21.6 22.1
Otdar Meanchey 24.3 23.1 26.1 22.3 21.7 23.6
Battambang/Pailin 21.7 22.2 23.0 24.2 23.1 22.6
Kampot/Kep 22.4 21.7 20.4 19.7 20.8 21.1
Preah Sihanouk/
Koh Kong 21.4 20.8 21.9 20.8 20.1 21.0
Preah Vihear/
Stung Treng 22.1 25.2 23.5 23.6 22.7 23.4
Mondul Kiri/
Ratanak Kiri 21.3 23.8 20.8 22.1 23.7 22.2
Education
No education 20.8 21.3 20.4 20.5 20.8 20.7
Primary 21.7 20.8 21.4 21.9 21.0 21.3
Secondary and
higher 22.8 22.9 23.0 22.3 23.0 22.8
Wealth quintile
Lowest 21.6 21.0 21.0 21.2 23.2 21.5
Second 21.5 21.5 20.8 22.0 21.3 21.4
Middle 23.3 21.5 22.6 20.9 20.7 21.9
Fourth 22.6 21.8 21.9 22.3 21.5 22.1
Highest 22.7 23.4 22.8 23.2 23.2 23.1
Total 22.4 21.9 21.8 21.9 22.0 22.0
9.5 RECENT SEXUAL ACTIVITY
In addition to age at first sexual intercourse, in the absence of effective contraception, exposure to
pregnancy depends on the pattern of sexual activity. The most important factors are frequency of
intercourse, postpartum abstinence, and abstinence for reasons other than being postpartum. Information
on recent sexual activity, therefore, can be used to refine measures of exposure to pregnancy. Table 9.7.1
shows patterns of sexual activity among women in the four weeks preceding the survey by background
characteristics, and Table 9.7.2 shows patterns among men.
106 • Other Proximate Determinants of Fertility
Table 9.7.1 Recent sexual activity: Women
Percent distribution of women age 15-49 by timing of last sexual intercourse, according to background characteristics, Cambodia 2014
Timing of last sexual intercourse Never had
sexual
intercourse Total
Number of
women
Background
characteristic
Within the last
4 weeks Within 1 year1
One or more
years Missing
Age
15-19 12.4 3.8 0.9 0.1 82.9 100.0 2,893
20-24 48.4 13.2 3.2 0.0 35.2 100.0 3,017
25-29 66.9 12.4 6.0 0.0 14.7 100.0 2,836
30-34 74.8 11.5 6.2 0.1 7.5 100.0 3,046
35-39 73.3 11.4 10.2 0.0 5.0 100.0 1,839
40-44 69.3 11.6 14.3 0.1 4.8 100.0 2,030
45-49 61.6 14.6 19.6 0.2 4.1 100.0 1,916
Marital status
Never married 0.4 0.3 0.5 0.1 98.7 100.0 4,428
Married or living
together 83.1 15.1 1.8 0.0 0.0 100.0 11,898
Divorced/separated/
widowed 2.0 9.7 88.0 0.3 0.0 100.0 1,252
Marital duration2
0-4 years 85.4 12.8 1.7 0.0 0.0 100.0 8,267
5-9 years 84.7 13.6 1.7 0.0 0.0 100.0 2,244
10-14 years 89.1 10.3 0.6 0.0 0.0 100.0 1,897
15-19 years 86.7 11.7 1.5 0.1 0.0 100.0 1,422
20-24 years 85.6 12.2 2.2 0.0 0.0 100.0 1,399
25+ years 79.5 17.3 3.2 0.0 0.0 100.0 1,306
Married more than
once 79.6 18.2 2.2 0.0 0.0 100.0 868
Residence
Urban 46.9 9.7 8.0 0.0 35.4 100.0 3,251
Rural 58.7 11.3 7.5 0.1 22.5 100.0 14,327
Province
Banteay Meanchey 57.9 14.7 6.1 0.0 21.4 100.0 689
Kampong Cham 61.5 11.6 7.3 0.0 19.6 100.0 2,021
Kampong Chhnang 51.3 8.6 8.6 0.0 31.6 100.0 662
Kampong Speu 60.9 10.1 7.2 0.0 21.7 100.0 1,196
Kampong Thom 60.3 7.0 8.0 0.0 24.8 100.0 851
Kandal 56.0 10.0 8.5 0.0 25.4 100.0 1,330
Kratie 64.8 8.9 4.5 0.1 21.7 100.0 488
Phnom Penh 45.3 9.8 7.5 0.0 37.4 100.0 1,994
Prey Veng 64.4 9.7 9.6 0.0 16.3 100.0 1,188
Pursat 54.0 12.0 6.1 0.0 27.8 100.0 631
Siem Reap 53.4 14.0 8.4 0.0 24.3 100.0 1,137
Svay Rieng 57.8 14.7 7.2 0.5 19.8 100.0 654
Takeo 50.4 11.0 10.9 0.5 27.1 100.0 1,082
Otdar Meanchey 63.2 10.5 4.3 0.0 22.0 100.0 294
Battambang/Pailin 53.5 12.3 6.2 0.0 28.0 100.0 1,333
Kampot/Kep 60.2 13.3 6.8 0.0 19.7 100.0 770
Preah Sihanouk/
Koh Kong 50.3 12.9 7.0 0.0 29.9 100.0 422
Preah Vihear/
Stung Treng 58.9 9.9 7.9 0.0 23.3 100.0 462
Mondul Kiri/
Ratanak Kiri 69.2 7.3 6.1 0.0 17.4 100.0 372
Education
No education 65.5 13.4 11.6 0.1 9.4 100.0 2,250
Primary 65.1 11.5 8.4 0.0 15.0 100.0 8,281
Secondary and
higher 43.5 9.6 5.4 0.1 41.4 100.0 7,047
Wealth quintile
Lowest 61.3 11.1 8.9 0.1 18.7 100.0 3,143
Second 59.9 12.6 6.7 0.0 20.7 100.0 3,314
Middle 58.4 11.0 7.6 0.1 22.9 100.0 3,381
Fourth 55.0 11.0 7.4 0.1 26.5 100.0 3,612
Highest 49.8 9.7 7.4 0.0 33.0 100.0 4,128
Total 56.5 11.0 7.6 0.1 24.9 100.0 17,578
1 Excludes women who had sexual intercourse within the last 4 weeks
2 Excludes women who are not currently married
More than half (57 percent) of all women had been sexually active during the four weeks
preceding the survey; 11 percent had not had sex within the past four weeks but had done so within the
past year; and 8 percent had not had sex in one year or longer. The remaining 25 percent had never had
sexual intercourse. The proportion of women who were sexually active in the four weeks prior to the
survey increased with age up to age 30-34 and declined thereafter. With respect to marital duration, the
Other Proximate Determinants of Fertility • 107
proportion sexually active in the past four weeks peaked at a duration of 10-14 years and declined
thereafter. A higher proportion of rural women (59 percent) than urban women (47 percent) were recently
sexually active. The proportion of women who were sexually active in the four weeks before the survey
declined with increasing education and wealth.
Table 9.7.2 Recent sexual activity: Men
Percent distribution of men age 15-49 by timing of last sexual intercourse, according to background characteristics, Cambodia 2014
Timing of last sexual intercourse Never had
sexual
intercourse Total
Number of
men
Background
characteristic
Within the last
4 weeks Within 1 year1
One or more
years Missing
Age
15-19 4.0 2.5 1.0 0.0 92.5 100.0 926
20-24 33.1 13.3 7.9 0.2 45.4 100.0 835
25-29 60.6 18.3 9.0 0.0 12.1 100.0 815
30-34 77.7 15.7 4.7 0.0 1.9 100.0 907
35-39 76.6 18.4 3.9 0.0 1.0 100.0 556
40-44 72.7 22.4 4.1 0.1 0.7 100.0 595
45-49 76.2 20.5 3.3 0.0 0.0 100.0 556
Marital status
Never married 2.4 7.3 8.4 0.1 81.8 100.0 1,663
Married or living
together 80.7 18.3 1.0 0.0 0.0 100.0 3,405
Divorced/separated/
widowed 5.8 25.9 66.7 0.5 1.1 100.0 122
Marital duration2
0-4 years 80.3 18.7 1.1 0.0 0.0 100.0 2,363
5-9 years 83.1 15.9 1.0 0.0 0.0 100.0 639
10-14 years 84.8 15.0 0.3 0.0 0.0 100.0 592
15-19 years 78.0 21.7 0.4 0.0 0.0 100.0 457
20-24 years 75.1 22.5 2.5 0.0 0.0 100.0 407
25+ years 75.4 22.5 2.0 0.1 0.0 100.0 269
Married more than
once 80.8 17.9 1.3 0.0 0.0 100.0 296
Residence
Urban 46.0 16.4 7.4 0.0 30.2 100.0 869
Rural 55.4 14.7 4.4 0.1 25.4 100.0 4,321
Province
Banteay Meanchey 61.5 8.9 4.0 0.0 25.6 100.0 192
Kampong Cham 53.8 21.9 7.0 0.0 17.3 100.0 663
Kampong Chhnang 54.1 10.8 6.9 0.1 28.1 100.0 182
Kampong Speu 54.8 16.4 3.3 0.0 25.5 100.0 323
Kampong Thom 59.4 4.5 3.0 0.0 33.1 100.0 232
Kandal 46.7 25.3 4.3 0.5 23.2 100.0 413
Kratie 63.9 9.3 2.5 0.0 24.3 100.0 143
Phnom Penh 44.1 18.0 6.3 0.0 31.6 100.0 550
Prey Veng 64.8 7.6 5.1 0.0 22.5 100.0 342
Pursat 49.7 12.7 3.8 0.0 33.7 100.0 184
Siem Reap 58.8 10.8 2.4 0.0 27.9 100.0 337
Svay Rieng 58.3 14.1 5.6 0.0 22.0 100.0 183
Takeo 44.5 21.3 7.5 0.0 26.7 100.0 334
Otdar Meanchey 54.8 12.0 2.2 0.2 30.8 100.0 99
Battambang/Pailin 49.1 12.5 6.4 0.0 32.1 100.0 405
Kampot/Kep 61.8 13.0 2.9 0.0 22.4 100.0 241
Preah Sihanouk/
Koh Kong 54.9 13.5 6.5 0.0 25.1 100.0 120
Preah Vihear/
Stung Treng 60.2 8.5 1.5 0.5 29.3 100.0 112
Mondul Kiri/
Ratanak Kiri 57.7 8.7 1.3 0.0 32.3 100.0 134
Education
No education 69.6 16.8 1.9 0.0 11.7 100.0 324
Primary 60.1 16.3 4.4 0.0 19.2 100.0 2,167
Secondary and
higher 47.0 13.6 5.7 0.1 33.6 100.0 2,699
Wealth quintile
Lowest 54.9 15.3 3.4 0.1 26.3 100.0 901
Second 57.9 13.3 4.1 0.0 24.8 100.0 954
Middle 55.3 15.0 4.5 0.0 25.2 100.0 1,040
Fourth 53.5 15.3 4.8 0.2 26.2 100.0 1,124
Highest 48.8 15.7 7.1 0.0 28.4 100.0 1,171
Total 53.9 15.0 4.9 0.1 26.2 100.0 5,190
1 Excludes men who had sexual intercourse within the last 4 weeks
2 Excludes men who are not currently married
108 • Other Proximate Determinants of Fertility
The proportion of men who reported being sexually active in the past four weeks (54 percent) was
similar to that of women. Fifteen percent of men had not had sex within the past four weeks but had done
so within the past year, and 5 percent had not had sex in one year or longer. Approximately the same
proportion of men as women had never had sex (26 percent). The proportion of men who were sexually
active in the four weeks prior to the survey increased with age up to age 30-34, with 78 percent of men in
that age group reporting sex in the past four weeks. The proportion of men who were sexually active in the
four weeks prior to the survey peaked at a marital duration of 10-14 years (85 percent) and declined
thereafter. Rural men were more likely to have had sexual intercourse in the four weeks preceding the
survey (55 percent) than urban men (46 percent). In terms of education, the proportion recently sexually
active fell from 70 percent among men with no education to 47 percent among men with a secondary
education or higher. Education was also related to the percentage of men who had never had sexual
intercourse, with this percentage rising steadily with increasing education. The proportion of men who
were sexually active in the four weeks preceding the survey was lower among those in the highest wealth
quintile (49 percent) than among those in the lower quintiles (54-58 percent). Recent sexual activity among
men ranged from a low of 44 percent in Phnom Penh to a high of 65 percent in Prey Veng.
9.6 POSTPARTUM AMENORRHEA, ABSTINENCE, AND INSUSCEPTIBILITY
Postpartum amenorrhea refers to the interval between childbirth and the resumption of ovulation, a
period during which a woman is temporarily infecund. As shown in various studies, the length and
intensity of breastfeeding influence the duration of postpartum amenorrhea. Women are considered
insusceptible if they are not exposed to the risk of pregnancy either because they are amenorrheic or
because they are abstaining from sexual intercourse after a birth. Table 9.8 shows the percentage of births
in the three years prior to the survey for which mothers are amenorrheic, abstaining from sex, and
insusceptible, by the number of months since the birth.
Table 9.8 Postpartum amenorrhea, abstinence, and insusceptibility
Percentage of births in the three years preceding the survey for which mothers are
postpartum amenorrheic, abstaining, and insusceptible, by number of months since
birth, and median and mean durations, Cambodia 2014
Months since
birth
Percentage of births for which the mother is: Number of
births Amenorrheic Abstaining Insusceptible1
<2 95.8 96.5 98.7 216
2-3 77.9 61.2 87.7 267
4-5 61.7 27.9 70.9 254
6-7 50.5 17.5 58.8 269
8-9 35.2 9.7 40.6 256
10-11 34.4 5.3 37.4 240
12-13 23.6 5.7 27.3 225
14-15 13.6 2.3 15.4 259
16-17 8.6 3.6 12.2 225
18-19 4.9 3.7 8.4 255
20-21 7.6 5.5 11.1 276
22-23 6.0 4.3 9.0 251
24-25 3.9 2.9 6.6 236
26-27 3.3 2.5 5.8 233
28-29 2.9 4.4 6.8 240
30-31 2.6 4.5 7.1 250
32-33 1.4 1.7 3.2 235
34-35 2.1 0.9 2.3 211
Total 24.4 14.3 28.6 4,397
Median 6.4 3.3 7.8 na
Mean 9.0 5.5 10.4 na
Note: Estimates are based on status at the time of the survey.
na = Not applicable
1 Includes births for which mothers are either still amenorrheic or still abstaining (or both)
following birth
Other Proximate Determinants of Fertility • 109
In Cambodia, the typical duration of
postpartum amenorrhea is considerably longer than
the typical duration of postpartum abstinence and is
the major determinant of postpartum insusceptibility
to pregnancy. Cambodian women are insusceptible
to pregnancy for a median period of almost eight
months after birth. They are amenorrheic for a
median period of more than six months, but they
abstain after childbirth for only about three months.
In the first two months after birth, almost all
mothers are postpartum amenorrheic and abstaining
from sex. However, by six to seven months after
birth, while half of mothers are still amenorrheic
only 18 percent are abstaining. Seventy-one percent
of mothers remain insusceptible to pregnancy at
four to five months postpartum.
Table 9.9 shows the median duration of
postpartum amenorrhea, abstinence, and insusceptibility to pregnancy according to background characteristics. The median duration of postpartum insusceptibility is slightly longer for births to older women and births in rural areas. Women in the highest
educational and wealth categories have the shortest
periods of postpartum insusceptibility.
9.7 TERMINATION OF EXPOSURE TO
PREGNANCY
The risk of childbearing declines as age
increases. The term infecundity denotes a process
rather than a well-defined event. Although the onset
of infecundity is difficult to determine for an
individual woman, there are ways of estimating it
for a group of women. Table 9.10 presents data on
menopause, an indicator of decreasing exposure to
the risk of pregnancy (infecundity) among women
age 30 and over.
Table 9.9 Median duration of amenorrhea, postpartum abstinence,
and postpartum insusceptibility
Median number of months of postpartum amenorrhea, postpartum
abstinence, and postpartum insusceptibility following births in the
three years preceding the survey, by background characteristics,
Cambodia 2014
Background
characteristic
Postpartum
amenorrhea
Postpartum
abstinence
Postpartum
insusceptibility1
Mother’s age
15-29 6.1 3.3 7.3
30-49 8.7 3.3 9.7
Residence
Urban 4.5 3.7 6.3
Rural 6.8 3.3 8.1
Province
Banteay Meanchey 5.3 2.4 5.8
Kampong Cham 8.6 3.4 9.3
Kampong Chhnang 4.6 3.2 7.0
Kampong Speu 5.5 2.9 7.3
Kampong Thom 6.4 2.3 8.6
Kandal 4.1 3.0 10.9
Kratie 8.6 3.2 8.8
Phnom Penh 3.6 5.2 7.2
Prey Veng 6.1 2.7 7.0
Pursat 5.6 3.3 7.6
Siem Reap 5.9 3.5 6.5
Svay Rieng 4.7 2.9 5.7
Takeo 7.6 4.5 9.3
Otdar Meanchey 5.8 4.4 6.2
Battambang/Pailin 6.2 2.7 6.4
Kampot/Kep 7.1 4.7 7.9
Preah Sihanouk/
Koh Kong 5.6 2.4 9.0
Preah Vihear/
Stung Treng 7.4 4.8 7.5
Mondul Kiri/
Ratanak Kiri 6.7 2.9 7.8
Education
No education 6.4 3.1 7.6
Primary 7.6 3.1 8.7
Secondary and
higher 5.6 3.8 6.6
Wealth quintile
Lowest 6.6 2.8 7.4
Second 7.7 3.8 8.5
Middle 6.4 3.0 8.0
Fourth 7.1 3.7 8.8
Highest 4.3 3.6 5.9
Total 6.4 3.3 7.8
Note: Medians are based on status at the time of the survey (current
status).
1 Includes births for which mothers are either still amenorrheic or still
abstaining (or both) following birth
110 • Other Proximate Determinants of Fertility
A woman is considered menopausal if she is not pregnant, is not
postpartum amenorrheic, and did not have a menstrual period for at least
six months before the survey. Twelve percent of Cambodian women age
30-49 are menopausal. As expected, the proportion of women who have
reached menopause increases with age, particularly after age 45. It rises
from 12 percent among women age 44-45 to 39 percent among women at
the end of their reproductive years (age 48-49).
Table 9.10 Menopause
Percentage of women age 30-49 who
are menopausal, by age, Cambodia
2014
Age
Percentage
menopausal1
Number of
women
30-34 5.5 3,046
35-39 7.0 1,839
40-41 9.8 742
42-43 10.3 818
44-45 11.9 901
46-47 21.8 730
48-49 39.0 756
Total 11.5 8,832
1 Percentage of all women who are not
pregnant and not postpartum
amenorrheic whose last menstrual
period occurred six or more months
preceding the survey
Fertility Preferences • 111
FERTILITY PREFERENCES 10
Key Findings
• About half of currently married women and men age 15-49 (52 percent
and 51 percent, respectively) either want no more children or have been
sterilized.
• The ideal number of children is 3.3 among currently married women and
3.4 among currently married men.
• The percentage of planned births has not changed from the figure
reported in the 2010 CDHS (84 percent).
• About 12 percent of currently married women have an unmet need for
family planning services, with 5 percent in need of spacing and 7 percent
in need of limiting.
he 2014 CDHS collected information on fertility preferences to measure the overall attitudes of
women and men toward childbearing and the general course of future fertility. Data on fertility
preferences are also useful for assessing unmet need for family planning and the number of
unwanted or mistimed births in the population. These data, together with information on contraceptive
prevalence, provide an estimation of the demand for family planning.
10.1 DESIRE FOR MORE CHILDREN
Currently married women and men in Cambodia were asked whether they wanted to have a child
(or another child) and, if so, how soon. Table 10.1 presents fertility preferences among currently married
women and men age 15-49 by number of living children. Forty-two percent of currently married women
state that they want to have another child; this is a slight increase from the 2010 CDHS, in which 38
percent of women stated that they wanted to have another child. Twelve percent of women want to have a
child within two years, 27 percent prefer to wait for two years or more to have another child, and 2 percent
want another child but are undecided as to when they want to have that child. Slightly more than half of
married women want no more children; 52 percent want no more or have been sterilized. This is a slight
decrease relative to the percentage in the 2010 CDHS who reported wanting no more children (56 percent).
Three percent of married women are undecided about whether they want more children. The information
presented in Table 10.1 indicates that, among women who would like to have another child, many prefer to
space their pregnancies and are potentially in need of family planning for that purpose, as are the larger
proportions of women who express the desire to limit their births.
Fertility preferences among men are similar to those of women. Forty-eight percent of currently
married men want to have another child, 51 percent do not want to have another child (or have been
sterilized), and less than 1 percent are undecided. Most men who want to have a child want to wait two or
more years (33 percent of all currently married men).
T
112 • Fertility Preferences
Table 10.1 Fertility preferences by number of living children
Percent distribution of currently married women and currently married men age 15-49 by desire for children, according to number of
living children, Cambodia 2014
Number of living children1
Total Desire for children 0 1 2 3 4 5 6+
WOMEN
Have another soon2 73.2 19.2 8.7 4.0 2.5 2.2 0.5 12.4
Have another later3 12.1 62.5 30.5 11.0 3.4 1.3 0.6 27.0
Have another, undecided when 4.3 3.3 2.3 1.5 1.0 0.8 0.1 2.1
Undecided 1.3 3.1 4.7 3.2 1.3 1.5 0.5 3.1
Want no more 4.4 9.6 48.4 71.0 79.3 81.8 85.7 48.4
Sterilized4 0.4 0.6 1.9 4.9 6.4 7.3 6.5 3.1
Declared infecund 4.3 1.8 3.2 4.5 6.1 5.0 6.2 3.8
Missing 0.0 0.0 0.1 0.0 0.0 0.1 0.0 0.0
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number 673 2,824 3,452 2,283 1,392 713 563 11,898
MEN
Have another soon2 72.1 18.7 9.0 7.2 4.6 4.9 2.9 13.8
Have another later3 14.1 70.0 39.3 17.9 6.8 3.6 0.6 32.5
Have another, undecided when 1.0 1.1 1.9 1.6 0.2 0.4 1.0 1.3
Undecided 0.9 0.9 0.6 0.5 0.5 0.0 0.0 0.6
Want no more 6.3 8.7 48.4 70.2 84.8 85.6 93.8 49.8
Sterilized4 0.4 0.2 0.2 1.7 2.1 1.7 0.9 0.9
Declared infecund 5.1 0.3 0.6 0.6 0.9 1.4 0.4 0.9
Missing 0.0 0.1 0.0 0.1 0.0 2.3 0.2 0.2
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number 215 754 1,002 669 400 220 145 3,405
1 The number of living children includes current pregnancy for women.
2 Wants next birth within 2 years
3 Wants to delay next birth for 2 or more years
4 Includes both female and male sterilization
Tables 10.2.1 and 10.2.2 display the percentage of currently married women and men age 15-49
who want no more children by number of living children and background characteristics. As mentioned
above, over half of currently married women want no more children (52 percent). Desire to limit
childbearing increases with increasing number of living children, from 5 percent among married women
with no living children to 92 percent among women with six or more living children. There are particularly
notable increases in the proportion of women wanting no more children between parities one and two (a
difference of 40 percentage points) and parities two and three (a difference of 26 percentage points). The
large proportion of women indicating a desire to have no more children at parities two and three is
consistent with an ideal family size of two to three children.
Fertility Preferences • 113
Table 10.2.1 Desire to limit childbearing: Women
Percentage of currently married women age 15-49 who want no more children, by number of living children, according to
background characteristics, Cambodia 2014
Background
characteristic
Number of living children1
Total 0 1 2 3 4 5 6+
Residence
Urban 4.2 12.2 54.8 79.5 87.4 90.6 93.6 50.8
Rural 4.9 9.8 49.4 75.2 85.4 88.9 92.1 51.7
Province
Banteay Meanchey (5.6) 10.4 45.9 82.6 85.1 (95.2) (92.2) 48.1
Kampong Cham (20.9) 11.4 40.1 74.7 88.5 (85.1) (90.2) 51.2
Kampong Chhnang (0.0) 4.5 52.2 75.7 86.0 (100.0) (90.9) 52.8
Kampong Speu (3.9) 6.1 51.2 80.0 92.0 (92.8) (97.0) 51.8
Kampong Thom (3.3) 15.9 52.5 78.6 93.6 93.4 (94.2) 59.1
Kandal (0.0) 6.4 51.6 84.5 89.0 * * 51.4
Kratie (1.7) 7.2 48.7 65.0 79.0 89.4 (99.2) 50.8
Phnom Penh 2.5 12.0 57.0 83.4 86.9 * * 49.8
Prey Veng (5.1) 18.0 56.7 77.2 85.9 (82.7) * 54.5
Pursat (0.0) 6.1 40.6 77.1 90.3 (97.0) (87.0) 50.7
Siem Reap (2.5) 12.5 51.8 75.8 78.5 (88.9) (100.0) 55.0
Svay Rieng * 20.6 63.8 87.1 93.1 * * 60.6
Takeo (0.0) 9.2 43.4 57.9 75.6 (65.2) * 42.7
Otdar Meanchey (0.0) 7.4 50.1 78.1 80.9 (92.0) (89.2) 51.5
Battambang/Pailin (5.3) 5.4 48.9 74.3 86.0 (92.5) * 50.5
Kampot/Kep (3.3) 7.2 61.5 64.0 74.0 (80.7) (82.3) 50.0
Preah Sihanouk/
Koh Kong (3.4) 5.7 45.9 79.1 83.1 (96.7) (89.2) 51.3
Preah Vihear/
Stung Treng (0.7) 6.9 41.0 66.5 86.1 (95.9) (96.3) 49.0
Mondul Kiri/
Ratanak Kiri (4.2) 9.7 38.5 69.2 92.3 (89.1) 92.7 48.2
Education
No education 7.0 17.2 49.7 71.4 85.8 86.1 87.2 62.1
Primary 5.3 11.7 50.2 75.6 86.4 89.1 94.7 55.7
Secondary and
higher 3.9 7.3 50.8 79.9 82.9 97.5 (91.8) 39.4
Wealth quintile
Lowest 9.5 11.8 43.6 75.6 85.0 90.2 93.5 55.5
Second 8.1 11.7 49.0 71.5 87.3 89.8 91.5 52.7
Middle 5.3 8.5 51.7 73.7 80.7 85.8 88.8 50.0
Fourth 0.8 9.4 50.9 77.1 90.6 87.9 96.2 50.3
Highest 2.8 9.8 54.6 80.9 83.5 93.3 (87.8) 49.4
Total 4.7 10.1 50.4 75.9 85.6 89.1 92.2 51.6
Note: Women who have been sterilized are considered to want no more children. Figures in parentheses are based on 2549 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been
suppressed.
1 The number of living children includes the current pregnancy.
It is worth noting that the proportion of women who want no more children is much larger among
those with no education (62 percent) than among those with a secondary education or higher (39 percent).
There is considerable variation across provinces; Takeo has the smallest proportion of women wishing to
curtail their fertility (43 percent), whereas Svay Rieng has the highest proportion (61 percent). The
proportion of women who want no more children is similar in urban and rural areas (51 percent and 52
percent, respectively). Desire to limit childbearing generally decreases with increasing household wealth.
As observed for women, the percentage of currently married men age 15-49 who want no more
children increases with number of living children. However, men in rural areas are slightly more likely
than men in urban areas to want no more children (51 percent and 48 percent, respectively). By province,
the percentage of men who want no more children ranges from 38 percent in Battambang/Pailin to 60
percent in Siem Reap. The percentage of men who want no more children is inversely associated with level
of education and is lower among those in the highest wealth quintile than among those in the lower four
quintiles.
114 • Fertility Preferences
Table 10.2.2 Desire to limit childbearing: Men
Percentage of currently married men age 15-49 who want no more children, by number of living children, according to
background characteristics, Cambodia 2014
Background
characteristic
Number of living children1
Total 0 1 2 3 4 5 6+
Residence
Urban 8.1 9.1 53.7 76.7 75.9 * * 47.9
Rural 6.4 8.8 47.7 71.2 88.4 87.4 96.0 51.2
Province
Banteay Meanchey * (7.4) 57.3 (68.8) * * * 50.6
Kampong Cham * (2.3) 44.5 (70.9) (82.5) * * 51.5
Kampong Chhnang * (6.8) (35.7) (71.2) * * * 46.2
Kampong Speu * (17.4) 62.6 (67.3) * * * 59.3
Kampong Thom * (8.0) 39.9 (76.5) * * * 53.4
Kandal * (8.2) (58.6) (75.1) * * * 53.2
Kratie * (11.0) 57.7 (71.3) * * * 53.8
Phnom Penh (15.3) (8.1) 58.6 (83.2) * * * 47.8
Prey Veng * (18.7) 54.3 (62.4) * * * 52.6
Pursat * (11.2) (19.8) (63.0) (94.1) * * 43.0
Siem Reap * (19.7) (61.7) (71.9) * * * 59.8
Svay Rieng * (4.3) (52.8) (71.2) * * * 44.7
Takeo * (5.6) (43.5) (75.8) (91.6) * * 52.9
Otdar Meanchey * (17.2) 56.4 (76.7) * * * 53.7
Battambang/Pailin * (2.9) 29.0 (79.2) * * * 37.5
Kampot/Kep * (9.9) 55.1 (74.2) (94.1) * * 58.9
Preah Sihanouk/
Koh Kong * (0.8) 40.0 (59.2) (86.6) * * 44.1
Preah Vihear/
Stung Treng * (7.6) (25.8) (49.2) * * * 39.5
Mondul Kiri/
Ratanak Kiri * (1.4) 21.8 (65.3) (86.5) * * 42.8
Education
No education * (20.1) 62.8 56.0 (94.0) (94.5) (93.4) 63.3
Primary 7.1 10.3 47.8 73.3 84.9 86.6 95.1 55.0
Secondary and
higher 6.8 6.8 47.4 73.0 88.2 (83.8) (94.9) 43.9
Wealth quintile
Lowest (12.2) 17.9 43.1 66.0 88.3 82.1 100.0 55.4
Second (6.0) 6.3 46.8 75.1 90.6 (91.5) (90.0) 52.0
Middle (2.0) 8.0 48.3 71.7 78.8 (93.0) (89.1) 49.9
Fourth (4.4) 7.6 53.2 68.3 92.4 (82.0) * 51.3
Highest 9.3 6.1 49.5 77.4 82.1 * * 45.4
Total 6.8 8.9 48.6 72.0 86.9 87.3 94.8 50.7
Note: Men who have been sterilized or who state in response to the question about desire for children that their wife has
been sterilized are considered to want no more children. Figures in parentheses are based on 25-29 unweighted cases.
An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.
1 The number of living children includes one additional child if the respondent’s wife is pregnant (or if any wife is pregnant
for men with more than one current wife).
10.2 NEED AND DEMAND FOR FAMILY PLANNING SERVICES
The proportion of women who want to stop childbearing or who want to space their next birth is a
crude measure of the extent of the need for family planning, given that not all of these women are exposed
to the risk of pregnancy and some may already be using contraception. This section discusses the extent of
need and the potential demand for family planning services. Women who want to postpone their next birth
for two or more years or who want to stop childbearing altogether but are not using a contraceptive method
are said to have an unmet need for family planning. Pregnant women are considered to have an unmet need
for spacing or limiting if their pregnancy was mistimed or unwanted. Similarly, amenorrheic women are
categorized as having an unmet need if their last birth was mistimed or unwanted. Women who are
currently using a family planning method are said to have a met need for family planning. The sum of
women with unmet need and met need constitutes the total demand for family planning.
Table 10.3 presents data on unmet need, met need, and total demand for family planning among
currently married women age 15-49 by background characteristics. These indicators help evaluate the
extent to which family planning programs in Cambodia meet the demand for services. The definition of
unmet need for family planning has been revised so that data on levels of unmet need are comparable over
time and across surveys. The unmet need estimates for the 2005 and 2010 CDHS surveys have been
Fertility Preferences • 115
recalculated using the revised definition of unmet need but differ only slightly from the numbers published
in the previous final reports.
The percentage of currently married women with a met need for family planning has increased
over the past decade, from 40 percent in 2005 to 51 percent in 2010 and 56 percent in 2014.1 This increase
in the use of family planning has resulted in a corresponding decrease in unmet need from 25 percent in
2005 and 17 percent in 2010 to 12 percent in 2014. The total demand for family planning among currently
married women is 69 percent, and 82 percent of that demand is satisfied. Fifty-six percent of total demand
is satisfied by modern methods. Total demand for family planning in 2014 remained about the same as that
observed in 2010 (68 percent), while total demand satisfied increased from the 2010 figure (76 percent).
Five percent of currently married women have an unmet need for spacing, and 7 percent have an
unmet need for limiting. The level of unmet need for spacing decreases with age, whereas the opposite is
true for unmet need for limiting. Unmet need is slightly higher among rural women than among urban
women (13 percent and 11 percent, respectively). Across provinces, the overall unmet need for family
planning is highest in Preah Vihear/Stung Treng and Kampong Cham (18 percent each) and lowest in
Kampong Chhnang and Takeo (8 percent each). Whereas unmet need for spacing increases as level of
education increases, unmet need for limiting is negatively associated with education. In general, unmet
need decreases with increasing wealth.
The total demand for family planning rises from a low of 44 percent among women age 15-19 to a
high of 80 percent among women age 35-39; and then declines to 46 percent among women age 45-49.
Total demand for family planning varies inconsistently across wealth quintiles and level of education. The
percentage of demand satisfied generally increases with increasing education and wealth.
1 Numbers from the 2005 and 2010 CDHS surveys correspond with the revised definition of unmet need described in
Bradley et al., 2012.
116 • Fertility Preferences
Table 10.3 Need and demand for family planning among currently married women
Percentage of currently married women age 15-49 with unmet need for family planning, percentage with met need for family planning, the total demand for family
planning, and the percentage of the demand for contraception that is satisfied, by background characteristics, Cambodia 2014
Unmet need for family planning
Met need for family planning
(currently using)
Total demand for family
planning1
Percentage
of demand
satisfied2
Percentage
of demand
satisfied by
modern
methods3
Number
of women
Background
characteristic
For
spacing
For
limiting Total
For
spacing
For
limiting Total
For
spacing
For
limiting Total
Age
15-19 13.0 1.9 14.9 28.2 0.9 29.1 41.2 2.8 44.0 66.0 45.8 450
20-24 12.4 1.3 13.6 39.6 8.2 47.8 52.0 9.4 61.5 77.8 55.9 1,833
25-29 7.9 3.5 11.4 41.0 20.7 61.6 48.8 24.2 73.0 84.4 59.9 2,249
30-34 4.7 5.0 9.7 25.6 42.4 68.0 30.3 47.4 77.7 87.5 61.1 2,625
35-39 2.8 10.1 12.9 7.8 59.4 67.2 10.6 69.4 80.1 83.9 59.3 1,573
40-44 0.6 13.3 13.9 2.6 57.0 59.6 3.2 70.4 73.6 81.1 52.1 1,673
45-49 0.3 14.2 14.5 0.6 30.7 31.3 0.9 44.9 45.8 68.3 40.6 1,495
Residence
Urban 5.2 5.7 10.8 24.3 35.5 59.8 29.4 41.2 70.6 84.7 46.5 1,818
Rural 5.5 7.3 12.8 21.6 34.1 55.7 27.1 41.3 68.4 81.4 58.3 10,080
Province
Banteay Meanchey 5.8 3.7 9.5 26.7 34.7 61.4 32.4 38.4 70.9 86.6 72.0 503
Kampong Cham 7.7 9.9 17.6 18.8 25.9 44.7 26.5 35.8 62.3 71.7 44.4 1,490
Kampong Chhnang 5.3 2.8 8.2 20.6 35.5 56.0 25.9 38.3 64.2 87.3 52.2 396
Kampong Speu 2.9 6.9 9.8 28.3 37.1 65.4 31.2 44.0 75.2 87.0 54.7 843
Kampong Thom 3.6 6.5 10.1 18.5 39.9 58.4 22.0 46.5 68.5 85.2 64.3 572
Kandal 5.0 7.0 12.0 24.8 36.2 61.0 29.8 43.2 73.0 83.5 55.4 870
Kratie 4.9 7.2 12.1 21.6 26.3 47.9 26.5 33.5 60.0 79.8 51.1 359
Phnom Penh 6.3 4.4 10.7 26.3 37.0 63.3 32.6 41.4 74.0 85.5 38.8 1,084
Prey Veng 5.2 6.2 11.5 22.2 33.2 55.4 27.4 39.4 66.8 82.9 61.8 889
Pursat 6.0 7.8 13.7 19.1 31.9 51.0 25.1 39.7 64.8 78.8 61.8 425
Siem Reap 5.0 6.9 11.9 23.6 35.5 59.0 28.5 42.4 70.9 83.2 65.5 765
Svay Rieng 4.6 9.4 14.1 17.8 40.1 57.9 22.4 49.5 71.9 80.5 56.5 483
Takeo 4.2 4.1 8.3 14.7 45.4 60.1 18.9 49.5 68.4 87.9 70.4 677
Otdar Meanchey 8.0 6.5 14.6 22.9 33.7 56.6 31.0 40.2 71.2 79.5 69.9 218
Battambang/Pailin 5.4 7.1 12.5 24.3 34.0 58.3 29.7 41.0 70.8 82.3 57.3 890
Kampot/Kep 5.4 10.2 15.6 17.3 36.5 53.8 22.7 46.7 69.4 77.5 55.2 574
Preah Sihanouk/
Koh Kong 4.1 7.6 11.7 26.2 34.4 60.6 30.3 42.0 72.3 83.8 57.4 266
Preah Vihear/
Stung Treng 5.2 12.8 17.9 18.4 23.6 42.0 23.5 36.4 59.9 70.1 58.2 314
Mondul Kiri/
Ratanak Kiri 7.9 6.2 14.1 24.0 26.0 50.0 31.9 32.2 64.1 78.0 66.7 281
Education
No education 3.9 9.8 13.7 15.1 36.9 52.0 19.0 46.7 65.7 79.2 60.7 1,774
Primary 5.3 7.9 13.1 20.0 36.4 56.5 25.3 44.3 69.6 81.1 57.1 6,399
Secondary and
higher 6.4 4.3 10.7 28.7 29.3 58.1 35.2 33.6 68.8 84.4 53.3 3,726
Wealth quintile
Lowest 6.4 10.7 17.0 19.9 32.8 52.7 26.2 43.5 69.8 75.6 56.7 2,294
Second 4.9 6.3 11.2 22.2 33.2 55.4 27.0 39.6 66.6 83.2 63.7 2,404
Middle 6.1 7.4 13.5 20.9 32.8 53.6 27.0 40.2 67.1 79.9 57.1 2,365
Fourth 5.0 5.8 10.8 21.7 36.1 57.7 26.6 41.9 68.5 84.2 57.3 2,393
Highest 4.9 5.2 10.1 25.4 36.4 61.8 30.3 41.6 71.8 86.0 48.2 2,443
Total 5.4 7.0 12.5 22.0 34.3 56.3 27.5 41.3 68.8 81.9 56.4 11,898
Note: Numbers in this table correspond to the revised definition of unmet need described in Bradley et al., 2012.
1 Total demand is the sum of unmet need and met need
2 Percentage of demand satisfied is met need divided by total demand
3 Modern methods include female sterilization, male sterilization, pill, IUD, injectables, implants, male condom, female condom, and lactational amenorrhea
method (LAM)
10.3 IDEAL FAMILY SIZE
Information on ideal family size was collected in two ways. Respondents who had no living
children were asked how many children they would like to have if they could choose the number of
children to have. Respondents with children were asked how many children they would like to have if they
could go back to the time when they did not have any children and could choose exactly the number of
children to have. Although these questions are based on hypothetical situations, they give an idea of the
total number of children women who have not started childbearing will have in the future, and, among
older and high parity women, these data provide a measure of the level of unwanted fertility.
Looking at the data for women, Table 10.4 shows that the majority of respondents were able to
provide a numeric response to these questions. Two percent of women gave nonnumeric responses such as
“any number,” “depends on fate,” or “do not know.” Among women with no living children, 52 percent
Fertility Preferences • 117
would like to have two children, 26 percent would like to have three children, and 12 percent would like to
have four. Only 2 percent of women with no living children want five or more children. Mean ideal family
size shows a positive association with number of living children, increasing from 2.5 children among
childless women to 4.6 children among women with six or more children. The observed positive
association between ideal family size and number of living children may arise for several possible reasons.
First, women may tend to rationalize their family size by reporting their actual number of children as their
ideal number, or, second, they may have achieved their preferred number of children. A third possibility is
that there has been a decrease in the ideal family size among the youngest cohorts. Nevertheless, the results
indicate a considerable level of unwanted fertility. For example, among women with six or more children,
71 percent said they would ideally have liked to have fewer. Among those with five children, almost half
reported an ideal number of children less than five. The average ideal family size among all women who
gave numeric responses is 3.1, whereas it is 3.3 children among currently married women. The data on
ideal family size reported by men follow a pattern similar to that seen among women.
Table 10.4 Ideal number of children
Percent distribution of women and men age 15-49 by ideal number of children, and mean ideal number of children for all
respondents and for currently married respondents, according to number of living children, Cambodia 2014
Number of living children1
Total Ideal number of children 0 1 2 3 4 5 6+
WOMEN
0 3.0 0.0 0.0 0.5 0.2 0.6 0.2 1.0
1 2.7 3.8 0.5 0.8 0.3 0.3 0.2 1.8
2 51.6 50.4 37.1 13.1 11.4 8.2 5.7 35.9
3 25.8 26.0 30.7 38.7 10.9 17.0 14.6 26.6
4 11.6 15.3 23.9 30.0 56.2 21.4 29.4 22.4
5 2.0 3.5 6.2 13.1 13.4 37.5 20.6 7.9
6+ 0.2 0.4 1.3 2.8 6.6 12.4 25.0 2.8
Non-numeric responses 3.2 0.6 0.3 1.0 1.0 2.6 4.2 1.6
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number 5,235 3,236 3,726 2,477 1,519 773 611 17,578
Mean ideal number of
children for:2
All women 2.5 2.7 3.0 3.5 4.0 4.3 4.6 3.1
Number of all women 5,069 3,217 3,714 2,452 1,504 753 585 17,295
Currently married women 2.7 2.6 3.0 3.5 4.0 4.3 4.6 3.3
Number of currently
married women 671 2,812 3,444 2,263 1,377 694 539 11,800
MEN
0 0.6 0.0 0.4 0.6 0.6 1.5 0.3 0.5
1 1.9 2.0 0.6 0.5 0.6 0.0 0.7 1.3
2 43.6 45.2 33.6 10.6 7.7 6.4 3.8 32.0
3 33.3 33.7 31.2 38.9 9.0 21.6 16.5 30.8
4 14.5 14.7 24.4 35.3 55.6 18.4 19.3 22.7
5 2.9 2.7 7.3 9.2 16.2 26.6 15.1 7.0
6+ 0.4 0.9 1.3 3.9 8.1 17.8 39.6 3.6
Non-numeric responses 2.8 0.8 1.2 1.0 2.3 7.6 4.7 2.1
Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0
Number 1,926 788 1,024 674 407 226 147 5,190
Mean ideal number of
children for:2
All men 2.7 2.7 3.1 3.5 4.1 4.3 5.2 3.1
Number of all men 1,873 782 1,011 667 398 209 140 5,079
Currently married men 2.7 2.7 3.1 3.5 4.1 4.3 5.2 3.4
Number of currently
married men 215 748 989 662 391 203 140 3,348
1 The number of living children includes one additional child if a female respondent or a male respondent’s wife is pregnant (or
if any wife is pregnant for men with more than one current wife).
2 Means are calculated excluding respondents who gave non-numeric responses.
118 • Fertility Preferences
The mean ideal number of children for all women by fiveyear age groups and background characteristics is shown in Table
10.5. The mean ideal number of children increases gradually with
increasing age, from 2.5 children among women age 15-19 to 3.9
children among women age 45-49. The mean ideal number of
children among rural women is somewhat higher than among their
urban counterparts (3.1 children versus 2.8 children). Women in
Phnom Penh have the lowest mean ideal number of children (2.8
children), and women in Mondul Kiri/Ratanak Kiri have the highest
(3.4 children). Mean ideal family size decreases with increasing
education and wealth.
10.4 FERTILITY PLANNING
The 2014 CDHS provides an opportunity to estimate levels
of unwanted fertility. Unwanted fertility can be estimated in one of
two ways. Women were asked a series of questions about each of
their children born in the five years preceding the survey, as well as
any current pregnancy, to determine whether the pregnancy was
wanted then (planned), wanted later (mistimed), or not wanted
(unplanned) at the time of conception. This information may
underestimate unplanned childbearing given that women may
rationalize unplanned births and declare them as planned once they
occur. Another way of measuring unwanted fertility utilizes the data
on ideal family size to calculate what the total fertility rate would be
if all unwanted births were avoided. This measure may also suffer
from underestimation to the extent that women are unwilling to
report an ideal family size lower than their actual family size.
Table 10.6 shows that 6 percent of births in the five years
preceding the survey were not wanted, down from 9 percent of births
in the 2010 CDHS. Ten percent of births were mistimed (wanted
later), an increase from 7 percent in 2010. The proportion of
unwanted births rises with birth order, increasing from less than 1
percent among first-order births to 2 percent among second-order
births, 7 percent among third-order births, and, finally, 25 percent
among fourth- and higher-order births. The percentage of unwanted
births also increases with mother’s age.
Table 10.6 Fertility planning status
Percent distribution of births to women age 15-49 in the five years preceding the survey (including current
pregnancies), by planning status of the birth, according to birth order and mother’s age at birth, Cambodia 2014
Planning status of birth
Total
Number of
births
Birth order and
mother’s age at birth Wanted then Wanted later
Wanted no
more Missing
Birth order
1 93.0 6.4 0.6 0.1 100.0 3,256
2 84.9 13.0 2.1 0.0 100.0 2,369
3 79.6 12.9 7.4 0.1 100.0 1,282
4+ 66.4 9.0 24.6 0.0 100.0 1,279
Mother’s age at birth
<20 89.7 9.9 0.4 0.0 100.0 950
20-24 87.3 10.3 2.3 0.1 100.0 2,609
25-29 85.7 10.9 3.3 0.0 100.0 2,405
30-34 81.6 9.0 9.2 0.1 100.0 1,488
35-39 72.6 5.7 21.7 0.0 100.0 516
40-44 59.3 2.9 37.7 0.0 100.0 199
45-49 * * * * 100.0 20
Total 84.4 9.7 5.8 0.0 100.0 8,187
Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.
Table 10.5 Mean ideal number of children
Mean ideal number of children for all women
age 15-49 by background characteristics,
Cambodia 2014
Background
characteristic Mean
Number of
women1
Age
15-19 2.5 2,776
20-24 2.6 2,994
25-29 2.8 2,824
30-34 3.1 3,024
35-39 3.4 1,819
40-44 3.6 1,998
45-49 3.9 1,860
Residence
Urban 2.8 3,157
Rural 3.1 14,137
Province
Banteay Meanchey 3.3 682
Kampong Cham 3.3 1,973
Kampong Chhnang 3.2 662
Kampong Speu 3.0 1,152
Kampong Thom 3.1 848
Kandal 3.0 1,328
Kratie 3.2 482
Phnom Penh 2.8 1,918
Prey Veng 3.0 1,183
Pursat 3.2 629
Siem Reap 3.2 1,126
Svay Rieng 2.9 653
Takeo 2.9 1,063
Otdar Meanchey 2.9 294
Battambang/Pailin 3.0 1,312
Kampot/Kep 3.0 767
Preah Sihanouk/
Koh Kong 3.2 411
Preah Vihear/
Stung Treng 3.3 443
Mondul Kiri/
Ratanak Kiri 3.4 369
Education
No education 3.5 2,221
Primary 3.2 8,148
Secondary and
higher 2.7 6,925
Wealth quintile
Lowest 3.3 3,105
Second 3.2 3,275
Middle 3.1 3,328
Fourth 3.0 3,563
Highest 2.8 4,024
Total 3.1 17,295
1 Number of women who gave a numeric
response
Fertility Preferences • 119
Table 10.7 shows wanted fertility rates calculated using
the second approach to measuring unwanted fertility. The wanted
fertility rate is computed in the same way as the total fertility rate,
except that unwanted births are excluded from the numerator. In
this case, unwanted births are those that exceed the number
mentioned as ideal by the respondent. This rate represents the level
of fertility that would have prevailed in the three years preceding
the survey if all unwanted births had been prevented.
The overall wanted fertility rate is 2.4 children, a decrease
from 2.6 children in the 2010 CDHS. The wanted fertility rate is
about one-third of a child lower than the actual total fertility rate of
2.7 children. Overall, the gap between wanted and observed
fertility is larger when the total fertility rate is still high, as can be
observed by comparing figures across provinces. The gap between
wanted and actual fertility is about half of a child in Preah
Vihear/Stung Treng and Kratie, where the total fertility rate is 3.6,
as well as in Otdar Meanchey, where the total fertility rate is 3.0.
The gap between wanted and observed fertility rates
among women living in rural areas and among those living in urban
areas is small (0.3 children and 0.2 children, respectively). The
difference between wanted and actual fertility is almost nonexistent
among women with a secondary education or higher (0.1 children).
In contrast, the difference is 0.4 children among women with no
education and 0.3 children among women with a primary
education. The gap between wanted and observed fertility among
women in the lowest wealth quintile (0.6 children) is larger than
that among other women (0.2 children). This finding suggests that
the poorest women are less likely to have access to modern
contraceptive methods than women in the other wealth quintiles,
thus resulting in difficulty in achieving their desired fertility.
Table 10.7 Wanted fertility rates
Total wanted fertility rates and total fertility rates
for the three years preceding the survey, by
background characteristics, Cambodia 2014
Background
characteristic
Total
wanted
fertility rate
Total fertility
rate
Residence
Urban 1.9 2.1
Rural 2.6 2.9
Province
Banteay Meanchey 2.6 2.8
Kampong Cham 2.9 3.3
Kampong Chhnang 2.3 2.4
Kampong Speu 2.3 2.4
Kampong Thom 2.7 2.9
Kandal 2.2 2.5
Kratie 3.0 3.6
Phnom Penh 1.7 2.0
Prey Veng 2.8 3.0
Pursat 2.8 3.1
Siem Reap 2.3 2.7
Svay Rieng 2.4 2.5
Takeo 2.2 2.4
Otdar Meanchey 2.5 3.0
Battambang/Pailin 2.6 2.9
Kampot/Kep 2.4 2.5
Preah Sihanouk/
Koh Kong 2.5 2.7
Preah Vihear/
Stung Treng 3.1 3.6
Mondul Kiri/
Ratanak Kiri 3.0 3.3
Education
No education 2.9 3.3
Primary 2.8 3.1
Secondary and
higher 2.2 2.3
Wealth quintile
Lowest 3.2 3.8
Second 2.6 2.8
Middle 2.6 2.8
Fourth 2.2 2.4
Highest 2.0 2.2
Total 2.4 2.7
Note: Rates are calculated based on births to
women age 15-49 in the period 1-36 months
preceding the survey. The total fertility rates are
the same as those presented in Table 5.2.
Adult and Maternal Mortality • 121
ADULT AND MATERNAL MORTALITY 11
Key Findings
• Adult mortality is much higher among men than among women (3.5
deaths and 2.0 deaths per 1,000 population, respectively).
• Maternal deaths account for 9 percent of all deaths to women age 15-49.
The maternal mortality rate for the seven-year period preceding the
survey was 0.15 maternal deaths per 1,000 woman-years of exposure.
• The maternal mortality ratio was 170 maternal deaths per 100,000 live
births for the seven-year period preceding the survey. This ratio is lower
than the ratio reported in the 2010 CDHS but is not significantly different.
stimates of maternal mortality require comprehensive and accurate reporting of maternal deaths.
Such reporting can be obtained through vital registration, longitudinal studies of pregnant women,
or repeated household surveys. The 2014 CDHS is the fourth population-based national survey
(following the 2000, 2005, and 2010 CDHS) to incorporate questions on maternal mortality. The CDHS
asked female respondents a series of questions designed with the explicit purpose of providing the
necessary information to make direct estimates of maternal mortality.
However, in order to avoid serious misinterpretation of the results of the survey, it is crucial for
users of this information to understand the problems inherent in measuring maternal mortality. Direct
estimates of maternal mortality rely on data on the age of surviving sisters of survey respondents, the age
at death of sisters who have died, and the number of years that have passed since the death of the sisters.
CDHS interviewers listed all of the brothers and sisters born to the natural mother of female respondents,
in chronological order, starting with the first born. Information was then obtained on the survivorship of
each of the siblings, the ages of surviving siblings, the year of death or years since death of deceased
siblings, and the age at death of deceased siblings. For each sister who died at age 12 or above, the
respondent was asked additional questions to determine whether the death was maternity related, that is,
whether the sister was pregnant when she died, and if so, whether the sister died during childbirth, and if
not, whether the sister died within six weeks of the termination of a pregnancy or childbirth. Listing all
siblings in chronological order of their birth is done with the intention of improving the completeness of
reporting. Collecting data on both male and female siblings also allows direct estimation of adult male and
female mortality.
11.1 DATA QUALITY ISSUES
Estimation of adult and maternal mortality requires reasonably accurate reporting of the number of
sisters and brothers the respondent ever had, the number who have died, and the number of sisters who
died of maternity-related causes. There is no definitive procedure for establishing the completeness or
accuracy of retrospective data on sibling survivorship. Table 11.1 shows the number of siblings reported
by female respondents and the completeness of the reported data on survival status, current age, age at
death, and years since death.
E
122 • Adult and Maternal Mortality
Table 11.1 Completeness of information on siblings
Number of siblings reported by female survey respondents and completeness of reported data on sibling
survival status, age of living siblings, and age at death (AD) and years since death (YSD) of dead siblings
(unweighted), Cambodia 2014
Sisters Brothers All siblings
Number Percent Number Percent Number Percent
All siblings 40,413 100.0 41,661 100.0 82,074 100.0
Living 35,332 87.4 34,543 82.9 69,875 85.1
Dead 5,042 12.5 7,030 16.9 12,072 14.7
Survival status unknown 39 0.1 88 0.2 127 0.2
Living siblings 35,332 100.0 34,543 100.0 69,875 100.0
Age reported 35,314 99.9 34,525 99.9 69,839 99.9
Age missing 18 0.1 18 0.1 36 0.1
Dead siblings 5,042 100.0 7,030 100.0 12,072 100.0
AD and YSD reported 5,028 99.7 7,005 99.6 12,033 99.7
Missing only AD 6 0.1 11 0.2 17 0.1
Missing only YSD 5 0.1 6 0.1 11 0.1
Missing AD and YSD 3 0.1 8 0.1 11 0.1
As a group, 2014 CDHS female respondents were able to report the survival status of more than
99 percent of their siblings; whether or not a brother or sister was alive or dead was unknown for only 0.2
percent of siblings. Sex ratio is defined as the number of males per 100 females. The sex ratio of siblings
who have died is calculated as the number of brothers per 100 sisters (7,030 brothers who died compared
with 5,042 sisters who died). The sex ratio of siblings who have died was 139, which is very high and may
be the consequence of the higher male mortality during the Khmer Rouge period. Fighting in the postKhmer Rouge period continued until the signing of the Paris Peace Accord in 1993; this fighting would
have also contributed to the high sex ratio of dead siblings. Overall, the data on siblings are nearly
complete, with age reported for 99.9 percent of living siblings and age at death and years since death
reported for 99.7 percent of siblings who have died, with little difference between brothers and sisters.
Rather than excluding siblings with missing information from the analysis, the information on the birth
order of siblings, in conjunction with other information, is used to impute the missing data.1
Table 11.2 Sibship size and sex ratio of siblings
Mean sibship size and sex ratio of siblings at birth,
Cambodia 2014
Age of
respondent
Respondent’s
year of birth
Mean sibship
size1
Sex ratio of
siblings at
birth2
45-49 1965-1969 6.3 98.4
40-44 1970-1974 6.2 98.9
35-39 1975-1979 6.5 108.6
30-34 1980-1984 6.0 100.2
25-29 1985-1989 5.8 104.0
20-24 1990-1994 5.3 106.4
15-19 1995-1999 4.8 107.0
Total 5.8 103.2
1 Includes the respondent
2 Excludes the respondent
1 The imputation procedure is based on the assumption that the reported birth ordering of the siblings in the birth
history is correct. The first step is to calculate birth dates. For each living sibling with a reported age and for each dead
sibling with complete information on both age at death and years since death, the birth date is calculated. For a sibling
missing these data, a birth date is imputed within the range defined by the birth dates of the bracketing siblings. In the
case of living siblings, an age is calculated from the imputed birth date. In the case of dead siblings, if either age at
death or years since death is reported, that information is combined with the birth date to provide missing information.
If both pieces of information are missing, the age at death is imputed. This imputation is based on the distribution of
the ages at death for those whose year of death is unreported but age at death is reported.
Adult and Maternal Mortality • 123
Another crude measure of data quality is the mean number of siblings, or the mean sibship size
(Table 11.2). Sibship size is expected to decline as fertility declines over time. The monotonic decline in
sibship size that would be expected to accompany declining fertility is supportive of more complete
reporting of older siblings. The average sex ratio at birth of 103.2 is within the internationally accepted
range of 103 to 105, indicating that, as a group, there is no serious underreporting or overreporting of
brothers or sisters. However, sibling sex ratios among respondents age 40-49 are somewhat below the
range, suggesting that there may be underreporting of brothers among the most senior respondents.
Nonetheless, it should be kept in mind that any information that relies on recall will suffer from some
degree of misreporting, especially if it pertains to deceased persons and involves events that occurred a
long period of time before the survey.
11.2 ADULT MORTALITY
Because maternal mortality is a subset of adult mortality,
estimates of overall adult mortality are calculated before estimates of
maternal mortality. If overall adult mortality estimates display a
general, stable, and plausible pattern, then credence is given to the
maternal mortality estimates derived thereafter.
Direct estimates of male and female adult mortality are
obtained from information collected in the sibling history. Agespecific death rates are computed by dividing the number of deaths in
each age group by the total person-years of exposure in that age group
during a specified reference period. In total, female respondents
reported 82,074 siblings, of whom 40,413 were sisters and 41,661
were brothers (Table 11.1). Direct estimates of age-specific mortality
rates for men and women are shown in Table 11.3. To minimize the
impact of possible heaping on years since death ending in zero and
five, direct estimates are presented for the period 0-6 years before the
survey, which roughly corresponds2 to June 2008 to December 2014.
Aggregating the data over the age range 15-49 will reduce the effects
of sampling variability. There are more male than female deaths in the
period 0-6 years preceding the survey (616 versus 348). The male
mortality rate is 3.50 deaths per 1,000 population, a figure higher than
the female mortality rate of 1.96 deaths per 1,000 population.
11.3 MATERNAL MORTALITY
Estimates of maternal mortality for the period 0-6 years before the survey are shown in Table
11.4. This period of time was chosen to reduce possible heaping of reported years since death on five-year
intervals. Age-specific mortality rates are calculated by dividing the number of maternal deaths by years of
exposure. To remove the effect of truncation bias (the upper boundary for eligibility in the 2014 CDHS is
49 years), the overall rate for women age 15-49 is standardized by the age distribution of the survey
respondents. Maternal deaths are defined as any death that occurred during pregnancy, childbirth, or within
six weeks after the birth or termination of a pregnancy. This time-specific definition includes all deaths
occurring during the specified period even if the death is due to causes that are not pregnancy related.
However, this definition is unlikely to result in overreporting of maternal deaths because most deaths to
women in the specified period are due to maternal causes, and maternal deaths in general are more likely to
2 The time period is not exact because, as with all DHS calculations of exposure time, exposure is calculated
separately for each respondent, counting back in time from the date of the interview, and dates of interview in the
2014 CDHS spanned a period of six months.
Table 11.3 Adult mortality rates
Direct estimates of female and male mortality
rates for the period 0-6 years preceding the
survey, by five-year age groups, Cambodia
2014
Age Deaths
Exposure
years
Mortality
rate1
FEMALE
15-19 31 33,159 0.93
20-24 32 40,909 0.78
25-29 40 40,900 0.98
30-34 46 30,606 1.50
35-39 47 23,590 1.99
40-44 76 19,321 3.93
45-49 76 14,071 5.43
15-49 348 202,557 1.96a
MALE
15-19 46 34,258 1.36
20-24 82 41,628 1.98
25-29 71 40,586 1.75
30-34 88 31,515 2.80
35-39 115 22,709 5.05
40-44 125 17,418 7.15
45-49 88 11,866 7.45
15-49 616 199,979 3.50a
Note: Exposure years are calculated using a
life table technique; here, they represent the
number of person-years that men or women
are exposed to the probability of dying.
1 Expressed per 1,000 population
a Age-adjusted rate
124 • Adult and Maternal Mortality
be underreported than overreported. For any given age group, maternal deaths are a relatively rare
occurrence, and as such the age-specific pattern should be interpreted with caution.
There were 32 maternal deaths reported by survey respondents in the period 0-6 years preceding
the survey. During the period 2008-2014, the maternal mortality rate, which is the annual number of
maternal deaths per 1,000 women age 15-49, was 0.15. Maternal deaths accounted for 9 percent of all
deaths to women age 15-49; in other words, about 1 in 11 Cambodian women who died in the period 0-6
years preceding the survey died as a result of pregnancy or pregnancy-related causes. Maternal deaths
accounted for a similar proportion of overall female deaths as they had in the 2010 CDHS.
The maternal mortality ratio, obtained by dividing the age-standardized maternal mortality rate by
the age-standardized general fertility rate, is often considered a more useful measure of maternal mortality
because it measures the obstetric risk associated with each live birth. Table 11.4 shows that the maternal
mortality ratio for Cambodia for the period 2008-2014 was 170 deaths per 100,000 live births (or,
alternatively, 1.70 deaths per 1,000 live births). The 95 percent confidence interval of this estimate ranges
from 95 to 246 deaths per 100,000 live births. The maternal mortality ratio can be converted to an estimate
of the lifetime risk of dying from maternal causes: 0.005 or, in other words, a risk of dying of 1 in 200.
Table 11.4 Maternal mortality
Direct estimates of maternal mortality rates for the period 0-6 years preceding the survey, by five-year
age groups, Cambodia 2014
Age
Percentage of
female deaths
that are maternal Maternal deaths Exposure years
Maternal
mortality rate1
15-19 0.0 0 33,159 0.00
20-24 13.2 4 40,909 0.10
25-29 27.1 11 40,901 0.27
30-34 10.5 5 30,606 0.16
35-39 16.1 8 23,590 0.32
40-44 2.8 2 19,321 0.11
45-49 3.0 2 14,071 0.16
15-49 9.1 32 202,557 0.15a
General fertility rate (GFR)2 89
Maternal mortality ratio (MMR)3 170 (±2 SE; CI = 95, 246)
Lifetime risk of maternal death4 0.005
CI = Confidence interval
1 Expressed per 1,000 woman-years of exposure
2 Expressed per 1,000 women age 15-49
3 Expressed per 100,000 live births; calculated as the age-adjusted maternal mortality rate times 100
divided by the age-adjusted general fertility rate
4 Calculated as 1-(1-MMR)TFR, where TFR represents the total fertility rate for the seven years preceding
the survey
a Age-adjusted rate
A comparison of the maternal mortality ratios from the 2005, 2010, and 2014 CDHS shows a large
decline between 2005 and 2010 but a small decline from 2010 to 2014. Although the decline between 2010
and 2014 is far too slight to be significant because of the overlapping confidence intervals of these two
data points (Figure 11.1), the results provide confirmation that the maternal mortality ratio has declined
over the past decade.
Adult and Maternal Mortality • 125
Figure 11.1 Confidence intervals for maternal mortality rates,
Cambodia 2005, 2010, and 2014
338
124
95
605
288
246
0
100
200
300
400
500
600
700
CDHS 2005 CDHS 2010 CDHS 2014
Deaths per
100,000 live births
472
206
170
Infant and Child Mortality • 127
INFANT AND CHILD MORTALITY 12
Key Findings
• One in every 36 Cambodian children die before their first birthday, and
one in every 29 do not survive to their fifth birthday.
• Infant mortality declined from 45 deaths to 28 deaths per 1,000 live births
between the 2010 CDHS and the 2014 CDHS.
• Under-5 mortality declined from 54 deaths per 1,000 live births to 35
deaths per 1,000 live births between the two survey periods.
• Childhood mortality is higher in rural areas than in urban areas. Mortality
rates are lowest among children living in the richest households.
• Neonatal and postneonatal mortality rates are 18 deaths per 1,000 live
births and 10 deaths per 1,000 live births, respectively. The perinatal
mortality rate is 20 deaths per 1,000 pregnancies.
his chapter describes levels of and trends in neonatal, postneonatal, infant, and child mortality in
Cambodia. Infant and child mortality rates reflect a country’s socioeconomic situation as well as
the quality of life of the population under study. Childhood mortality is affected by socioeconomic
conditions and can vary according to the demographic characteristics of children and their mothers.
Therefore, differentials in infant and child mortality by socioeconomic and demographic characteristics are
also presented in this chapter.
Disaggregation of mortality indicators by economic, social, and demographic categories helps to
identify groups of the population at risk. Preparation, implementation, monitoring, and evaluation of
population, health, and other socioeconomic programs and policies depend to a large extent on
identification of a target population. The data presented here can help identify at-risk populations and
provide an indication of the current mortality situation, which can be compared with previously collected
data to determine whether improvements in health and quality of life have occurred over time.
The data used to compute the childhood mortality rates presented in this chapter were derived
from the birth history section of the Woman’s Questionnaire. Each woman age 15-49 was asked whether
she had ever given birth, and, if she had, she was asked to report the number of sons and daughters who
live with her, the number who live elsewhere, and the number who have died. In addition, she was asked to
provide a detailed birth history of her children in chronological order starting with the first child. Women
were asked whether a birth was single or multiple, the sex of the child, the date of birth (month and year,
according to either the Gregorian or the Khmer calendar system), survival status, age of the child on the
date of the interview if alive, and, if not alive, the age at death of each live birth. Childhood mortality rates,
expressed as deaths per 1,000 live births, are defined as follows:
Neonatal mortality: the probability of dying within the first month of life
Postneonatal mortality: the probability of dying between the first month of life and first
birthday (computed as the difference between infant and neonatal
mortality)
Infant mortality: the probability of dying between birth and the first birthday
Child mortality: the probability of dying between the first and the fifth birthday
Under-5 mortality: the probability of dying between birth and the fifth birthday
T
128 • Infant and Child Mortality
12.1 ASSESSMENT OF DATA QUALITY
The reliability of mortality estimates depends on sampling errors and nonsampling errors.
Sampling errors are discussed in detail in Appendix B. Nonsampling errors depend on the extent to which
the date of birth and age at death are accurately reported and recorded and the completeness with which
child deaths are reported. Omission of births and deaths affects mortality estimates, displacement of dates
of births and of deaths impacts mortality trends, and misreporting of age at death may alter the age pattern
of mortality. Typically, the most serious source of nonsampling errors in a survey that collects
retrospective information on births and deaths is underreporting of both births and deaths of children who
are not alive at the time of the survey. It may be that mothers are generally reluctant to talk about their
dead children because of the sorrow associated with any death, or they may live in a culture that
discourages discussing the dead. Underreporting of births and deaths is generally more severe the further
back in time an event occurred.
An unusual pattern in the distribution of births by calendar years is an indication of omission of
children or age displacement. However, Table C.4 in Appendix C shows that the percentage of all births
for which a month and year of birth were reported remains stable over time, ranging from 100 percent of
births in 2011 to 99.6 percent of births prior to 1992. There is little difference in reporting by whether or
not the child is alive (99.9 percent of births) or dead (98.8 percent of births).
Underreporting of deaths is usually assumed to be higher for deaths that occur very early in
infancy. An examination of the ratios in Tables C.5 and C.6 shows no significant number of early infant
deaths being omitted in the 2014 CDHS. Another problem with survey data is misreporting deaths that
occur in the late postneonatal period. Such misreporting results in an underestimate of the infant mortality
rate and an overestimate of the child mortality rate. Table C.6 displays some digit preferences in reported
deaths at age 12 months. This age “heaping” occurred despite the care taken in the CDHS to minimize
such errors by requiring that age at death be recorded in days if the death took place within one month of
birth, in months if the child died within 24 months of birth, and in years if the child died between age 2 and
5.
Omissions can also be detected by examining the proportion of neonatal deaths that occur during
the first week of life and the proportion of infant deaths that take place during the first month of life. If
there is substantial underreporting of deaths, the result would be an abnormally low ratio of deaths before
seven days to all neonatal deaths. Because underreporting of deaths is likely to be more common for births
that occurred a long period of time before the survey, it is important to explore whether these ratios change
markedly over time.
Inspection of the ratio of deaths in the first six days of life to all neonatal deaths (shown in
Appendix C, Table C.5) shows that the proportion of neonatal deaths that took place in the first week of
life ranges from 82 percent for deaths during the period 0-4 years before the survey to 63 percent for
deaths during the period 15-19 years before the survey. There is some variation over time in the proportion
of neonatal deaths to all infant deaths (shown in Appendix C, Table C.6), which ranges from 67 percent in
the period 0-4 years before the survey to 34 percent during the period 15-19 years before the survey. These
ratios are within acceptable limits for the levels of mortality observed during these time periods.
12.2 LEVELS AND TRENDS IN CHILDHOOD MORTALITY
Table 12.1 presents neonatal, postneonatal, infant, child, and under-5 mortality rates for five-year
periods preceding the survey. Neonatal mortality in the most recent period is 18 deaths per 1,000 live
births. This rate is higher than the postneonatal mortality rate (10 deaths per 1,000 live births) during the
same period; that is, the risk of dying is considerably higher in the first month of life than in the next 11
months. Thus, 28 of every 1,000 babies born in Cambodia do not survive to their first birthday. Under-5
mortality in Cambodia is 35 deaths per 1,000 live births.
Infant and Child Mortality • 129
Table 12.1 Early childhood mortality rates
Neonatal, postneonatal, infant, child, and under-5 mortality rates for five-year periods
preceding the survey, Cambodia 2014
Years preceding
the survey
Neonatal
mortality
(NN)
Postneonatal
mortality
(PNN)1
Infant
mortality
(1q0)
Child
mortality
(4q1)
Under-5
mortality
(5q0)
0-4 18 10 28 7 35
5-9 24 24 49 12 60
10-14 24 40 63 17 79
1 Computed as the difference between the infant and neonatal mortality rates
Trends in the childhood mortality rate can be established by comparing the results of the 2014
CDHS with the findings from the 2000, 2005, and 2010 CDHS in which data were collected using the
same techniques and estimates were calculated using the same methodology. Figure 12.1 shows that infant
mortality has declined gradually and substantially in the past 14 years, from 95 deaths per 1,000 live births
in 2000 to 28 per 1,000 in 2014. Under-5 mortality also declined during this period, from 124 deaths per
1,000 live births in 2000 to 35 per 1,000 in 2014.
Figure 12.1 Trends in childhood mortality, 2000-2014
12.3 SOCIOECONOMIC DIFFERENTIALS IN CHILDHOOD MORTALITY
The results presented in Table 12.2 and Figure 12.2 show that childhood mortality in Cambodia
varies significantly by the socioeconomic characteristics of households and mothers.1 Mortality in urban
areas is consistently lower than in rural areas. For example, infant mortality and under-5 mortality in rural
areas (42 deaths and 52 deaths per 1,000 live births, respectively) are about three times higher than in
urban areas (13 deaths and 18 deaths per 1,000 live births, respectively). The urban-rural gap is wider for
postneonatal mortality, which is five times higher in rural areas than in urban areas. Differentials in
mortality by province are also substantial. Phnom Penh has the lowest rates of both infant mortality (17
deaths per 1,000 live births) and under-5 mortality (23 deaths per 1,000 live births). Preah Vihear/Stung
Treng and Mondul Kiri/Ratanak Kiri have the highest rates of infant mortality (70 or more deaths per
1,000 live births), and Kratie, Preah Vihear/Stung Treng, and Mondul Kiri/Ratanak Kiri have the highest
rates of under-5 mortality (79 or more deaths per 1,000 live births).
1 To have a sufficient number of cases to ensure statistically reliable mortality estimates, rates presented in Tables
12.2 and 12.3 are calculated for a 10-year period.
95
33
124
66
19
83
45
9
54
28
7
35
Infant mortality Child mortality Under-5 mortality
Deaths per 1,000
live births
CDHS 2000 CDHS 2005 CDHS 2010 CDHS 2014
130 • Infant and Child Mortality
Table 12.2 Early childhood mortality rates by socioeconomic characteristics
Neonatal, postneonatal, infant, child, and under-5 mortality rates for the 10-year period
preceding the survey, by background characteristics, Cambodia 2014
Background
characteristic
Neonatal
mortality
(NN)
Postneonatal
mortality
(PNN)1
Infant
mortality
(1q0)
Child
mortality
(4q1)
Under-5
mortality
(5q0)
Residence
Urban 10 4 13 5 18
Rural 23 20 42 10 52
Province
Banteay Meanchey 20 9 29 3 32
Kampong Cham 25 14 39 9 48
Kampong Chhnang 27 23 50 6 55
Kampong Speu 19 7 26 5 31
Kampong Thom 29 11 41 20 60
Kandal 17 14 30 10 40
Kratie 30 31 61 20 80
Phnom Penh 13 4 17 6 23
Prey Veng 33 31 64 11 75
Pursat 14 17 31 5 36
Siem Reap 17 23 40 16 56
Svay Rieng 20 26 46 18 63
Takeo 16 12 28 4 31
Otdar Meanchey 17 15 32 9 41
Battambang/Pailin 12 16 28 9 37
Kampot/Kep 20 17 38 6 44
Preah Sihanouk/
Koh Kong 20 15 35 7 42
Preah Vihear/
Stung Treng 25 45 70 9 79
Mondul Kiri/
Ratanak Kiri 36 36 72 9 80
Mother’s education
No education 22 41 63 18 79
Primary 22 15 37 9 46
Secondary 19 6 26 5 30
Wealth quintile
Lowest 27 35 62 15 76
Second 23 22 44 13 56
Middle 24 9 33 8 41
Fourth 18 9 27 6 33
Highest 12 4 16 3 19
1 Computed as the difference between the infant and neonatal mortality rates
Figure 12.2 Infant mortality rates by socioeconomic characteristics
16
27
33
44
62
26
37
63
42
13
Highest
Fourth
Middle
Second
Lowest
WEALTH QUINTILE
Secondary or higher
Primary
None
EDUCATION
Rural
Urban
RESIDENCE
Deaths per 1,000 live births
CDHS 2014
Infant and Child Mortality • 131
As expected, mortality declines markedly as mother’s education increases. Children born to
mothers with no schooling have the highest mortality rates. According to the survey results, the infant
mortality rate among children of mothers with a secondary education or higher is 26 deaths per 1,000 live
births, much lower than the rate of 63 deaths per 1,000 live births among children of mothers with no
schooling.
In addition, mortality declines markedly as the wealth of the household increases. Children born in
poorer households suffer higher mortality than those born in wealthier households. For example, infant and
under-5 mortality rates are approximately four times higher among children living in the poorest
households than among those living in the wealthiest households.
12.4 DEMOGRAPHIC DIFFERENTIALS IN MORTALITY
Infant and child mortality varies substantially by the demographic characteristics of mothers and
children. Table 12.3 shows childhood mortality rates by selected demographic variables. Childhood
mortality rates are higher among male children than among female children during all periods of life before
age 5. This excess mortality among boys is not observed only in Cambodia but is a universal phenomenon.
Table 12.3 Early childhood mortality rates by demographic characteristics
Neonatal, postneonatal, infant, child, and under-5 mortality rates for the 10-year period
preceding the survey, by demographic characteristics, Cambodia 2014
Demographic
characteristic
Neonatal
mortality
(NN)
Postneonatal
mortality
(PNN)1
Infant
mortality
(1q0)
Child
mortality
(4q1)
Under-5
mortality
(5q0)
Child’s sex
Male 22 22 44 10 54
Female 20 13 33 9 41
Mother’s age at birth
<20 20 10 31 13 44
20-29 17 14 31 7 38
30-39 27 23 50 14 64
40-49 (60) (68) (128) * *
Birth order
1 20 11 31 9 39
2-3 17 13 30 7 36
4-6 22 28 50 17 66
7+ 76 71 147 15 160
Previous birth interval2
<2 years 42 44 87 15 100
2 years 19 20 39 13 52
3 years 9 16 25 9 34
4+ years 21 14 35 6 41
Birth size3
Small/very small 63 20 82 * *
Average or larger 10 8 17 na na
Note: Figures in parentheses are based on 250-499 unweighted person-years of exposure to
the risk of death. An asterisk indicates that a figure is based on fewer than 250 unweighted
person-years of exposure to the risk of death and has been suppressed.
na = Not available
1 Computed as the difference between the infant and neonatal mortality rates
2 Excludes first-order births
3 Rates for the five-year period before the survey
In general infant mortality increases as the age of the mother at birth increases. The distribution of
under-5 mortality by maternal age at birth is a U-shaped curve, being higher among children born to
mothers under age 20 and over age 30 than among children born to mothers in the middle age groups.
Relationships between infant mortality and specific demographic characteristics are illustrated in Figure
12.3.
First-order births appear to be at the same risk of mortality as second- or third-order births,
whereas the risk increases for births of order four to six. However, significant increases in risk are most
apparent for births of order seven and higher. Infant mortality rates for children of a seventh or higher birth
order are nearly three times the rates for children of a fourth to sixth birth order.
132 • Infant and Child Mortality
Figure 12.3 Infant mortality rates by demographic characteristics
Short birth interval is one of the risk factors for childhood mortality. For example, children born
less than two years after a preceding birth are more than twice as likely to die within the first month of life
as children born after a two-year interval (42 deaths per 1,000 live births versus 19 per 1,000). There is a
similar relationship between short birth interval and postneonatal mortality, infant mortality, and under-5
mortality; mortality rates for children born less than two years after a preceding birth are approximately
twice as high as those for children born two or more years after a preceding birth.
Studies have demonstrated that children’s weight at birth is an important determinant of their
survival chances. Actual birth weights were unavailable for most children; instead, mothers were asked
whether their child was very large, larger than average, average, smaller than average, or very small at
birth, because this has been found to be a good proxy for a child’s weight at birth. Those children reported
by their mother to be small or very small were six times more likely to die before age 1 month than those
reported to be average or larger.
12.5 PERINATAL MORTALITY
Perinatal deaths include pregnancy losses occurring after seven completed months of gestation
(stillbirths) and deaths within the first seven days of life (early neonatal deaths). The perinatal death rate is
calculated by dividing the total number of perinatal deaths by the total number of pregnancies reaching
seven months of gestation. The distinction between a stillbirth and an early neonatal death may be a fine
one, depending often on the observed presence or absence of some faint signs of life after delivery.
The causes of stillbirths and early neonatal deaths overlap, and examining just one or the other can
understate the true level of mortality around delivery. For these reasons, both events are usually combined
and examined together. Information on stillbirths for the five years preceding the survey was derived from
the calendar at the end of the Woman’s Questionnaire.
Table 12.4 presents the number of stillbirths, the number of early neonatal deaths, and perinatal
mortality rates for the five-year period preceding the 2014 CDHS, by selected demographic and
socioeconomic characteristics. The perinatal mortality rate in Cambodia is 20 deaths per 1,000
pregnancies. The perinatal mortality rate is highest among children whose mothers were age 40-49 (73
deaths per 1,000 pregnancies) and for pregnancies that occurred fewer than 15 months after the previous
pregnancy (28 deaths per 1,000 pregnancies). Perinatal mortality is higher in rural areas than in urban
areas.
35
25
39
87
147
50
30
31
128
50
31
31
4 + years
3 years
2 years
<2 years
PREVIOUS BIRTH INTERVAL
7+
4-6
2-3
1
BIRTH ORDER
40-49
30-39
20-29
<20
MOTHER'S AGE
Deaths per 1,000 live births
CDHS 2014
Infant and Child Mortality • 133
Table 12.4 Perinatal mortality
Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the five-year
period preceding the survey, by background characteristics, Cambodia 2014
Background
characteristic
Number of
stillbirths1
Number of early
neonatal deaths2
Perinatal
mortality rate3
Number of
pregnancies of
7+ months’
duration
Mother’s age at birth
<20 4 6 12 818
20-29 18 55 16 4,483
30-39 19 27 25 1,796
40-49 2 12 73 198
Previous pregnancy
interval in months4
First pregnancy 11 40 20 2,562
<15 7 21 28 999
15-26 6 14 20 973
27-38 8 3 14 832
39+ 10 22 17 1,929
Residence
Urban 3 4 7 1,044
Rural 39 96 22 6,251
Province
Banteay Meanchey 3 1 15 256
Kampong Cham 5 25 30 1,013
Kampong Chhnang 0 5 22 248
Kampong Speu 3 7 20 471
Kampong Thom 4 6 29 341
Kandal 8 6 27 530
Kratie 1 3 14 270
Phnom Penh 3 7 15 629
Prey Veng 0 9 19 499
Pursat 4 2 20 302
Siem Reap 2 6 16 489
Svay Rieng 3 4 26 264
Takeo 2 5 16 388
Otdar Meanchey 1 0 5 137
Battambang/Pailin 2 6 13 555
Kampot/Kep 1 2 10 277
Preah Sihanouk/
Koh Kong 2 2 21 170
Preah Vihear/
Stung Treng 0 2 9 239
Mondul Kiri/
Ratanak Kiri 1 3 18 218
Mother’s education
No education 2 10 11 1,019
Primary 28 55 22 3,823
Secondary 10 34 20 2,251
Wealth quintile
Lowest 7 33 22 1,778
Second 9 18 18 1,462
Middle 10 18 20 1,372
Fourth 10 22 26 1,262
Highest 7 10 12 1,422
Total 42 100 20 7,295
1 Stillbirths are fetal deaths in pregnancies lasting seven or more months.
2 Early neonatal deaths are deaths at age 0-6 days among live-born children.
3 The sum of the number of stillbirths and early neonatal deaths divided by the number of
pregnancies of seven or more months’ duration, expressed per 1,000
4 Categories correspond to birth intervals of <24 months, 24-35 months, 36-47 months, and 48+
months.
12.6 HIGH-RISK FERTILITY BEHAVIOR
The survival of infants and children depends in part on the demographic and biological
characteristics of their mothers. Typically, the probability of dying in infancy is much greater among
children born to mothers who are too young (under age 18) or too old (over age 34), children born after a
short birth interval (less than 24 months after the preceding birth), and children born to mothers of high
parity (more than three children). The risk is elevated when a child is born to a mother who has a
combination of these risk characteristics.
134 • Infant and Child Mortality
Table 12.5 shows the percent distribution of children born in the five years before the survey by
these risk factors. Nearly 2 in 5 births (37 percent) were not in any high-risk category. Thirty-six percent
were first births to women between age 18 and 34—considered an unavoidable risk category—whereas
20 percent of births were in a single high-risk category and only 8 percent were in a multiple high-risk
category. The most common single high-risk category was births of order three and above (8 percent), and
the most common multiple high-risk category was births to mothers older than age 34 and of birth order
three and above (6 percent).
Table 12.5 High-risk fertility behavior
Percent distribution of children born in the five years preceding the survey by category of
elevated risk of mortality and the risk ratio, and percent distribution of currently married women
by category of risk if they were to conceive a child at the time of the survey, Cambodia 2014
Births in the 5 years preceding the
survey Percentage of
currently married
women1 Risk category
Percentage of
births Risk ratio
Not in any high-risk category 36.6 1.00 30.0a
Unavoidable risk category
First-order births between age 18 and
34 35.7 1.45 7.6
Single high-risk category
Mother’s age <18 2.7 1.22 0.4
Mother’s age >34 2.9 1.35 10.0
Birth interval <24 months 5.8 2.34 10.1
Birth order >3 8.3 1.40 8.2
Subtotal 19.8 1.64 28.6
Multiple high-risk category
Age <18 and birth interval <24
months2 0.0 * 0.1
Age >34 and birth interval <24 months 0.2 * 0.5
Age >34 and birth order >3 5.6 3.65 29.0
Age >34 and birth interval <24 months
and birth order >3 0.5 (8.80) 1.2
Birth interval <24 months and birth
order >3 1.6 5.64 3.0
Subtotal 7.8 4.42 33.7
In any avoidable high-risk category 27.6 2.43 62.3
Total 100.0 na 100.0
Number of births/women 7,253 na 11,898
Note: Risk ratio is the ratio of the proportion dead among births in a specific high-risk category
to the proportion dead among births not in any high-risk category. Figures in parentheses are
based on 25-49 unweighted cases. An asterisk indicates that a ratio is based on fewer than 25
unweighted cases and has been suppressed.
na = Not applicable
1 Women are assigned to risk categories according to the status they would have at the birth of
a child if they were to conceive at the time of the survey: current age less than 17 years and 3
months or older than 34 years and 2 months, latest birth less than 15 months ago, or latest birth
being of order 3 or higher.
2 Includes the category age <18 and birth order >3
a Includes sterilized women
The risk ratios displayed in the second column of Table 12.5 denote the relationship between risk
factors and mortality. For example, the risk of dying for a child who falls into any of the avoidable highrisk categories is 2.4 times higher than for a child not in any high-risk category. In general, risk ratios are
higher for children in a multiple high-risk category than for children in a single high-risk category. Most
vulnerable are children born to a mother older than age 34, born less than 24 months after a preceding
birth, and of a birth order greater than three; they are nine times as likely to die as children who are not in
any high-risk category. However, less than 1 percent of births fall into this category. Among the single
high-risk categories, children born after a birth interval shorter than 24 months have 2.3 times the risk of
dying of children not in any high-risk category.
The final column of Table 12.5 illustrates the potential currently married women have of
experiencing a high-risk birth. A woman’s status at the time of the survey with regard to her age, time
elapsed since the last birth, and parity is used to classify her into a potential risk category if she were to
Infant and Child Mortality • 135
become pregnant at the time of the survey. For example, if a respondent who is age 40, has had four births,
and had her last birth 12 months ago were to become pregnant, she would fall into the multiple high-risk
category of being too old, too high parity (four or more births), and giving birth too soon (less than 24
months) after a previous birth.
Overall, approximately 3 in 5 currently married women (62 percent) have the potential of giving
birth to a child at elevated risk of mortality. Twenty-nine percent of women have the potential for having a
birth in a single high-risk category, and about one-third of women (34 percent) have the potential for
having a birth in a multiple high-risk category (mainly older maternal age and high birth order).
Maternal Health • 137
MATERNAL HEALTH 13
Key Findings
• More than 9 in 10 (95 percent) mothers received antenatal care from a
skilled provider.
• The median duration of pregnancy at the first antenatal visit is 2.5
months.
• Eighty-nine percent of mothers with a birth in the five years preceding the
survey were protected against neonatal tetanus.
• Nine in 10 (89 percent) births in the five years preceding the survey were
assisted by a skilled provider, and 83 percent of births were delivered in a
health facility.
• In the two years before the survey, 90 percent of women received
postnatal care for their last birth in the first two days after delivery.
his chapter presents findings on important areas of maternal health: antenatal, delivery, and
postnatal care. This information, in combination with data from other chapters, is useful in
formulating programs and policies to improve maternal and child health services.
13.1 ANTENATAL CARE
The health care that a mother receives during pregnancy and at the time of delivery is important
for the survival and well-being of both the mother and the child. Antenatal care (ANC) from a trained
provider is vital in monitoring the pregnancy and reducing morbidity risk for the mother and child during
pregnancy and delivery. A well-designed and well-implemented ANC program facilitates detection and
treatment of problems during pregnancy, such as anemia and infections, and provides an opportunity to
disseminate health messages to women and their families. In the 2014 CDHS, women who had given birth
in the five years preceding the survey were asked about the type of ANC provider, number of ANC visits,
stage of pregnancy at the time of the first visit, and services and information provided during ANC. For
women with two or more live births during the five-year period, data on antenatal care refer to the most
recent birth only.
13.1.1 Source of Antenatal Care
Table 13.1 shows the percent distribution of women who had a birth in the five years preceding
the survey by source of antenatal care received during pregnancy. Ninety-five percent of women received
ANC from trained personnel (doctors, nurses, and midwives) at least once. Nearly 9 in 10 women (88
percent) received care during pregnancy from midwives, 6 percent received care from a doctor, and 1
percent received care from a nurse. Only 5 percent of women received no antenatal care for births in the
preceding five years. The 2014 data show continued improvement in antenatal care since the 2010 CDHS,
when 89 percent of women had received antenatal care from a trained health professional. In 2010, onetenth of women received no antenatal care.
Younger women (less than age 35) were more likely than older women (age 35 and older) to
receive antenatal care from trained personnel (96 percent versus 89 percent). Women were more likely to
receive care from a health professional for first births (98 percent) than for births of order six and higher
(72 percent). Urban and rural women differed slightly in their use of antenatal care services. Health
professionals provided antenatal care for 99 percent of women in urban areas and 95 percent of women in
rural areas. Five percent of women in rural areas received no antenatal care at all, as compared with 1
percent in urban areas.
T
138 • Maternal Health
Table 13.1 Antenatal care
Percent distribution of women age 15-49 who had a live birth in the five years preceding the survey by antenatal care (ANC) provider during pregnancy for the most
recent birth and the percentage receiving antenatal care from a skilled provider for the most recent birth, according to background characteristics, Cambodia 2014
Antenatal care provider
Total
Percentage
receiving
antenatal
care from a
skilled
provider1
Number of
women
Background
characteristic Doctor Nurse Midwife
Traditional
birth
attendant
Village
health
volunteer Other No one Missing
Mother’s age at birth
<20 5.5 0.2 89.8 0.0 0.1 0.0 4.4 0.0 100.0 95.5 620
20-34 5.9 1.4 88.8 0.1 0.0 0.0 3.7 0.0 100.0 96.2 4,749
35-49 4.5 1.1 83.0 0.4 0.0 0.0 11.0 0.0 100.0 88.6 603
Birth order
1 7.0 1.2 90.1 0.0 0.0 0.0 1.6 0.0 100.0 98.4 2,127
2-3 4.9 1.6 90.0 0.1 0.1 0.0 3.2 0.1 100.0 96.5 2,826
4-5 5.8 0.3 84.6 0.3 0.0 0.0 9.0 0.0 100.0 90.7 748
6+ 3.9 0.7 67.3 0.8 0.0 0.0 27.2 0.0 100.0 71.9 272
Place where ANC
received
Public sector 5.0 1.3 93.6 0.0 0.0 0.0 0.0 0.0 100.0 99.9 5,366
Private sector 24.8 1.7 73.5 0.0 0.0 0.0 0.0 0.0 100.0 100.0 274
Home (11.8) (0.0) (80.8) (6.3) (1.2) (0.0) (0.0) (0.0) 100.0 (92.5) 53
Other * * * * * * * * 100.0 * 12
No ANC 0.0 0.0 0.0 0.0 0.0 0.0 100.0 0.0 100.0 0.0 267
Residence
Urban 9.1 4.0 85.5 0.0 0.0 0.0 1.4 0.0 100.0 98.6 876
Rural 5.1 0.8 88.8 0.1 0.0 0.0 5.0 0.0 100.0 94.8 5,096
Province
Banteay Meanchey 2.5 0.4 96.0 0.0 0.0 0.0 0.6 0.5 100.0 98.9 219
Kampong Cham 17.6 0.3 79.0 0.0 0.0 0.0 3.1 0.0 100.0 96.9 819
Kampong Chhnang 0.1 0.1 99.2 0.0 0.0 0.0 0.5 0.0 100.0 99.5 203
Kampong Speu 0.2 0.0 97.5 0.0 0.0 0.0 2.2 0.0 100.0 97.8 395
Kampong Thom 1.6 0.0 94.0 0.0 0.0 0.0 4.4 0.0 100.0 95.6 279
Kandal 1.9 2.3 92.1 0.0 0.0 0.0 3.7 0.0 100.0 96.3 420
Kratie 2.0 0.0 70.8 0.6 0.0 0.0 26.6 0.0 100.0 72.8 214
Phnom Penh 10.3 8.0 80.1 0.0 0.0 0.0 1.5 0.0 100.0 98.5 535
Prey Veng 3.8 0.0 95.1 0.0 0.0 0.0 1.0 0.0 100.0 99.0 405
Pursat 0.3 0.0 94.4 0.0 0.0 0.0 5.0 0.3 100.0 94.7 245
Siem Reap 21.6 3.2 71.3 1.3 0.4 0.0 2.2 0.0 100.0 96.1 379
Svay Rieng 0.5 0.0 97.6 0.0 0.0 0.0 1.9 0.0 100.0 98.1 229
Takeo 1.5 0.0 96.1 0.0 0.0 0.0 2.4 0.0 100.0 97.6 321
Otdar Meanchey 0.9 0.0 95.7 0.0 0.0 0.0 2.9 0.4 100.0 96.7 116
Battambang/Pailin 1.5 1.5 94.0 0.0 0.0 0.0 2.9 0.0 100.0 97.1 460
Kampot/Kep 0.7 0.1 93.1 0.0 0.0 0.0 6.1 0.0 100.0 93.9 236
Preah Sihanouk/
Koh Kong 3.4 0.2 94.1 0.0 0.0 0.0 2.4 0.0 100.0 97.6 142
Preah Vihear/
Stung Treng 0.2 0.0 85.3 0.3 0.0 0.0 14.2 0.0 100.0 85.5 188
Mondul Kiri/
Ratanak Kiri 0.3 0.0 75.7 0.0 0.4 0.0 23.7 0.0 100.0 76.0 169
Mother’s education
No education 4.2 1.1 81.0 0.2 0.1 0.0 13.3 0.1 100.0 86.3 805
Primary 5.1 0.8 89.4 0.2 0.0 0.0 4.4 0.1 100.0 95.3 3,100
Secondary and higher 7.2 2.1 89.5 0.0 0.1 0.0 1.1 0.0 100.0 98.8 2,068
Wealth quintile
Lowest 4.4 0.5 84.8 0.4 0.0 0.0 9.9 0.0 100.0 89.7 1,359
Second 4.4 0.3 89.9 0.1 0.2 0.0 5.1 0.0 100.0 94.7 1,215
Middle 5.1 0.9 90.2 0.0 0.0 0.0 3.7 0.2 100.0 96.2 1,133
Fourth 4.4 1.0 92.7 0.1 0.0 0.0 1.9 0.0 100.0 98.1 1,069
Highest 10.4 3.8 85.1 0.0 0.0 0.0 0.7 0.0 100.0 99.3 1,196
Total 5.7 1.3 88.3 0.1 0.0 0.0 4.5 0.0 100.0 95.3 5,973
Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. Figures in parentheses are
based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.
1 Skilled provider includes doctor, nurse, and midwife.
Provincial differences in antenatal care coverage were significant. For example, while nearly all
women in several provinces received antenatal care from a health professional, only about three-quarters of
women in Kratie and Mondul Kiri/Ratanak Kiri received qualified antenatal care (73 percent and 76
percent, respectively).
The use of antenatal care services was strongly associated with a woman’s level of education.
Women with a secondary education or higher were more likely to receive antenatal care from trained
Maternal Health • 139
personnel (99 percent) than women with a primary education (95 percent) and women with no education
(86 percent). Thirteen percent of uneducated women received no antenatal care at all, with the proportion
decreasing to 4 percent among women with a primary school education and 1 percent among women with
a secondary education or higher. The proportion of women who receive ANC from a skilled provider
increases steadily with increasing wealth.
Antenatal care is more beneficial in preventing
adverse pregnancy outcomes when it is sought early in the
pregnancy and is continued throughout pregnancy. Health
professionals recommend that the first antenatal visit occur
within the first three months of the pregnancy and that
visits continue on a monthly basis through week 28 of
pregnancy and then every two weeks up to week 36 (or
until birth). If the first antenatal visit is made during the
third month of pregnancy and then visits occur as regularly
as recommended, there will be a total of at least 12 to 13
antenatal visits. Table 13.2 shows that three-quarters of
women (76 percent) make four or more antenatal care
visits during their entire pregnancy. Table 13.2 includes
antenatal care received from any type of provider listed in
Table 13.1.
Four in five women (79 percent) make their first
antenatal care visit before the fourth month of pregnancy.
The median duration of pregnancy at the first antenatal
care visit is 2.5 months. This indicates that, overall, women
in Cambodia start antenatal care during the first trimester
of their pregnancy. Rural women tend to have fewer ANC
visits and to start care later in pregnancy than urban
women.
13.1.2 Components of Antenatal Care
Apart from receiving basic care, every pregnant woman should be monitored for complications.
For that reason, pregnant women should receive information on pregnancy complications or danger signs
and be screened for complications at all antenatal care visits. The 2014 CDHS asked respondents a number
of questions about the care they received during pregnancy for their most recent live birth in the past five
years. Table 13.3 presents information on the percentage of women who took iron tablets and intestinal
parasite drugs during pregnancy and on the content of ANC services, including the percentage of women
who were informed of the symptoms of pregnancy complications.
Nearly all women (96 percent) took iron tablets or syrup during pregnancy, and 72 percent took
intestinal parasite drugs. Eighty-two percent of mothers who received antenatal care reported that they
were informed about the signs of pregnancy-related complications during their visits. Blood pressure
measurements were part of antenatal care for 96 percent of mothers, and 95 percent were weighed as part
of their antenatal care. Urine and blood samples were taken from 49 percent and 77 percent of women,
respectively.
Table 13.2 Number of antenatal care visits and timing of
first visit
Percent distribution of women age 15-49 who had a live birth
in the five years preceding the survey by number of
antenatal care (ANC) visits for the most recent live birth, and
by the timing of the first visit, and among women with ANC,
median months pregnant at first visit, according to
residence, Cambodia 2014
Number and timing of
ANC visits
Residence
Total Urban Rural
Number of ANC visits
None 1.4 5.0 4.5
1 1.4 3.1 2.9
2-3 11.5 17.6 16.7
4+ 85.4 73.9 75.6
Don’t know/missing 0.3 0.3 0.3
Total 100.0 100.0 100.0
Number of months
pregnant at time of
first ANC visit
No antenatal care 1.4 5.0 4.5
<4 87.6 77.5 79.0
4-5 8.4 13.3 12.6
6-7 2.1 3.6 3.4
8+ 0.4 0.5 0.5
Don’t know/missing 0.1 0.1 0.1
Total 100.0 100.0 100.0
Number of women 876 5,096 5,973
Median months
pregnant at first visit
(for those with ANC) 2.1 2.6 2.5
Number of women with
ANC 864 4,840 5,704
140 • Maternal Health
Table 13.3 Components of antenatal care
Among women age 15-49 with a live birth in the five years preceding the survey, the percentage who took iron tablets or syrup and drugs for
intestinal parasites during the pregnancy of the most recent birth, and among women receiving antenatal care (ANC) for the most recent live birth
in the five years preceding the survey, the percentage receiving specific antenatal services, according to background characteristics, Cambodia
2014
Among women with a live birth in the
past five years, the percentage who
during the pregnancy of their last birth:
Among women who received antenatal care for their most recent birth in the
past five years, the percentage with selected services
Background
characteristic
Took iron
tablets or
syrup
Took
intestinal
parasite
drugs
Number of
women with
a live birth in
the past five
years
Informed of
signs of
pregnancy
complications Weighed
Blood
pressure
measured
Urine
sample
taken
Blood
sample
taken
Number of
women with
ANC for
their most
recent birth
Mother’s age at birth
<20 94.7 71.5 620 76.4 95.4 95.9 42.5 77.1 592
20-34 96.5 73.2 4,749 82.7 95.7 96.5 50.0 77.8 4,574
35-49 89.6 64.6 603 83.6 91.8 93.3 46.6 71.2 537
Birth order
1 98.1 74.9 2,127 80.6 96.3 96.5 50.3 81.5 2,093
2-3 96.8 73.7 2,826 84.2 96.0 96.7 49.2 76.1 2,733
4-5 91.4 66.1 748 80.5 92.5 95.4 44.2 71.6 680
6+ 74.9 51.0 272 75.6 85.8 86.0 46.1 63.6 198
Residence
Urban 97.4 62.0 876 83.1 97.5 97.9 60.8 82.6 864
Rural 95.3 73.9 5,096 82.0 94.9 95.8 46.8 76.1 4,840
Province
Banteay Meanchey 98.7 72.1 219 78.0 98.6 94.5 59.4 90.7 217
Kampong Cham 97.3 64.3 819 70.6 91.3 94.3 33.2 70.6 793
Kampong Chhnang 99.3 96.6 203 96.4 97.0 97.7 83.3 92.9 202
Kampong Speu 98.2 71.7 395 75.7 94.2 97.0 22.6 73.4 386
Kampong Thom 94.7 90.6 279 98.5 97.4 96.1 84.9 92.4 266
Kandal 95.0 71.1 420 86.4 95.7 95.5 52.8 72.3 404
Kratie 77.0 57.0 214 85.0 90.3 91.7 39.8 55.1 157
Phnom Penh 97.9 53.6 535 84.6 98.0 99.4 63.9 78.8 527
Prey Veng 98.9 84.5 405 90.1 93.0 95.1 56.7 75.9 401
Pursat 95.5 89.2 245 93.6 97.6 96.8 54.9 86.0 232
Siem Reap 96.4 74.3 379 80.3 98.4 96.1 82.9 95.8 371
Svay Rieng 98.1 70.1 229 78.7 99.2 97.9 32.7 78.9 224
Takeo 97.9 71.1 321 89.8 96.1 98.0 41.3 78.1 313
Otdar Meanchey 95.6 82.0 116 73.0 98.5 91.5 54.7 73.7 112
Battambang/Pailin 97.5 78.4 460 73.4 98.1 97.9 45.6 91.1 447
Kampot/Kep 92.8 72.7 236 81.8 93.4 94.3 21.1 79.2 222
Preah Sihanouk/
Koh Kong 96.7 66.1 142 83.5 95.9 95.2 55.6 84.2 138
Preah Vihear/
Stung Treng 90.1 59.6 188 76.3 84.1 95.4 18.4 28.8 161
Mondul Kiri/
Ratanak Kiri 77.7 72.0 169 87.5 94.8 95.1 15.1 15.6 129
Education
No education 87.8 63.0 805 76.7 89.5 90.3 43.6 68.4 697
Primary 95.6 72.8 3,100 81.7 94.9 96.0 46.5 75.3 2,961
Secondary and
higher 98.6 74.8 2,068 84.5 97.9 98.3 54.2 82.6 2,045
Wealth quintile
Lowest 91.0 70.5 1,359 78.7 92.3 93.0 44.9 73.4 1,224
Second 95.2 71.6 1,215 81.1 91.9 94.5 47.1 74.0 1,153
Middle 96.4 76.3 1,133 83.2 97.0 97.6 44.6 77.9 1,091
Fourth 98.3 74.4 1,069 85.0 97.9 97.8 49.9 79.2 1,049
Highest 98.0 68.7 1,196 83.1 98.0 98.1 57.8 81.3 1,187
Total 95.6 72.2 5,973 82.1 95.3 96.1 48.9 77.1 5,704
Urban-rural differences existed for various components of antenatal care. Urban women and rural
women were equally likely to have been informed about signs of pregnancy complications, to have been
weighed, and to have their blood pressure measured; however, urban women were more likely than rural
women to have blood and urine taken for testing. Women in rural areas were more likely than those in
urban areas to take intestinal parasite drugs, but rural and urban were equally likely to take iron tablets or
syrup during pregnancy. Antenatal care content was also greatly related to education and wealth. Women
with a secondary education or higher and women in the highest wealth quintile were more likely to have
received most services than other women.
Maternal Health • 141
13.1.3 Tetanus Toxoid Vaccinations
Tetanus toxoid (TT) injections are given to
women during pregnancy to prevent deaths from
neonatal tetanus. Neonatal tetanus can result when
sterile procedures are not followed in cutting the
umbilical cord after delivery. In the 2014 CDHS,
information was collected on the number of doses of TT
vaccine the mother received for her most recent birth
during the five-year period prior to the survey. In
addition, questions were included to ascertain whether
mothers received tetanus injections prior to the last birth
as a means of determining whether that birth was fully
protected from neonatal tetanus.
Table 13.4 shows the percentage of women
with a live birth in the five years preceding the survey
who reported receiving TT injections during the
pregnancy for the last live birth. Also shown is whether
the last birth was fully protected against neonatal
tetanus. An infant is considered to be fully protected if
the mother had two tetanus toxoid injections during the
pregnancy or if she had the requisite number of
injections prior to the pregnancy (see footnote in Table
13.4). According to the 2014 CDHS results, 89 percent
of last-born children during the five-year period before
the survey were fully protected against neonatal tetanus.
This figure is slightly higher than that observed in the
2010 CDHS (85 percent). There were provincial
differences in the percentage of last-born children who
were fully protected against neonatal tetanus. For
example, 98 percent of births in Kampong Chhnang
were fully protected, as compared with 72 percent of
births in Mondul Kiri/Ratanak Kiri. The proportion of
births protected against tetanus is higher in urban than
rural areas and increases with increasing mother’s
education and wealth.
For approximately three in five births in the
past five years (62 percent), the mother received two or
more tetanus toxoid injections. This figure is similar to
that reported in 2010, when 61 percent of women
received two or more doses of tetanus toxoid vaccine.
13.2 CHILDBIRTH AND DELIVERY
An important component of efforts to reduce the health risks of mothers and children is increasing
the proportion of babies delivered under the supervision of health professionals. Proper medical attention
and hygienic conditions during delivery can reduce the risk of complications and infections that may cause
death or serious illness to either the mother or the baby (or both). Data on delivery care were obtained for
all births that occurred in the five years preceding the survey.
Table 13.4 Tetanus toxoid injections
Among mothers age 15-49 with a live birth in the five years
preceding the survey, the percentage receiving two or more
tetanus toxoid injections during the pregnancy for the last live
birth and the percentage whose last live birth was protected
against neonatal tetanus, according to background
characteristics, Cambodia 2014
Background
characteristic
Percentage
receiving
two or more
injections
during last
pregnancy
Percentage
whose last
birth was
protected
against
neonatal
tetanus1
Number of
mothers
Mother’s age at birth
<20 66.7 83.1 620
20-34 62.4 90.3 4,749
35-49 58.2 80.8 603
Birth order
1 72.3 89.8 2,127
2-3 57.9 90.1 2,826
4-5 55.9 87.4 748
6+ 49.3 65.9 272
Residence
Urban 64.2 92.9 876
Rural 62.1 87.8 5,096
Province
Banteay Meanchey 70.2 93.8 219
Kampong Cham 62.9 84.6 819
Kampong Chhnang 79.5 97.9 203
Kampong Speu 53.4 90.5 395
Kampong Thom 73.6 92.7 279
Kandal 61.6 88.3 420
Kratie 50.3 83.6 214
Phnom Penh 69.0 94.3 535
Prey Veng 72.3 91.2 405
Pursat 64.5 89.8 245
Siem Reap 51.6 86.4 379
Svay Rieng 69.1 93.1 229
Takeo 79.4 93.9 321
Otdar Meanchey 62.1 90.9 116
Battambang/Pailin 47.3 79.7 460
Kampot/Kep 59.7 86.7 236
Preah Sihanouk/
Koh Kong 56.8 89.6 142
Preah Vihear/
Stung Treng 45.1 88.8 188
Mondul Kiri/
Ratanak Kiri 53.9 71.8 169
Education
No education 57.0 79.8 805
Primary 60.7 87.6 3,100
Secondary and
higher 67.1 93.4 2,068
Wealth quintile
Lowest 57.8 83.2 1,359
Second 61.7 87.5 1,215
Middle 63.0 87.3 1,133
Fourth 64.9 92.4 1,069
Highest 65.6 93.5 1,196
Total 62.4 88.6 5,973
1 Includes mothers with two injections during the pregnancy of
their last birth, or two or more injections (the last within 3 years
of the last live birth), or three or more injections (the last within 5
years of the last birth), or four or more injections (the last within
10 years of the last live birth), or five or more injections at any
time prior to the last birth.
142 • Maternal Health
13.2.1 Place of Delivery
More than four in five births (83 percent) in the five years before the survey were delivered in a
health facility, and 17 percent were delivered at home (Table 13.5). The percentage of deliveries occurring
in the home has declined dramatically from the figures reported in 2005 (78 percent) and 2010 (45
percent).
Table 13.5 Place of delivery
Percent distribution of live births in the five years preceding the survey by place of delivery and percentage delivered in a health
facility, according to background characteristics, Cambodia 2014
Health facility
Home Other Missing Total
Percentage
delivered in
a health
facility
Number of
births
Background
characteristic
Public
sector
Private
sector
Mother’s age at birth
<20 68.5 14.8 16.4 0.3 0.0 100.0 83.3 814
20-34 69.7 14.7 15.2 0.2 0.1 100.0 84.5 5,777
35-49 61.6 10.0 28.4 0.0 0.0 100.0 71.6 662
Birth order
1 72.5 17.5 9.8 0.2 0.1 100.0 90.0 2,822
2-3 69.5 13.5 16.9 0.1 0.1 100.0 83.0 3,274
4-5 60.9 10.4 27.9 0.7 0.0 100.0 71.3 833
6+ 51.5 4.6 43.6 0.0 0.3 100.0 56.1 323
Antenatal care visits1
None 22.1 6.1 71.2 0.0 0.6 100.0 28.2 269
1-3 62.9 11.1 25.5 0.4 0.0 100.0 74.0 1,169
4+ 74.3 16.4 9.2 0.1 0.0 100.0 90.7 4,516
Residence
Urban 65.8 30.2 3.9 0.0 0.0 100.0 96.0 1,041
Rural 69.4 11.6 18.7 0.2 0.1 100.0 81.0 6,212
Province
Banteay Meanchey 70.0 17.9 11.0 0.0 1.1 100.0 87.9 253
Kampong Cham 61.0 23.5 15.2 0.4 0.0 100.0 84.5 1,008
Kampong Chhnang 96.0 1.2 2.9 0.0 0.0 100.0 97.1 248
Kampong Speu 66.9 17.2 15.5 0.4 0.0 100.0 84.1 469
Kampong Thom 67.5 6.9 25.7 0.0 0.0 100.0 74.3 337
Kandal 63.6 17.2 19.2 0.0 0.0 100.0 80.8 523
Kratie 40.3 5.9 53.7 0.0 0.0 100.0 46.3 269
Phnom Penh 65.2 30.7 4.1 0.0 0.0 100.0 95.9 626
Prey Veng 69.4 20.5 10.0 0.0 0.0 100.0 90.0 499
Pursat 72.6 5.8 21.6 0.0 0.0 100.0 78.4 298
Siem Reap 87.0 4.6 8.4 0.0 0.0 100.0 91.6 487
Svay Rieng 74.3 8.2 17.2 0.4 0.0 100.0 82.4 261
Takeo 80.1 12.0 6.9 0.9 0.0 100.0 92.2 386
Otdar Meanchey 85.9 2.5 11.1 0.2 0.3 100.0 88.4 137
Battambang/Pailin 81.3 8.9 9.6 0.0 0.2 100.0 90.2 553
Kampot/Kep 72.2 8.7 18.2 0.8 0.0 100.0 80.9 276
Preah Sihanouk/
Koh Kong 68.6 20.4 10.2 0.0 0.9 100.0 88.9 168
Preah Vihear/
Stung Treng 49.3 1.8 48.8 0.1 0.0 100.0 51.1 239
Mondul Kiri/
Ratanak Kiri 39.3 11.9 48.1 0.7 0.0 100.0 51.2 217
Mother’s education
No education 62.2 5.7 31.6 0.5 0.0 100.0 67.8 1,017
Primary 70.3 10.7 18.7 0.2 0.1 100.0 81.0 3,795
Secondary and
higher 69.4 23.5 7.0 0.1 0.0 100.0 92.9 2,442
Wealth quintile
Lowest 65.2 3.2 31.2 0.3 0.1 100.0 68.4 1,771
Second 71.6 7.1 20.8 0.3 0.1 100.0 78.8 1,453
Middle 76.0 10.8 13.1 0.0 0.1 100.0 86.8 1,362
Fourth 72.1 18.7 9.0 0.2 0.0 100.0 90.8 1,252
Highest 60.9 35.0 3.8 0.2 0.1 100.0 95.9 1,415
Total 68.9 14.3 16.6 0.2 0.1 100.0 83.2 7,253
Note: Total includes 19 births for which the number of antenatal care visits is missing.
1 Includes only the most recent birth in the five years preceding the survey
Maternal Health • 143
First births are more likely to be delivered in a health facility (90 percent) than are subsequent
births. Children born in urban areas (96 percent) are more likely to be delivered in a health facility than
children born in rural areas (81 percent). The proportion of births delivered in a health facility is highest in
Kampong Chhnang (97 percent) and Phnom Penh (96 percent) and lowest in Kratie (46 percent), Preah
Vihear/Stung Treng (51 percent), and Mondul Kiri/Ratanak Kiri (51 percent). Facility-based delivery is
positively associated with mother’s educational level. About two-thirds of births to women (68 percent)
with no education are delivered in a health facility, as compared with 93 percent of births to women with a
secondary education or higher. A similar relationship is observed between place of delivery and wealth.
13.2.2 Assistance at Delivery
Obstetric care by a trained provider during delivery is recognized as critical for the reduction of
maternal and neonatal mortality. Table 13.6 shows the percent distribution of births in the five years
preceding the survey by the person providing assistance at delivery, the percentage of births attended by a
skilled health worker, and the percentage of births delivered by cesarean section, according to background
characteristics. Eighty-nine percent of births are delivered with the assistance of a trained health
professional (i.e., a doctor, nurse, or midwife), an increase from 71 percent in 2010. Only 11 percent are
delivered with the assistance of a traditional birth attendant. Six percent of births are delivered via
cesarean, an increase from 3 percent in 2010.
First births are more likely to be assisted by a trained health professional (94 percent) than
subsequent births. Births to urban women are more likely (98 percent) to be assisted by a trained health
professional than births to rural women (88 percent). Conversely, rural births are more likely (12 percent)
than urban births (2 percent) to receive assistance from a traditional birth attendant. At least 80 percent of
deliveries are assisted by a trained health professional in all provinces other than Kratie (52 percent), Preah
Vihear/Stung Treng (55 percent), and Mondul Kiri/Ratanak Kiri (54 percent). As expected, mother’s
education is related to delivery care. Births to women with a primary school education (89 percent) and
women with a secondary education or higher (97 percent) are more likely than births to women with no
education (72 percent) to be assisted by a health professional. Household wealth is also positively
associated with professionally assisted delivery.
First births and births to older women (age 35-49) are more likely to be delivered via cesarean
than other births. The proportion of births delivered by cesarean section is about three times higher in
urban areas than rural areas (14 percent versus 5 percent) and is highest in Phnom Penh. Births to women
with a secondary education or higher and those to women in the highest wealth quintile are more likely
than other births to be delivered via cesarean.
144 • Maternal Health
Table 13.6 Assistance during delivery
Percent distribution of live births in the five years preceding the survey by person providing assistance during delivery, percentage of births assisted by a skilled
provider, and percentage delivered by cesarean section, according to background characteristics, Cambodia 2014
Person providing assistance during delivery Percentage
delivered by
a skilled
provider1
Percentage
delivered by
C-section
Number of
births
Background
characteristic Doctor Nurse Midwife
Traditional
birth
attendant
Relative/
other No one
Don’t
know/
missing Total
Mother’s age at birth
<20 11.3 3.6 74.4 10.7 0.0 0.0 0.0 100.0 89.3 4.3 814
20-34 16.2 3.2 70.4 9.9 0.1 0.0 0.1 100.0 89.9 6.4 5,777
35-49 12.5 2.7 66.1 18.2 0.5 0.0 0.0 100.0 81.3 8.0 662
Birth order
1 18.2 2.9 73.1 5.8 0.0 0.0 0.1 100.0 94.1 8.2 2,822
2-3 14.8 3.7 70.9 10.3 0.2 0.0 0.1 100.0 89.4 5.3 3,274
4-5 10.0 3.5 66.3 19.8 0.3 0.2 0.0 100.0 79.8 4.8 833
6+ 9.8 0.9 53.9 35.1 0.0 0.0 0.3 100.0 64.6 3.7 323
Place of delivery
Health facility 18.3 3.8 77.8 0.0 0.0 0.0 0.0 100.0 99.9 7.6 6,032
Elsewhere 0.8 0.5 34.2 63.7 0.6 0.2 0.0 100.0 35.5 0.0 1,215
Residence
Urban 30.8 7.2 59.7 2.0 0.2 0.0 0.0 100.0 97.8 14.3 1,041
Rural 12.8 2.6 72.3 12.2 0.1 0.0 0.1 100.0 87.6 4.9 6,212
Province
Banteay Meanchey 6.6 3.9 85.4 3.0 0.5 0.0 0.7 100.0 95.8 8.9 253
Kampong Cham 28.7 1.4 61.4 8.5 0.0 0.0 0.0 100.0 91.5 7.5 1,008
Kampong Chhnang 5.3 0.0 92.2 2.4 0.0 0.0 0.0 100.0 97.6 3.3 248
Kampong Speu 6.1 0.1 83.1 10.4 0.0 0.3 0.0 100.0 89.3 2.2 469
Kampong Thom 9.6 8.3 62.5 19.6 0.0 0.0 0.0 100.0 80.4 5.1 337
Kandal 7.5 1.0 87.2 3.9 0.4 0.0 0.0 100.0 95.7 8.5 523
Kratie 9.1 4.5 38.3 48.1 0.1 0.0 0.0 100.0 51.9 4.5 269
Phnom Penh 34.2 11.2 50.8 3.6 0.3 0.0 0.0 100.0 96.1 14.4 626
Prey Veng 4.8 0.0 92.8 2.4 0.0 0.0 0.0 100.0 97.6 4.4 499
Pursat 2.5 0.0 83.6 13.7 0.3 0.0 0.0 100.0 86.1 2.2 298
Siem Reap 37.1 10.7 45.2 6.7 0.3 0.0 0.0 100.0 93.0 3.8 487
Svay Rieng 12.2 0.0 82.2 5.0 0.4 0.2 0.0 100.0 94.3 6.5 261
Takeo 16.4 3.6 77.4 2.6 0.0 0.0 0.0 100.0 97.4 4.2 386
Otdar Meanchey 7.0 0.3 81.4 11.0 0.0 0.3 0.0 100.0 88.7 3.7 137
Battambang/Pailin 14.9 5.1 74.0 5.5 0.0 0.0 0.5 100.0 94.1 8.3 553
Kampot/Kep 8.7 0.0 81.8 9.5 0.0 0.0 0.0 100.0 90.5 5.0 276
Preah Sihanouk/
Koh Kong 8.5 0.0 88.9 1.6 0.6 0.0 0.3 100.0 97.5 9.4 168
Preah Vihear/
Stung Treng 2.8 0.0 51.8 45.4 0.0 0.0 0.0 100.0 54.6 2.3 239
Mondul Kiri/
Ratanak Kiri 5.2 0.1 48.3 46.0 0.3 0.0 0.1 100.0 53.6 4.0 217
Mother’s education
No education 7.6 2.6 61.6 27.8 0.3 0.2 0.0 100.0 71.8 2.6 1,017
Primary 12.0 2.8 73.7 11.3 0.1 0.0 0.1 100.0 88.5 5.1 3,795
Secondary and
higher 23.7 4.2 69.1 2.7 0.2 0.0 0.1 100.0 97.0 9.6 2,442
Wealth quintile
Lowest 7.9 2.0 65.3 24.4 0.3 0.0 0.1 100.0 75.2 3.1 1,771
Second 9.6 2.6 74.8 12.7 0.1 0.1 0.1 100.0 87.0 3.0 1,453
Middle 11.9 2.3 78.5 7.2 0.1 0.0 0.0 100.0 92.7 4.4 1,362
Fourth 18.2 4.1 74.1 3.5 0.0 0.0 0.0 100.0 96.5 7.7 1,252
Highest 31.3 5.6 61.5 1.3 0.2 0.0 0.1 100.0 98.4 14.2 1,415
Total 15.3 3.2 70.5 10.7 0.1 0.0 0.1 100.0 89.0 6.3 7,253
Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. Total includes 6
births for which the place of delivery is missing.
1 Skilled provider includes doctor, nurse, midwife, and auxiliary nurse/midwife.
13.3 POSTNATAL CARE AND PRACTICES
A large proportion of maternal and neonatal deaths occur during the first 48 hours after delivery.
Safe motherhood programs have recently increased their emphasis on the importance of postnatal care,
recommending that all women receive a health checkup within two days of delivery. To assess the extent
of postnatal care utilization, respondents who had given birth in the five years preceding the survey were
asked whether they had received a health check after the delivery of their last birth. Table 13.7.1 shows the
timing of the first postnatal checkup for women giving birth in the past two years.
Maternal Health • 145
Table 13.7.1 Timing of first postnatal checkup
Among women age 15-49 giving birth in the two years preceding the survey, the percent distribution of the mother’s first postnatal checkup for the
last live birth by time after delivery, and the percentage of women with a live birth in the two years preceding the survey who received a postnatal
checkup in the first two days after giving birth, according to background characteristics, Cambodia 2014
Time after delivery of mother’s first postnatal checkup
No postnatal
checkup1 Total
Percentage
of women
with a
postnatal
checkup in
the first two
days after
birth
Number of
women
Background
characteristic
Less than 4
hours 4-23 hours 1-2 days 3-41 days
Don’t know/
missing
Mother’s age at birth
<20 74.4 7.5 6.8 0.7 1.0 9.6 100.0 88.7 326
20-34 77.2 9.9 3.8 0.3 0.8 8.1 100.0 90.9 2,380
35-49 67.1 13.9 6.1 0.7 0.7 11.5 100.0 87.1 238
Birth order
1 76.9 10.5 4.3 0.4 1.2 6.7 100.0 91.7 1,204
2-3 77.3 8.8 4.1 0.1 0.5 9.2 100.0 90.2 1,310
4-5 69.4 13.7 4.8 1.4 0.7 10.0 100.0 87.8 346
6+ 72.0 4.6 5.7 0.3 0.0 17.3 100.0 82.3 86
Place of delivery
Health facility 80.4 10.6 3.5 0.1 0.9 4.4 100.0 94.5 2,614
Elsewhere 41.7 4.8 10.8 2.2 0.0 40.5 100.0 57.3 329
Residence
Urban 72.9 22.0 3.1 0.1 0.5 1.3 100.0 98.1 414
Rural 76.6 7.9 4.5 0.4 0.8 9.7 100.0 89.1 2,531
Province
Banteay Meanchey 70.7 3.0 15.5 1.0 0.5 9.3 100.0 89.3 120
Kampong Cham 64.9 8.1 9.7 0.0 1.4 15.9 100.0 82.7 418
Kampong Chhnang 98.4 1.6 0.0 0.0 0.0 0.0 100.0 100.0 111
Kampong Speu 83.8 5.9 1.1 0.0 0.8 8.4 100.0 90.8 182
Kampong Thom 96.4 0.3 3.2 0.0 0.0 0.0 100.0 100.0 141
Kandal 66.1 13.9 5.8 1.0 0.0 13.3 100.0 85.7 193
Kratie 74.1 1.5 16.1 0.0 0.0 8.2 100.0 91.8 107
Phnom Penh 61.2 37.1 1.7 0.0 0.0 0.0 100.0 100.0 257
Prey Veng 96.5 2.2 0.0 0.0 1.3 0.0 100.0 98.7 194
Pursat 88.6 4.8 2.4 0.0 0.0 4.2 100.0 95.8 122
Siem Reap 67.0 17.2 3.8 1.3 2.1 8.6 100.0 87.9 182
Svay Rieng 85.2 4.0 0.9 0.9 0.0 9.0 100.0 90.1 108
Takeo 85.4 9.2 1.8 2.0 0.8 0.8 100.0 96.4 164
Otdar Meanchey 91.1 3.1 0.0 0.5 0.0 5.3 100.0 94.2 54
Battambang/Pailin 79.4 15.1 1.0 0.0 2.9 1.6 100.0 95.5 247
Kampot/Kep 78.6 11.3 3.2 0.0 0.0 7.0 100.0 93.0 116
Preah Sihanouk/
Koh Kong 89.4 3.1 2.4 0.0 0.8 4.2 100.0 94.9 61
Preah Vihear/
Stung Treng 57.0 2.4 8.8 0.7 0.0 31.1 100.0 68.2 92
Mondul Kiri/
Ratanak Kiri 37.6 1.6 0.0 0.0 0.0 60.8 100.0 39.2 75
Education
No education 71.5 4.3 4.1 0.6 0.7 18.8 100.0 79.8 366
Primary 76.3 8.8 5.1 0.5 0.7 8.8 100.0 90.1 1,491
Secondary and
higher 77.3 13.4 3.4 0.1 1.0 4.7 100.0 94.2 1,088
Wealth quintile
Lowest 74.2 5.2 5.0 0.5 0.2 15.0 100.0 84.3 694
Second 77.8 5.9 3.8 0.9 0.8 10.8 100.0 87.5 589
Middle 82.7 5.4 5.6 0.2 1.2 5.0 100.0 93.6 565
Fourth 75.0 13.2 4.0 0.2 1.1 6.5 100.0 92.2 536
Highest 70.9 21.5 3.2 0.1 0.8 3.5 100.0 95.6 560
Total 76.1 9.9 4.3 0.4 0.8 8.5 100.0 90.3 2,944
Note: Total includes 1 birth for which place of delivery is missing.
1 Includes women who received a checkup after 41 days
Ninety percent of mothers received postnatal care within the crucial first two days of delivery,
with 76 percent receiving care within four hours of delivery. Only 9 percent of mothers received no
postnatal care.
Urban women were more likely to receive postnatal care (98 percent) than rural women (89
percent) during the first two days after delivery. Women with a secondary education or higher (94 percent)
were more likely to receive postnatal care within two days of delivery than women with either no
146 • Maternal Health
schooling (80 percent) or only a primary school education (90 percent). Only 57 percent of women who
did not deliver in a health facility received a postnatal checkup.
Table 13.7.2 presents information on the provider of postnatal care for women who delivered in
the two years preceding the survey. Eighty-seven percent of women received postnatal care from a health
professional (midwife, doctor, or nurse), and only 3 percent received postnatal care from traditional birth
attendants. Women in urban areas (98 percent) were more likely than those in rural areas (85 percent) to
receive postnatal care from a health professional. Similarly, mothers with a secondary education or higher
(93 percent) were much more likely to receive postnatal care from a trained health professional than
women with either no schooling (71 percent) or only a primary school education (86 percent).
Table 13.7.2 Type of provider of first postnatal checkup for the mother
Among women age 15-49 giving birth in the two years preceding the survey, the percent distribution by type of provider of the
mother’s first postnatal health check in the two days after the last live birth, according to background characteristics, Cambodia 2014
Type of health provider of mother’s first postnatal checkup
No postnatal
checkup in
the first two
days after
birth1 Total
Number of
women
Background
characteristic Doctor Nurse Midwife
Traditional
birth
attendant
Don’t know/
missing
Mother’s age at birth
<20 10.3 1.7 71.7 5.1 0.0 11.3 100.0 326
20-34 11.5 2.1 74.2 3.0 0.1 9.0 100.0 2,380
35-49 13.8 0.0 68.5 4.8 0.0 12.9 100.0 238
Birth order
1 13.5 2.2 73.8 2.2 0.2 8.1 100.0 1,204
2-3 10.2 2.2 74.9 2.8 0.0 9.8 100.0 1,310
4-5 9.8 0.0 70.3 7.7 0.0 12.2 100.0 346
6+ 11.9 0.0 59.3 11.2 0.0 17.7 100.0 86
Place of delivery
Health facility 12.9 2.0 79.6 0.1 0.1 5.4 100.0 2,614
Elsewhere 1.3 1.0 25.1 30.0 0.0 42.7 100.0 329
Residence
Urban 26.1 7.9 63.7 0.4 0.0 1.9 100.0 414
Rural 9.2 0.9 75.1 3.9 0.1 10.8 100.0 2,531
Province
Banteay Meanchey 6.6 1.1 81.6 0.0 0.0 10.7 100.0 120
Kampong Cham 25.0 1.5 53.7 2.5 0.0 17.3 100.0 418
Kampong Chhnang 1.6 0.0 98.4 0.0 0.0 0.0 100.0 111
Kampong Speu 2.1 0.4 82.8 5.5 0.6 8.6 100.0 182
Kampong Thom 3.8 0.0 82.0 14.2 0.0 0.0 100.0 141
Kandal 8.7 0.3 76.0 0.7 0.0 14.3 100.0 193
Kratie 9.2 0.0 53.8 28.8 0.0 8.2 100.0 107
Phnom Penh 28.6 16.7 52.9 1.8 0.0 0.0 100.0 257
Prey Veng 4.8 0.0 93.9 0.0 0.0 1.3 100.0 194
Pursat 3.4 0.0 89.9 2.5 0.0 4.2 100.0 122
Siem Reap 15.7 0.0 72.1 0.0 0.0 12.1 100.0 182
Svay Rieng 9.3 0.9 79.0 0.9 0.0 9.9 100.0 108
Takeo 20.7 1.0 73.8 0.9 0.0 3.6 100.0 164
Otdar Meanchey 2.2 0.0 87.6 4.3 0.0 5.8 100.0 54
Battambang/Pailin 6.5 0.0 89.0 0.0 0.0 4.5 100.0 247
Kampot/Kep 3.3 0.0 87.3 2.4 0.9 6.1 100.0 116
Preah Sihanouk/
Koh Kong 9.7 1.7 82.8 0.6 0.0 5.1 100.0 61
Preah Vihear/
Stung Treng 2.1 0.0 54.6 11.4 0.0 31.8 100.0 92
Mondul Kiri/
Ratanak Kiri 2.7 0.0 35.4 1.2 0.0 60.8 100.0 75
Education
No education 6.8 0.0 63.9 9.1 0.0 20.2 100.0 366
Primary 8.9 1.2 76.2 3.8 0.1 9.7 100.0 1,491
Secondary and
higher 16.8 3.5 73.0 0.9 0.0 5.8 100.0 1,088
Wealth quintile
Lowest 7.4 0.9 66.8 9.2 0.0 15.7 100.0 694
Second 6.7 0.3 77.3 3.2 0.2 12.3 100.0 589
Middle 8.9 0.4 82.0 2.3 0.2 6.3 100.0 565
Fourth 11.7 1.8 78.1 0.6 0.0 7.8 100.0 536
Highest 24.3 6.5 64.7 0.2 0.0 4.4 100.0 560
Total 11.6 1.9 73.5 3.4 0.1 9.6 100.0 2,944
1 Includes women who received a checkup after 41 days
Maternal Health • 147
Table 13.8.1 shows the timing of the first postnatal checkup for newborns born in the past two
years. Seventy-seven percent of newborns received postnatal care within the crucial first two days of
delivery, with 68 percent receiving care within four hours of delivery. About 21 percent of newborns
received no postnatal care.
Postnatal care for newborns was more likely to be provided in urban areas (84 percent) than in
rural areas (78 percent) during the first two days after delivery. Newborns whose mothers had a secondary
education or higher (84 percent) were more likely to receive postnatal care within two days of delivery
than those whose mothers had either no schooling (69 percent) or only a primary school education (78
percent). Only 52 percent of babies who were not delivered in a health facility received a postnatal
checkup.
Table 13.8.1 Timing of first postnatal checkup for the newborn
Percent distribution of last births in the two years preceding the survey by time after birth of first postnatal checkup, and the percentage of births with a postnatal
checkup in the first two days after birth, according to background characteristics, Cambodia 2014
Time after birth of newborn’s first postnatal checkup
No postnatal
checkup1 Total
Percentage
of births with
a postnatal
checkup in
the first two
days after
birth
Number of
births
Background
characteristic
Less than
1 hour 1-3 hours 4-23 hours 1-2 days 3-6 days
Don’t know/
missing
Mother’s age at birth
<20 26.4 38.0 6.5 3.8 0.1 0.5 24.9 100.0 74.6 326
20-34 26.9 42.4 8.1 2.0 0.2 1.2 19.1 100.0 79.6 2,380
35-49 21.3 41.6 9.0 5.2 0.5 0.9 21.5 100.0 77.0 238
Birth order
1 27.1 41.3 8.3 2.2 0.2 0.8 20.0 100.0 79.1 1,204
2-3 27.7 41.5 7.8 1.9 0.3 1.4 19.4 100.0 79.0 1,310
4-5 18.2 45.0 9.3 4.2 0.0 1.1 22.3 100.0 76.8 346
6+ 28.8 43.4 0.9 7.6 0.3 0.7 18.3 100.0 80.7 86
Place of delivery
Health facility 27.0 44.8 8.7 1.7 0.1 1.1 16.6 100.0 82.3 2,614
Elsewhere 21.5 19.0 2.7 8.1 1.1 1.2 46.3 100.0 51.6 329
Residence
Urban 28.8 32.9 19.8 2.4 0.8 0.5 14.8 100.0 83.8 414
Rural 26.0 43.4 6.1 2.5 0.2 1.2 20.8 100.0 78.0 2,531
Province
Banteay Meanchey 1.2 4.1 0.0 0.6 0.3 1.1 92.7 100.0 5.9 120
Kampong Cham 40.3 18.6 5.4 2.9 0.0 0.0 32.9 100.0 67.1 418
Kampong Chhnang 12.1 85.1 1.6 0.0 0.0 0.0 1.2 100.0 98.8 111
Kampong Speu 31.6 44.8 4.2 0.0 0.0 0.8 18.6 100.0 80.6 182
Kampong Thom 27.1 65.6 0.0 3.1 0.0 2.6 1.5 100.0 97.8 141
Kandal 24.9 38.7 10.0 6.3 0.0 0.0 20.0 100.0 80.0 193
Kratie 46.5 25.0 1.7 12.1 0.2 0.4 14.1 100.0 85.7 107
Phnom Penh 22.2 33.4 37.7 2.2 0.9 0.0 3.5 100.0 95.6 257
Prey Veng 31.7 59.3 1.4 1.0 0.0 1.3 5.3 100.0 93.4 194
Pursat 24.3 51.5 4.1 2.4 0.0 0.5 17.2 100.0 82.3 122
Siem Reap 6.0 53.1 10.0 2.7 0.3 8.6 19.3 100.0 71.8 182
Svay Rieng 19.3 54.1 2.0 1.8 1.8 0.0 21.0 100.0 77.2 108
Takeo 25.2 56.5 8.1 1.0 1.1 0.0 8.1 100.0 90.8 164
Otdar Meanchey 5.6 79.2 2.4 0.2 0.5 0.0 12.1 100.0 87.5 54
Battambang/Pailin 43.0 33.8 12.9 0.8 0.0 2.2 7.3 100.0 90.5 247
Kampot/Kep 10.8 70.7 6.4 1.9 0.0 0.6 9.5 100.0 90.5 116
Preah Sihanouk/
Koh Kong 46.0 40.7 0.7 1.9 0.0 0.8 9.9 100.0 89.3 61
Preah Vihear/
Stung Treng 25.7 30.0 2.3 5.3 0.0 0.0 36.6 100.0 63.4 92
Mondul Kiri/
Ratanak Kiri 6.5 10.4 1.0 0.7 0.0 0.0 81.4 100.0 18.6 75
Mother’s education
No education 20.5 42.2 2.6 3.2 0.3 1.3 29.9 100.0 68.5 366
Primary 25.4 42.8 6.8 2.6 0.4 1.0 21.1 100.0 77.7 1,491
Secondary and
higher 29.7 40.6 11.5 2.0 0.1 1.2 15.0 100.0 83.8 1,088
Wealth quintile
Lowest 23.2 45.5 3.4 3.0 0.3 0.6 24.0 100.0 75.2 694
Second 25.0 44.7 3.9 2.3 0.3 2.1 21.7 100.0 76.4 589
Middle 29.7 44.6 4.8 2.8 0.0 0.6 17.5 100.0 81.9 565
Fourth 25.9 40.0 9.2 2.8 0.0 1.6 20.6 100.0 77.8 536
Highest 29.0 33.4 19.9 1.4 0.6 0.8 14.9 100.0 83.8 560
Total 26.4 41.9 8.0 2.5 0.2 1.1 19.9 100.0 78.8 2,944
Note: Total includes 1 case for which information on place of delivery is missing.
1 Includes newborns who received a checkup after the first week
148 • Maternal Health
Table 13.8.2 presents information on the provider of postnatal care for newborns who were
delivered in the two years preceding the survey. Nearly all newborns receiving postnatal care received it
from a health professional (midwife, doctor, or nurse), and only 3 percent received postnatal care from
traditional birth attendants. Postnatal care was more likely to be provided by a health professional in urban
areas (84 percent) than in rural areas (75 percent). Similarly, babies whose mothers had a secondary
education or higher (83 percent) were much more likely to receive postnatal care from a trained health
professional than babies whose mothers had either no schooling (60 percent) or only a primary school
education (74 percent).
Table 13.8.2 Type of provider of first postnatal checkup for the newborn
Percent distribution of last births in the two years preceding the survey by type of provider of the newborn’s first
postnatal health check during the two days after the last live birth, according to background characteristics, Cambodia
2014
Type of health provider of newborn’s first
postnatal checkup
No postnatal
checkup in the
first two days
after birth,
don’t know or
missing Total
Number of
births
Background
characteristic
Doctor/nurse/
midwife Nurse/midwife
Traditional
birth attendant
Mother’s age at birth
<20 68.2 1.7 4.8 25.4 100.0 326
20-34 74.6 2.2 2.8 20.4 100.0 2,380
35-49 72.0 1.0 4.0 23.0 100.0 238
Birth order
1 74.5 2.6 2.0 20.9 100.0 1,204
2-3 74.2 2.2 2.6 21.0 100.0 1,310
4-5 69.6 0.3 6.9 23.2 100.0 346
6+ 69.7 0.0 10.9 19.3 100.0 86
Place of delivery
Health facility 79.9 2.3 0.1 17.7 100.0 2,614
Elsewhere 24.5 0.1 27.0 48.4 100.0 329
Residence
Urban 74.3 9.3 0.3 16.2 100.0 414
Rural 73.6 0.9 3.6 22.0 100.0 2,531
Province
Banteay Meanchey 5.9 0.0 0.0 94.1 100.0 120
Kampong Cham 63.2 0.8 3.1 32.9 100.0 418
Kampong Chhnang 98.8 0.0 0.0 1.2 100.0 111
Kampong Speu 75.2 0.4 4.9 19.4 100.0 182
Kampong Thom 84.2 0.0 13.6 2.2 100.0 141
Kandal 80.0 0.0 0.0 20.0 100.0 193
Kratie 58.3 0.0 27.4 14.3 100.0 107
Phnom Penh 73.7 20.2 1.8 4.4 100.0 257
Prey Veng 93.4 0.0 0.0 6.6 100.0 194
Pursat 80.4 0.0 1.9 17.7 100.0 122
Siem Reap 71.8 0.0 0.0 28.2 100.0 182
Svay Rieng 75.5 1.7 0.0 22.8 100.0 108
Takeo 88.9 1.0 0.9 9.2 100.0 164
Otdar Meanchey 84.5 0.0 3.0 12.5 100.0 54
Battambang/Pailin 90.5 0.0 0.0 9.5 100.0 247
Kampot/Kep 90.5 0.0 0.0 9.5 100.0 116
Preah Sihanouk/
Koh Kong 87.6 0.8 0.9 10.7 100.0 61
Preah Vihear/
Stung Treng 52.0 0.0 11.4 36.6 100.0 92
Mondul Kiri/
Ratanak Kiri 18.3 0.0 0.4 81.4 100.0 75
Mother’s education
No education 59.6 0.0 8.9 31.5 100.0 366
Primary 73.5 0.8 3.4 22.3 100.0 1,491
Secondary and
higher 78.6 4.4 0.8 16.2 100.0 1,088
Wealth quintile
Lowest 66.2 0.5 8.5 24.8 100.0 694
Second 72.8 0.4 3.2 23.6 100.0 589
Middle 79.9 0.2 1.8 18.1 100.0 565
Fourth 75.6 1.6 0.6 22.2 100.0 536
Highest 75.8 7.9 0.1 16.2 100.0 560
Total 73.7 2.0 3.1 21.2 100.0 2,944
Note: Total includes 1 case for which information on place of delivery is missing.
Maternal Health • 149
13.4 PERCEIVED PROBLEMS IN ACCESSING WOMEN’S HEALTH CARE
Many factors can prevent women from getting medical advice or treatment for themselves. In the
2014 CDHS, women were asked about various problems they might face in accessing health care. Table
13.9 shows that 75 percent of women reported having one or more problems in accessing health care for
themselves. This figure is similar to that reported by women in 2010 (72 percent).
Table 13.9 Problems in accessing health care
Percentage of women age 15-49 who reported that they have serious problems in accessing health care for themselves when they are
sick, by type of problem, according to background characteristics, Cambodia 2014
Problems in accessing health care
Background
characteristic
Getting
permission to go
for treatment
Getting money
for treatment
Distance to
health facility
Not wanting to
go alone
At least one
problem
accessing health
care
Number of
women
Age
15-19 25.1 64.0 34.4 55.8 78.7 2,893
20-34 20.1 62.0 33.3 42.6 71.8 8,899
35-49 21.5 68.2 37.8 44.4 76.6 5,786
Number of living
children
0 21.8 61.2 31.9 49.1 73.9 5,698
1-2 21.3 63.4 35.0 42.8 72.1 6,622
3-4 20.4 66.1 36.5 42.4 75.7 3,893
5+ 22.8 77.4 43.0 50.6 85.8 1,365
Marital status
Never married 22.6 61.0 31.4 50.7 74.1 4,428
Married or living
together 20.9 64.8 36.1 43.7 74.4 11,898
Divorced/separated/
widowed 21.8 72.1 36.5 41.7 77.3 1,252
Employed last 12
months
Not employed 20.8 63.9 35.6 47.8 75.4 3,600
Employed for cash 21.4 63.7 33.4 43.4 73.3 12,702
Employed not for cash 22.8 72.9 48.6 57.9 84.2 1,273
Residence
Urban 10.6 44.5 14.4 26.5 54.7 3,251
Rural 23.8 68.9 39.6 49.6 79.0 14,327
Province
Banteay Meanchey 76.2 88.8 74.1 77.1 93.1 689
Kampong Cham 27.0 88.4 51.4 72.4 97.7 2,021
Kampong Chhnang 11.0 77.2 15.3 45.9 81.0 662
Kampong Speu 26.6 85.2 43.0 53.4 91.0 1,196
Kampong Thom 33.4 90.0 25.3 26.9 91.1 851
Kandal 5.0 55.5 25.3 39.1 70.2 1,330
Kratie 22.0 67.0 53.3 51.5 82.4 488
Phnom Penh 2.1 33.7 5.4 13.4 41.4 1,994
Prey Veng 38.3 43.8 23.3 24.6 48.0 1,188
Pursat 31.5 84.9 59.4 58.7 90.9 631
Siem Reap 19.4 39.2 25.0 51.4 63.8 1,137
Svay Rieng 5.9 41.3 45.7 56.6 66.1 654
Takeo 37.5 76.0 46.4 50.4 80.7 1,082
Otdar Meanchey 29.5 72.8 50.0 38.4 76.7 294
Battambang/Pailin 3.4 54.8 27.2 38.5 71.1 1,333
Kampot/Kep 11.0 82.5 38.3 47.6 85.1 770
Preah Sihanouk/
Koh Kong 38.1 71.2 49.6 56.4 86.3 422
Preah Vihear/
Stung Treng 14.8 57.4 42.2 54.0 75.0 462
Mondul Kiri/
Ratanak Kiri 7.8 38.3 29.8 33.1 55.6 372
Education
No education 27.3 74.5 49.0 55.3 84.7 2,250
Primary 23.5 70.1 39.2 47.4 79.6 8,281
Secondary and higher 17.0 54.4 25.5 39.7 65.3 7,047
Wealth quintile
Lowest 26.1 79.2 50.9 58.3 87.8 3,143
Second 25.9 72.8 44.2 51.9 82.8 3,314
Middle 24.9 72.9 39.2 49.1 81.4 3,381
Fourth 22.1 62.3 32.0 44.5 72.9 3,612
Highest 10.7 41.2 14.5 27.9 53.5 4,128
Total 21.4 64.4 35.0 45.4 74.5 17,578
150 • Maternal Health
The most frequently cited problem in accessing health care was not having money for treatment
(64 percent), followed by not wanting to go to the facility alone (45 percent). Thirty-five percent of women
cited distance to the health facility as a problem, and 21 percent reported that getting permission to go to a
facility was a problem. As expected, rural women were more likely than urban women to report each of the
factors as being a problem, especially distance to a health facility and getting money for treatment. The
proportion of women reporting each of these problems as a serious obstacle to accessing health care
decreases with increasing education and wealth.
Child Health • 151
CHILD HEALTH 14
Key Findings
• Seventy-three percent of children age 12-23 months are fully immunized.
• Six percent of children under age 5 showed symptoms of acute
respiratory infection in the two weeks before the survey, and 81 percent
of these children received antibiotics.
• Twenty-eight percent of children under age 5 had a fever in the two
weeks before the survey, and 61 percent of them were taken to a health
facility or provider for advice or treatment.
• Thirteen percent of children under age 5 had diarrhea in the two weeks
before the survey.
• Fifty-six percent of children with diarrhea were taken to a health facility or
provider for advice or treatment.
his chapter presents findings on several areas of importance to child health: characteristics of the
neonate (birth weight and size at birth), vaccination status of children, and important childhood
illnesses and their treatment. Information on birth weight and birth size is important for the design
and implementation of programs aimed at reducing neonatal and infant mortality. Many early childhood
deaths can be prevented by immunizing children against preventable diseases and by ensuring that children
receive prompt and appropriate treatment when they become ill.
14.1 CHILD’S SIZE AT BIRTH
Birth weight is one of the major determinants of infant and child health and mortality. Children
whose birth weight is less than 2.5 kilograms, or children reported to be “very small” or “smaller than
average,” are considered to have a higher than average risk of early childhood death. For births in the five
years preceding the 2014 CDHS, birth weight was recorded in the questionnaire if available from either a
written record or the mother’s recall. Because birth weight may not be known for many babies, the
mother’s estimate of the baby’s size at birth was also obtained. Even though such an estimate is subjective,
it can be a useful proxy for the weight of the child. Table 14.1 presents information on child’s size at birth
according to background characteristics.
Table 14.1 shows that 91 percent of babies were weighed at birth; this represents a significant
increase since the 2010 CDHS, which reported that 72 percent of babies were weighed at birth. Among
those births for which the mother was able to report the baby’s weight, 8 percent were classified as low
birth weight (less than 2.5 kilograms at birth), which is the same as the figure reported in 2010. Low birth
weight was more common among children of birth order six or higher (13 percent) and first-born children
(10 percent) than among children of birth orders two through five (6-7 percent). Children born to mothers
who smoke were more likely to be of low birth weight (11 percent) than children born to mothers who do
not smoke (8 percent). The proportion of low birth weight births varied somewhat across provinces (from 4
percent to 12 percent). However, the proportion with a reported birth weight varied substantially, from a
low of 56 percent in Mondul Kiri/Ratanak Kiri to a high of just under 100 percent in Kampong Chhnang.
Table 14.1 also includes information on the mother’s assessment of the baby’s size at birth. In the
absence of birth weight, a mother’s subjective assessment of the size of the baby at birth may be useful.
However, this assessment may vary among respondents because it is based on the mother’s own perception
of what is small, average, or large for a baby and not on a uniform definition. Eighty-eight percent of
T
152 • Child Health
infants were considered by their mothers to be average or larger than average in size. Nine percent were
perceived as smaller than average, and 3 percent were considered very small. For less than 1 percent of
births, mothers did not remember the size of their baby at birth.
Table 14.1 Child’s size and weight at birth
Percent distribution of live births in the five years preceding the survey by mother’s estimate of baby’s size at birth, percentage of live births in the five
years preceding the survey that have a reported birth weight, and among live births in the five years preceding the survey with a reported birth weight,
percentage less than 2.5 kg, according to background characteristics, Cambodia 2014
Percent distribution of all live births by size of child at birth
Percentage
of all births
that have a
reported
birth weight1
Number of
births
Percent distribution of
births with a reported birth
weight
Background
characteristic Very small
Smaller than
average
Average or
larger
Don’t know/
missing Total
Less than
2.5 kg
Number of
births
Mother’s age at birth
<20 3.3 10.5 85.9 0.3 100.0 89.5 814 8.1 729
20-34 2.5 8.6 88.1 0.8 100.0 91.5 5,777 7.8 5,289
35-49 3.8 8.9 86.8 0.6 100.0 85.6 662 8.8 567
Birth order
1 3.3 11.1 85.2 0.5 100.0 94.6 2,822 9.9 2,670
2-3 1.8 7.4 90.2 0.6 100.0 91.4 3,274 6.1 2,991
4-5 3.4 6.1 89.1 1.3 100.0 84.2 833 6.7 702
6+ 5.3 10.8 81.5 2.4 100.0 68.4 323 12.7 221
Mother’s smoking status
Smokes cigarettes/tobacco 6.2 17.0 75.7 1.1 100.0 47.0 215 11.1 101
Does not smoke 2.6 8.6 88.1 0.7 100.0 92.1 7,037 7.9 6,482
Residence
Urban 1.7 6.8 91.1 0.4 100.0 98.1 1,041 5.6 1,022
Rural 2.9 9.2 87.1 0.8 100.0 89.5 6,212 8.4 5,562
Province
Banteay Meanchey 7.0 6.8 83.0 3.2 100.0 94.6 253 6.6 240
Kampong Cham 4.3 8.6 85.4 1.7 100.0 92.9 1,008 6.9 936
Kampong Chhnang 1.8 4.6 93.6 0.0 100.0 99.6 248 8.9 247
Kampong Speu 7.4 11.0 81.6 0.0 100.0 90.7 469 9.3 425
Kampong Thom 1.1 3.1 95.8 0.0 100.0 85.0 337 8.4 286
Kandal 0.4 9.1 90.5 0.0 100.0 93.1 523 7.6 486
Kratie 10.3 10.7 79.0 0.0 100.0 70.5 269 11.5 190
Phnom Penh 1.0 6.1 92.9 0.0 100.0 98.2 626 5.7 615
Prey Veng 1.2 6.7 92.1 0.0 100.0 97.8 499 9.9 488
Pursat 0.3 10.7 88.6 0.5 100.0 86.9 298 4.4 259
Siem Reap 2.3 16.6 80.5 0.6 100.0 94.5 487 12.2 460
Svay Rieng 3.5 6.7 89.4 0.4 100.0 89.3 261 11.9 233
Takeo 1.9 3.1 94.5 0.5 100.0 98.4 386 8.2 380
Otdar Meanchey 0.8 9.3 89.3 0.6 100.0 94.2 137 8.5 129
Battambang/Pailin 0.5 9.2 89.0 1.4 100.0 93.5 553 5.2 517
Kampot/Kep 0.9 12.3 85.7 1.1 100.0 87.6 276 6.1 241
Preah Sihanouk/
Koh Kong 1.1 6.3 91.7 0.9 100.0 94.1 168 6.6 158
Preah Vihear/
Stung Treng 2.5 5.2 92.4 0.0 100.0 72.1 239 7.8 172
Mondul Kiri/
Ratanak Kiri 3.7 25.0 68.3 3.1 100.0 55.8 217 9.2 121
Mother’s education
No education 3.9 11.7 82.1 2.3 100.0 77.9 1,017 11.9 792
Primary 2.6 8.4 88.3 0.7 100.0 90.1 3,795 7.3 3,419
Secondary and higher 2.4 8.4 89.1 0.1 100.0 97.2 2,442 7.5 2,373
Wealth quintile
Lowest 3.8 10.1 85.0 1.1 100.0 80.2 1,771 10.8 1,420
Second 2.4 9.1 87.6 0.9 100.0 88.1 1,453 8.2 1,279
Middle 2.9 9.7 86.7 0.7 100.0 94.0 1,362 7.3 1,280
Fourth 2.7 8.0 88.8 0.5 100.0 96.5 1,252 7.6 1,209
Highest 1.5 6.9 91.3 0.3 100.0 98.6 1,415 5.6 1,395
Total 2.7 8.8 87.7 0.7 100.0 90.8 7,253 7.9 6,584
Note: Total includes 1 birth with missing information on mother’s smoking status
1 Based on either a written record or the mother’s recall
14.2 IMMUNIZATION OF CHILDREN
Universal immunization of children against six vaccine-preventable diseases (namely,
tuberculosis, diphtheria, whooping cough, tetanus, polio, and measles) is crucial to reducing infant and
child mortality. Data on differences in vaccination coverage among subgroups of the population are of
Child Health • 153
great assistance for program planning. In addition, information on immunization coverage is important for
monitoring and evaluation of the Expanded Program on Immunization.
Similar to the previous CDHS, the 2014 CDHS collected information on vaccination coverage for
all living children born in the five years preceding the survey. Guidelines developed by the World Health
Organization define children as fully vaccinated when they have received a vaccination against
tuberculosis (BCG); three doses each of the diphtheria, pertussis, and tetanus (DPT) and polio vaccines;
and a measles vaccination by age 12 months. BCG should be given at birth or at first clinical contact; DPT
and polio require three vaccinations at approximately age 4, 8, and 12 weeks. Measles should be given at
or soon after age 9 months. In 2006, the Cambodian National Immunization Program replaced the DPT
vaccine with a tetravalent vaccine that includes DPT and Haemophilus influenzae type b vaccine (Hib) and
a pentavalent vaccine that includes DPT, Hib, and hepatitis B vaccine (HepB). The program also
administers HepB vaccine at birth or at first clinical contact (HB 0).
Information on vaccination coverage was collected in two ways: from vaccination cards shown to
the interviewer and from mothers’ verbal reports. If cards were available, the interviewer copied the
vaccination dates directly onto the questionnaire. When there was no vaccination card for the child or if a
vaccine had not been recorded on the card as being given, the respondent was asked to recall the vaccines
given to her child. The top three rows of Table 14.2 show the percentage of children age 12-23 months
who have received various vaccinations by source of information, that is, from the vaccination card or a
mother’s report. Data are presented only for those children who have reached the age by which they should
be fully vaccinated (i.e., age 12-23 months) so as to provide estimates of the most recent vaccination
coverage.
Table 14.2 Vaccinations by source of information
Percentage of children age 12-23 months who received specific vaccines at any time before the survey, by source of information (vaccination card or mother’s
report), and percentage vaccinated by age 12 months, Cambodia 2014
Source of information BCG
Tetravalent/pentavalent
HB 01
Polio
Measles
All basic
vaccinations2
No vaccinations
Number
of children 1 2 3 1 2 3
Vaccinated at any
time before survey
Vaccination card 76.4 75.4 72.8 68.6 65.1 75.9 72.0 67.2 63.4 60.0 0.0 1,129
Mother’s report 19.7 18.6 17.6 15.1 17.7 18.9 17.6 15.1 15.2 13.5 2.4 332
Either source 96.1 94.0 90.4 83.7 82.8 94.8 89.5 82.3 78.6 73.4 2.4 1,460
Vaccinated by age
12 months3 95.9 93.6 89.7 81.9 82.6 94.5 88.8 80.2 70.3 65.3 2.6 1,460
1 HB 0 is hepatitis B vaccine given at birth.
2 BCG, measles, and three doses each of tetravalent/pentavalent and polio vaccine
3 For children whose information was based on the mother’s report, the proportion of vaccinations given during the first year of life was assumed to be the same
as for children with a written record of vaccination.
The last row of Table 14.2 shows that two-thirds of children (65 percent) age 12-23 months were
fully vaccinated by age 12 months. Nearly all children had received the BCG vaccination and the first two
doses of tetravalent/pentavalent vaccine or polio vaccine (89 percent to 96 percent), and 70 percent had
been vaccinated against measles. Because the tetravalent/pentavalent and polio vaccines are often
administered at the same time, their coverage rates are similar. Eighty-two percent and 80 percent of
children received the third doses of tetravalent/pentavalent and polio vaccines, respectively. When looking
at the proportion of children who received vaccines at any time before the survey (not necessarily before
age 12 months), the percentages are higher, with 73 percent fully vaccinated.
Table 14.3 shows vaccination coverage at any time before the survey among children age 12-23
months by background characteristics. These data may provide certain information for the assessment of
the immunization program in reaching out to all population subgroups. The vaccination coverage rates of
male and female children are practically the same. Children in urban areas are more likely to be fully
vaccinated than those in rural areas (86 percent versus 71 percent). Also, there are substantial differences
in coverage across provinces. The percentage of children fully vaccinated is lowest in Mondul
154 • Child Health
Kiri/Ratanak Kiri (44 percent), Preah Vihear/Stung Treng (56 percent), and Kampong Cham (57 percent).
The provinces with the highest proportion of children fully vaccinated are Banteay Meanchey (91 percent),
Phnom Penh (89 percent), Battambang/Pailin (89 percent), and Takeo (88 percent).
The percentage of children fully vaccinated increases substantially with increasing mother’s
education. Children of mothers with a secondary education or higher are much more likely to be fully
vaccinated (84 percent) than children whose mothers have no schooling (58 percent). The percentage of
children fully vaccinated also increases according to the wealth of the household; children living in the
wealthiest households are more likely to be fully vaccinated (91 percent) than children from the poorest
households (61 percent).
Table 14.3 Vaccinations by background characteristics
Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother’s report), and
percentage with a vaccination card, by background characteristics, Cambodia 2014
Background
characteristic BCG
Tetravalent/pentavalent
HB 01
Polio
Measles
All basic
vaccinations2
No vaccinations
Percentage with a
vaccination card
seen
Number
of children 1 2 3 1 2 3
Sex
Male 96.2 93.4 90.4 83.0 81.8 94.3 90.3 82.6 79.1 73.9 2.6 77.2 750
Female 96.0 94.5 90.4 84.3 83.8 95.3 88.7 82.0 78.1 73.0 2.2 77.4 711
Birth order
1 98.1 94.6 91.5 87.2 85.1 96.7 91.5 86.5 80.9 76.0 1.0 80.3 586
2-3 94.7 93.9 90.8 83.9 81.9 94.2 89.3 82.2 79.1 74.1 3.3 75.3 648
4-5 95.6 94.9 88.1 75.3 83.2 94.9 87.7 73.1 73.1 68.2 2.2 74.7 181
6+ (91.7) (82.4) (80.6) (67.2) (63.6) (77.1) (73.9) (65.9) (63.8) (52.4) (6.7) (78.6) 45
Residence
Urban 97.6 99.1 97.3 92.9 87.9 98.5 96.8 90.0 90.7 86.4 0.5 71.3 217
Rural 95.8 93.1 89.2 82.1 81.9 94.1 88.3 80.9 76.5 71.2 2.7 78.3 1,244
Province
Banteay Meanchey 96.4 96.6 95.4 94.0 86.3 96.6 95.4 94.0 93.4 91.3 1.6 88.8 63
Kampong Cham 95.0 81.1 81.1 70.6 77.1 86.6 78.7 71.1 64.1 56.8 4.7 67.6 182
Kampong Chhnang 100.0 98.2 92.9 86.3 98.3 98.2 92.9 86.3 74.6 74.6 0.0 77.5 52
Kampong Speu 97.1 97.3 90.1 78.2 74.5 97.3 88.4 78.2 66.5 66.5 1.4 87.9 90
Kampong Thom 97.6 94.8 90.3 82.0 96.0 96.4 91.9 82.0 74.1 70.9 2.4 86.3 77
Kandal 100.0 100.0 97.3 81.5 83.9 100.0 91.3 74.1 75.2 64.5 0.0 80.9 89
Kratie 86.5 89.5 81.8 72.8 62.3 88.6 83.9 72.5 79.7 65.1 7.7 72.1 57
Phnom Penh 98.6 100.0 98.6 93.1 86.3 98.6 98.2 90.0 91.0 89.1 0.0 69.6 145
Prey Veng 95.2 89.8 79.2 76.0 60.2 89.8 79.2 76.0 63.2 61.7 4.8 68.8 101
Pursat 95.3 94.0 90.6 83.3 88.0 95.6 92.2 84.5 88.9 79.7 3.0 84.4 60
Siem Reap 98.2 99.0 93.7 90.9 95.4 99.0 93.7 86.6 85.1 78.6 1.0 91.9 100
Svay Rieng 92.4 90.9 90.9 88.8 71.5 90.9 90.9 88.8 86.7 82.7 5.6 72.4 53
Takeo 96.5 99.8 99.5 97.9 98.1 99.8 94.8 93.1 94.2 87.8 0.2 89.7 84
Otdar Meanchey 97.4 92.7 85.6 83.4 77.2 94.8 87.7 81.8 85.3 75.0 2.6 71.7 27
Battambang/Pailin 99.5 98.4 98.4 95.4 88.5 98.4 98.4 95.4 89.6 89.2 0.0 81.2 120
Kampot/Kep 94.0 93.1 88.6 80.0 93.8 93.1 88.6 80.0 81.1 72.0 2.0 70.7 54
Preah Sihanouk/
Koh Kong 98.0 98.0 96.2 92.0 93.3 98.0 96.2 89.9 86.4 82.6 2.0 79.7 28
Preah Vihear/
Stung Treng 91.9 93.1 89.5 79.3 72.8 93.1 87.8 77.7 62.8 55.6 1.2 74.6 44
Mondul Kiri/
Ratanak Kiri 81.4 79.7 67.4 55.9 62.8 83.9 65.2 54.1 56.1 43.9 10.6 41.1 35
Mother’s education
No education 91.6 85.4 78.6 69.0 70.1 83.8 76.3 68.9 65.5 58.4 5.9 73.6 197
Primary 96.0 93.2 88.8 80.0 83.0 94.6 88.5 78.7 75.3 69.7 2.8 79.1 732
Secondary and
higher 97.9 98.2 97.0 94.1 87.1 99.1 95.9 92.1 88.0 84.2 0.5 76.2 532
Wealth quintile
Lowest 93.1 88.3 81.1 71.6 75.2 89.1 80.5 71.7 65.9 60.9 4.5 72.4 369
Second 92.4 91.9 86.7 78.3 77.9 93.1 86.0 77.0 71.7 65.4 5.2 76.5 285
Middle 98.8 93.1 91.0 82.5 84.7 95.7 89.8 80.2 77.7 70.0 0.4 84.1 267
Fourth 99.3 99.2 98.0 94.3 88.3 98.7 97.7 93.7 87.6 85.2 0.5 83.5 253
Highest 98.3 99.4 98.9 96.2 90.7 99.5 97.2 92.9 94.7 90.5 0.2 72.6 286
Total 96.1 94.0 90.4 83.7 82.8 94.8 89.5 82.3 78.6 73.4 2.4 77.3 1,460
Note: Figures in parentheses are based on 25-49 unweighted cases.
1 HB 0 is hepatitis B vaccine given at birth.
2 BCG, measles, and three doses each of tetravalent/pentavalent and polio vaccine
Child Health • 155
Trends in vaccination coverage can be seen by comparing similarly collected data in the previous
CDHS surveys (2000, 2005, and 2010) with data from the 2014 CDHS (Figure 14.1). The data show that
full vaccination coverage in Cambodia substantially improved from 2000 to 2005. From 2005 to 2010,
vaccination coverage further improved but at a smaller increment than the increase between 2000 and
2005. However, between 2010 and 2014 vaccination coverage has declined, from 74 percent to 65 percent.
Examining trends for individual vaccines reveals that the decline in full coverage is largely due to
decreases in coverage of measles and polio 3 vaccinations, particularly measles.
Figure 14.1 Trends in vaccination by age 12 months among
children age 12-23 months, 2000-2014
14.3 ACUTE RESPIRATORY INFECTION
Acute respiratory infection (ARI) is one of the leading causes of childhood morbidity and
mortality throughout the world. Early diagnosis and treatment with antibiotics can prevent a large
proportion of deaths caused by ARI. In the 2014 CDHS, the prevalence of ARI was estimated by asking
mothers whether their children under age 5 had been ill with a cough accompanied by short, rapid
breathing in the two weeks preceding the survey. These symptoms are compatible with ARI. It should be
noted that the morbidity data collected are subjective—that is, they are based on the mother’s perception of
illness with no validation from medical personnel—and that the prevalence of ARI is subject to
seasonality.
Table 14.4 shows the percentage of children under age 5 with symptoms of ARI during the two
weeks preceding the survey according to selected background characteristics. Six percent of children under
age 5 showed ARI symptoms at some point in the two weeks preceding the survey. Only about 3 percent of
children under age 6 months experienced ARI symptoms. The prevalence of ARI increased to 6 percent
among children age 6-11 months and 7 percent among those age 12-23 months. After age 23 months, ARI
prevalence decreased with increasing age. The prevalence of ARI was significantly higher among children
whose mothers smoke (10 percent) than among children whose mothers do not smoke (5 percent). There
was only minor variation in the prevalence of ARI symptoms between urban and rural children.
65
70
80
89
95
82
90
94
96
74
77
84
90
93
84
89
93
94
60
70
74
84
90
76
84
90
91
31
41
45
59
69
43
53
63
66
All vaccines
Measles
Polio 3
Polio 2
Polio 1
DPT/tetravalent/
pentavalent 3
DPT/tetravalent/
pentavalent 2
DPT/tetravalent/
pentavalent 1
BCG
Percentage
2000 CDHS
2005 CDHS
2010 CDHS
2014 CDHS
"All vaccines" includes BCG, measles and three doses each
of DPT or tetravalent or pentavalent and polio vaccine.
156 • Child Health
Table 14.4 Prevalence and treatment of symptoms of ARI
Among children under age 5, the percentage who had symptoms of acute respiratory infection (ARI) in the two weeks preceding the
survey, and among children with symptoms of ARI, the percentage for whom advice or treatment was sought from a health facility or
provider and the percentage who received antibiotics as treatment, according to background characteristics, Cambodia 2014
Among children under age 5: Among children under age 5 with symptoms of ARI:
Background
characteristic
Percentage with
symptoms of ARI1
Number of
children
Percentage for whom
advice or treatment
was sought from a
health facility or
provider2
Percentage who
received antibiotics
Number of
children
Age in months
<6 2.9 736 * * 22
6-11 5.9 761 (75.9) (82.9) 45
12-23 7.4 1,460 68.8 85.2 109
24-35 6.0 1,368 64.6 80.2 82
36-47 5.5 1,343 61.8 77.8 73
48-59 4.1 1,376 78.2 80.2 56
Sex
Male 5.7 3,522 62.2 77.8 201
Female 5.3 3,523 75.9 85.0 186
Mother’s smoking
status
Smokes cigarettes/
tobacco 10.0 202 * * 20
Does not smoke 5.4 6,842 70.1 82.1 367
Cooking fuel
Electricity 0.7 47 na na 0
LPG 5.8 1,150 62.3 77.9 67
Biogas * 1 na na 0
Coal/lignite 5.0 554 (78.7) (86.1) 28
Charcoal 5.5 5,269 69.0 81.6 290
Wood/straw/
agricultural crop3 * 19 * * 2
No food cooked in
household * 3 na na 0
Residence
Urban 5.4 1,033 69.6 74.4 56
Rural 5.5 6,011 68.6 82.4 332
Province
Banteay Meanchey 5.6 250 * * 14
Kampong Cham 5.7 974 * * 56
Kampong Chhnang 11.8 236 (94.6) (98.3) 28
Kampong Speu 3.9 457 * * 18
Kampong Thom 4.1 327 * * 13
Kandal 3.6 506 * * 18
Kratie 10.5 254 (59.6) (79.3) 27
Phnom Penh 6.4 618 (62.8) (72.9) 39
Prey Veng 3.8 478 * * 18
Pursat 3.5 294 * * 10
Siem Reap 10.2 470 (75.0) (82.8) 48
Svay Rieng 5.5 253 * * 14
Takeo 6.5 374 * * 24
Otdar Meanchey 3.5 134 * * 5
Battambang/Pailin 3.4 545 * * 18
Kampot/Kep 4.0 272 * * 11
Preah Sihanouk/
Koh Kong 11.8 164 (78.4) (50.4) 19
Preah Vihear/
Stung Treng 1.7 228 * * 4
Mondul Kiri/
Ratanak Kiri 1.3 208 * * 3
Mother’s education
No education 5.3 973 (66.1) (76.9) 52
Primary 6.5 3,687 66.8 82.3 239
Secondary and
higher 4.1 2,384 74.9 81.2 97
Wealth quintile
Lowest 7.1 1,689 67.9 89.0 119
Second 5.3 1,403 64.9 77.2 74
Middle 5.0 1,332 78.1 81.1 67
Fourth 5.4 1,217 67.3 74.8 66
Highest 4.4 1,404 66.5 78.3 61
Total 5.5 7,044 68.8 81.3 387
Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25
unweighted cases and has been suppressed.
na = Not applicable
LPG = Liquid petroleum gas
1 Symptoms of ARI (cough accompanied by short, rapid breathing that was chest-related) are considered a proxy for pneumonia.
2 Excludes pharmacy, shop, and traditional practitioner
3 Includes grass, shrubs, and crop residues
Child Health • 157
The proportion of children with ARI symptoms was negatively associated with wealth quintile.
Seven percent of children living in households in the lowest wealth quintile experienced ARI symptoms, as
compared with 4 percent of children living in households in the highest wealth quintile. There were
significant provincial variations in the prevalence of ARI, ranging from a low of 1 percent in Mondul
Kiri/Ratanak Kiri to a high of 12 percent in Kampong Chhnang and Preah Sihanouk/Koh Kong.
About 7 of 10 children under age 5 (69 percent) with a cough and rapid breathing were taken to a
health facility or provider to seek treatment or advice. Children of mothers with no schooling or with a
primary education were less likely to receive treatment for ARI symptoms (66-67 percent) than were
children of mothers with a secondary education or higher (75 percent). About 8 in 10 children with ARI
symptoms were given antibiotics.
14.4 FEVER
Fever is a primary manifestation of several acute infections in children. Fever and other infections
can contribute to high levels of malnutrition and mortality. The 2014 CDHS asked mothers whether their
children experienced fever during the two weeks preceding the survey.
Table 14.5 shows the percentage of children under age 5 who had a fever during the two weeks
preceding the survey according to selected background characteristics. Overall, 28 percent of children
under age 5 had a fever at some time in the two weeks preceding the survey. The prevalence of fever
varied by the age of the child, and children age 6-11 months and 12-23 months were more commonly sick
with fever (35 percent and 36 percent, respectively) than other children. The prevalence of fever among
boys was slightly higher than that among girls. There were no significant differences by residence in the
prevalence of fever.
Provincial variations, however, were significant; fever prevalence ranged from a low of 11 percent
in Kampot/Kep to a high of 40 percent in Battambang/Pailin. Mother’s education and wealth quintile had
little association with the prevalence of fever among children less than age 5.
Sixty-one percent of all children under age 5 with a fever were taken to a health facility or
provider to seek treatment or advice. Children of mothers with a primary education and a secondary
education or higher were more likely to receive treatment for fever (61 percent and 62 percent,
respectively) than children of mothers with no schooling (56 percent). The proportion of children for
whom treatment was sought from a health facility or provider was highest in Kampong Chhnang (95
percent) and lowest in Mondul Kiri/Ratanak Kiri (44 percent).
Less than 1 percent of children with a fever received antimalarial drugs, whereas 73 percent
received antibiotic drugs. Use of antibiotic drugs was more common in urban areas (75 percent) than in
rural areas (64 percent). Mothers in Kampong Chhnang, Takeo, Svay Rieng, and Kampong Thom were
most likely to use antibiotic drugs to treat fever (90 percent or more).
158 • Child Health
Table 14.5 Prevalence and treatment of fever
Among children under age 5, the percentage who had a fever in the two weeks preceding the survey, and among children with fever,
the percentage for whom advice or treatment was sought from a health facility or provider, the percentage who took antimalarial
drugs, and the percentage who received antibiotics as treatment, by background characteristics, Cambodia 2014
Among children under age 5: Among children under age 5 with fever:
Background
characteristic
Percentage with
fever
Number of
children
Percentage for
whom advice or
treatment was
sought from a
health facility or
provider1
Percentage who
took antimalarial
drugs
Percentage who
took antibiotic
drugs
Number of
children
Age in months
<6 19.9 736 54.5 0.0 73.3 146
6-11 35.1 761 64.5 0.0 82.4 267
12-23 35.7 1,460 61.7 0.4 77.4 521
24-35 30.1 1,368 58.6 0.4 68.3 412
36-47 24.7 1,343 61.8 0.5 71.4 332
48-59 21.0 1,376 59.7 0.2 67.7 289
Sex
Male 29.3 3,522 57.4 0.3 72.8 1,030
Female 26.6 3,523 64.1 0.3 74.1 937
Residence
Urban 28.3 1,033 57.9 0.2 63.8 292
Rural 27.9 6,011 61.1 0.3 75.1 1,675
Province
Banteay Meanchey 23.6 250 48.9 2.2 61.1 59
Kampong Cham 31.0 974 53.6 0.0 75.1 302
Kampong Chhnang 30.1 236 94.9 0.0 96.4 71
Kampong Speu 21.4 457 49.4 0.0 81.1 98
Kampong Thom 20.6 327 76.9 0.0 90.2 67
Kandal 26.0 506 68.2 0.0 79.4 132
Kratie 34.1 254 71.7 1.1 77.1 87
Phnom Penh 37.0 618 59.5 0.0 53.2 229
Prey Veng 14.5 478 (85.2) (0.0) (77.5) 69
Pursat 19.6 294 47.0 0.0 52.9 58
Siem Reap 34.6 470 49.5 0.9 55.6 163
Svay Rieng 17.5 253 84.9 0.0 89.8 44
Takeo 33.7 374 53.5 0.0 93.5 126
Otdar Meanchey 16.3 134 53.7 8.4 79.3 22
Battambang/Pailin 40.0 545 57.3 0.0 87.4 218
Kampot/Kep 11.2 272 (68.1) (0.0) (57.3) 30
Preah Sihanouk/
Koh Kong 35.7 164 69.3 0.0 58.6 59
Preah Vihear/
Stung Treng 32.6 228 67.4 0.0 77.0 74
Mondul Kiri/
Ratanak Kiri 28.7 208 44.1 0.0 51.7 60
Mother’s education
No education 24.3 973 56.2 0.1 73.5 237
Primary 28.9 3,687 60.8 0.4 73.5 1,064
Secondary and
higher 28.0 2,384 61.8 0.1 73.3 667
Wealth quintile
Lowest 29.2 1,689 61.8 0.3 74.5 493
Second 25.0 1,403 67.0 0.1 75.5 351
Middle 28.6 1,332 55.8 0.5 78.4 381
Fourth 27.8 1,217 59.1 0.5 71.4 339
Highest 28.8 1,404 59.3 0.0 67.4 404
Total 27.9 7,044 60.6 0.3 73.4 1,967
Note: Figures in parentheses are based on 25-49 unweighted cases.
1 Excludes pharmacy, shop, and traditional practitioner
14.5 DIARRHEA
Dehydration caused by severe diarrhea is a major cause of morbidity and mortality among young
children, although the condition can be easily treated with oral rehydration therapy (ORT). Exposure to
diarrhea-causing agents is frequently related to the use of contaminated water and to unhygienic practices
in food preparation and disposal of excreta.
Child Health • 159
Table 14.6 shows the percentage of children under age 5 with diarrhea in the two weeks preceding
the survey according to selected background characteristics. Overall, 13 percent of all children under age 5
had diarrhea, and 2 percent had diarrhea with blood.
Table 14.6 Prevalence of diarrhea
Percentage of children under age 5 who had diarrhea in the two weeks preceding the
survey, by background characteristics, Cambodia 2014
Background
characteristic
Diarrhea in the two weeks preceding
the survey Number of
children All diarrhea Diarrhea with blood
Age in months
<6 12.8 0.5 736
6-11 20.0 2.3 761
12-23 19.0 2.4 1,460
24-35 13.7 2.0 1,368
36-47 7.4 1.3 1,343
48-59 6.6 0.6 1,376
Sex
Male 13.4 1.7 3,522
Female 12.2 1.4 3,523
Residence
Urban 12.5 1.4 1,033
Rural 12.9 1.6 6,011
Province
Banteay Meanchey 13.0 3.3 250
Kampong Cham 12.8 2.3 974
Kampong Chhnang 10.6 0.9 236
Kampong Speu 10.5 0.6 457
Kampong Thom 6.1 0.5 327
Kandal 9.0 0.2 506
Kratie 17.0 2.4 254
Phnom Penh 17.2 2.6 618
Prey Veng 4.7 0.7 478
Pursat 8.2 0.3 294
Siem Reap 16.9 2.5 470
Svay Rieng 5.6 0.0 253
Takeo 18.9 4.2 374
Otdar Meanchey 10.2 0.1 134
Battambang/Pailin 20.9 0.5 545
Kampot/Kep 5.1 0.9 272
Preah Sihanouk/
Koh Kong 17.0 3.0 164
Preah Vihear/
Stung Treng 19.3 2.2 228
Mondul Kiri/
Ratanak Kiri 15.6 0.8 208
Mother’s education
No education 13.3 2.2 973
Primary 12.9 1.3 3,687
Secondary and higher 12.4 1.6 2,384
Wealth quintile
Lowest 16.1 2.2 1,689
Second 11.8 1.6 1,403
Middle 10.5 1.4 1,332
Fourth 13.6 1.3 1,217
Highest 11.3 1.1 1,404
Source of drinking water
during dry season1
Improved 11.4 1.5 4,472
Not improved 15.2 1.6 2,571
Source of drinking water
during rainy season1,2
Improved 12.3 1.6 5,833
Not improved 15.3 1.5 1,208
Toilet facility3
Improved, not shared 11.0 1.2 2,941
Non-improved or shared 14.1 1.8 4,103
Total 12.8 1.5 7,044
1 See Table 2.6 for definition of categories.
2 Not including 4 missing cases
3 See Table 2.7 for definition of categories.
160 • Child Health
The occurrence of diarrhea varies by age of the child. Similar to fever, young children age 6-11
and 12-23 months are more prone to diarrhea (20 percent and 19 percent, respectively) than children in the
other age groups. The prevalence of diarrhea is about the same among rural children and urban children,
and there is no variation by sex of the child. However, there are significant variations in the prevalence of
diarrhea by province. Children living in Battambang/Pailin (21 percent), Preah Vihear/Stung Treng (19
percent), and Takeo (19 percent) are more susceptible to episodes of diarrhea than children living in other
provinces. Children living in Kampot/Kep and Prey Veng have the lowest prevalence of diarrhea (5
percent each). The prevalence of diarrhea is higher among children who live in the poorest households, in
households without an improved source of drinking water (in both the dry and rainy seasons), and in
households with a non-improved or shared toilet facility.
The 2014 CDHS asked mothers of children under age 5 who had diarrhea what was done to treat
the illness. Table 14.7 shows the percentage of children with diarrhea who received specific treatments
according to background characteristics. Fifty-six percent of children with diarrhea were taken to a health
provider. A larger percentage of children in rural areas and children living in the poorest households were
taken to a health provider than other children. Children with bloody diarrhea are much more likely to be
taken to a health provider. There is little variation by sex of the child in whether or not treatment for
diarrhea was sought.
Comparable data from the 2010 CDHS show that the percentage of children with diarrhea taken to
a health provider has not changed significantly (59 percent in 2010 versus 56 percent in 2014).
Fifty-seven percent of children with diarrhea were treated with a solution prepared from an oral
rehydration salt (ORS) packet or tablet or were given increased fluids. Very few children with diarrhea
were treated with antibiotics, antimotility drugs, or other medicines. Almost one in five children (18
percent) with diarrhea did not receive any treatment at all.
Diarrhea treatment varied by age: 39 percent of children less than age 6 months received ORT or
increased fluids, as compared with 58-62 percent of children age 6 months and older. Children who had
diarrhea with blood were more likely than children with non-bloody diarrhea to receive ORT or increased
fluids (68 percent versus 56 percent).
Child Health • 161
Table 14.7 Diarrhea treatment
Among children under age 5 who had diarrhea in the two weeks preceding the survey, the percentage for whom advice or treatment was sought from a health
facility or provider, the percentage given oral rehydration therapy (ORT), the percentage given increased fluids, the percentage given ORT or increased fluids,
and the percentage who were given other treatments, by background characteristics, Cambodia 2014
Percentage of
children with
diarrhea for whom
advice or treatment
was sought from a
health facility or
provider1
Oral
rehydration
therapy
(ORT)
Increased
fluids
ORT or
increased
fluids
Other treatments
No treatment
Number
of children
with
diarrhea
Background
characteristic
Antibiotic
drugs
Antimotility
drugs
Zinc
supplements
Intravenous
solution
Home
remedy/
other
Age in months
<6 43.6 18.7 29.1 39.1 5.5 5.8 4.1 0.0 27.0 42.0 94
6-11 58.1 39.2 38.3 61.7 4.2 0.0 9.7 2.8 62.4 14.1 152
12-23 57.4 35.9 36.8 57.7 3.9 2.0 6.6 1.0 68.2 13.3 277
24-35 54.8 33.5 38.6 60.1 2.8 2.0 1.7 1.0 62.2 17.5 188
36-47 57.3 38.5 35.3 57.7 7.4 2.3 3.5 0.8 55.2 16.6 100
48-59 56.7 43.5 34.1 59.0 5.4 3.4 5.6 4.2 59.4 12.1 91
Sex
Male 53.1 37.4 35.7 56.2 4.3 2.4 5.6 1.0 57.2 18.6 473
Female 58.1 32.9 36.7 58.0 4.5 2.0 5.2 2.1 61.7 16.4 429
Type of diarrhea2
Non-bloody 53.4 32.7 36.4 55.6 3.7 2.3 4.8 1.2 57.9 18.8 786
Bloody 72.6 53.9 34.7 68.3 7.2 0.0 9.9 4.1 72.2 7.9 109
Residence
Urban 47.0 30.2 40.1 59.1 3.8 0.9 3.3 2.7 65.3 19.2 129
Rural 56.9 36.1 35.5 56.7 4.5 2.5 5.8 1.3 58.3 17.3 772
Province
Banteay Meanchey (52.1) (34.9) (18.5) (41.9) (13.3) (0.0) (0.0) (0.0) (39.1) (33.4) 32
Kampong Cham (52.6) (34.1) (32.3) (51.5) (3.1) (0.0) (0.0) (2.3) (71.5) (10.5) 124
Kampong Chhnang (84.7) (77.2) (8.3) (78.3) (7.0) (0.0) (20.4) (5.4) (63.9) (14.2) 25
Kampong Speu (63.3) (23.6) (49.9) (56.4) (0.9) (0.0) (0.7) (0.0) (87.8) (6.8) 48
Kampong Thom * * * * * * * * * * 20
Kandal * * * * * * * * * * 46
Kratie 59.8 20.2 32.8 47.4 1.1 0.0 18.4 0.0 70.5 18.7 43
Phnom Penh 57.5 33.5 52.0 69.2 2.9 0.5 3.1 3.8 73.6 14.9 107
Prey Veng * * * * * * * * * * 23
Pursat (31.0) (49.7) (54.1) (57.0) (0.7) (4.4) (11.0) (0.0) (49.4) (8.0) 24
Siem Reap 48.1 54.4 46.9 80.5 10.4 4.0 27.7 0.0 29.1 11.0 79
Svay Rieng * * * * * * * * * * 14
Takeo 52.5 57.7 37.5 74.3 10.0 0.0 0.0 4.2 56.7 16.3 71
Otdar Meanchey (29.9) (22.6) (11.1) (22.6) (2.3) (3.5) (3.5) (2.5) (69.4) (23.7) 14
Battambang/Pailin 48.3 22.3 46.5 62.2 7.5 13.1 1.4 0.0 46.9 17.9 114
Kampot/Kep * * * * * * * * * * 14
Preah Sihanouk/Koh
Kong 58.8 47.9 30.4 63.4 2.4 0.0 8.4 0.0 41.1 26.4 28
Preah Vihear/Stung
Treng 60.3 28.4 20.7 40.0 0.0 0.0 0.0 4.5 53.0 29.0 44
Mondul Kiri/Ratanak
Kiri 53.3 42.8 12.8 45.7 0.0 0.0 0.0 0.0 57.2 25.4 32
Mother’s education
No education 58.8 46.3 34.4 61.3 1.7 1.5 7.6 0.0 57.6 15.1 129
Primary 55.2 34.6 33.1 54.9 5.5 2.8 5.3 1.8 55.7 21.0 477
Secondary and
higher 54.3 31.4 41.9 58.6 3.9 1.7 4.6 1.7 65.9 13.0 296
Wealth quintile
Lowest 62.0 39.8 33.2 56.3 2.9 2.3 6.3 2.2 62.0 16.2 271
Second 53.6 35.2 34.0 53.5 8.7 2.2 5.5 0.0 57.5 17.8 166
Middle 57.8 41.6 31.0 57.1 0.2 0.8 4.8 1.4 55.3 20.9 140
Fourth 55.7 30.6 39.5 57.6 5.8 5.2 4.4 0.8 60.0 12.2 166
Highest 43.8 26.7 44.7 61.4 4.9 0.3 5.3 2.5 59.6 22.1 158
Total 55.5 35.2 36.2 57.0 4.4 2.2 5.4 1.5 59.3 17.5 902
Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has
been suppressed. ORT includes fluid prepared from oral rehydration salt (ORS) packets and ORS tablets.
1 Excludes pharmacy, shop, and traditional practitioner
2 Excludes 7 cases for which information on type of diarrhea is missing
14.6 FEEDING PRACTICES
Mothers are normally encouraged to continue feeding children with diarrhea and to increase the
amount of fluids given. These practices help to reduce dehydration and minimize the adverse consequences
of diarrhea on the child’s nutritional status. Mothers were asked whether they gave their child less, the
same amount, or more fluids and food than usual when the child had diarrhea. Table 14.8 shows the
percent distribution of children under age 5 who had diarrhea in the two weeks preceding the survey by
feeding practices, according to background characteristics.
16
2

C
hi ld H
ea lth
Ta bl e 14
.8
F
ee di ng p ra ct ic es d ur in g di ar rh ea P
er ce nt d is tri
bu tio
n of c hi ld re n un de r ag e 5
w ho h ad d ia rr he a in th e tw o w ee ks p re ce di ng th e su rv ey b y am ou nt o f l
iq ui ds a nd fo od o ffe
re d co m pa re d w ith
n or m al p ra ct ic e, th e pe rc en ta ge o f c
hi ld re n gi ve n in cr ea se d flu
id s an d co nt in ue d fe ed in g du rin
g th e di ar rh ea e pi so de , a
nd th e pe rc en ta ge o f c
hi ld re n w ho c on tin
ue d fe ed in g an d w er e gi ve n O
R
T
an d/ or in cr ea se d flu
id s du rin
g th e ep is od e of d ia rr he a, b y ba ck gr ou nd c ha ra ct er is tic
s, C
am bo di a 20
14
A
m ou nt o f l
iq ui ds g iv en A
m ou nt o f f
oo d gi ve n P
er ce nt ag e gi ve n in cr ea se d flu
id s an d co nt in ue d fe ed in g1 ,2
P
er ce nt ag e w ho co nt in ue d fe ed in g an d w er e gi ve n O
R
T
an d/ or in cr ea se d flu
id s3 N
um be r o
f ch ild
re n w ith
di ar rh ea B
ac kg ro un d ch ar ac te ris
tic
M
or e S
am e as us ua l S
om ew ha t le ss M
uc h le ss N
on e D
on ’t
kn ow /
m is si ng To ta l M
or e S
am e as us ua l S
om ew ha t le ss M
uc h le ss N
on e N
ev er ga ve fo od D
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kn ow /
m is si ng To ta l A
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td ar M
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ia rr he a is m is si ng 162 • Child Health
Child Health • 163
Fifty-one percent of children who had diarrhea were given the same amount of liquid as usual, and
36 percent were given more. Eight percent of children were given somewhat less than the usual amount,
and 3 percent were given much less than the usual amount. Less than 1 percent of children who had
diarrhea were given no liquids.
Regarding the amount of food offered to children who had diarrhea, 59 percent were given the
same as usual, 15 percent were given more than usual, another 15 percent were given somewhat less than
usual, 2 percent were given much less than usual, and less than 1 percent did not receive food during their
illness.
Overall, one-third of children with diarrhea were given increased fluids with continued feeding
(i.e., more, the same amount as usual, or somewhat less to eat). Just over half of children with diarrhea
continued feeding and were given ORT and/or increased fluids.
Children under age 6 months were more likely than older
children to receive the same amount of liquid or more during
episodes of diarrhea. Children with bloody diarrhea were less
likely than those with non-bloody diarrhea to receive the same
amount of food or more.
14.7 KNOWLEDGE OF ORS PACKETS
A simple and effective response to dehydration caused by
diarrhea is a prompt increase in the child’s fluid intake through
some form of oral rehydration therapy, which may include the use
of a solution prepared from packets of oral rehydration salts. To
ascertain how widespread knowledge of ORS is in Cambodia,
respondents were asked whether they know about ORS packets or
Oralyte/Orasel. Interviewers displayed a sample ORS packet to
respondents when asking the question.
Table 14.9 shows that nearly all (96 percent) of the
women who gave birth in the five years preceding the survey
know about ORS packets. In the 2010 CDHS, almost the same
proportion of women reported knowing about ORS packets
(95 percent).
Young mothers age 15-19 are less likely than older
mothers to know about ORS. Mothers with no schooling are less
likely to know about ORS packets (90 percent) than mothers with
a primary school education (96 percent) or a secondary education
or higher (98 percent). Mothers in Mondul Kiri/Ratanak Kiri
(82 percent) are least likely to know about ORS packets.
14.8 STOOL DISPOSAL
If human feces are left uncontained, disease may spread
by direct contact or by animal contact with the feces. Hence, the
proper disposal of children’s stools is extremely important in
preventing the spread of disease. Table 14.10 presents information
on disposal of the stools of children under age 5, by background
characteristics.
Almost 30 percent of children’s stools are left uncontained: 5 percent are put or rinsed into a drain
or ditch, 6 percent are thrown into the garbage, and 19 percent are rinsed away. Seventy-one percent of
Table 14.9 Knowledge of ORS packets or prepackaged liquids
Percentage of women age 15-49 with a live birth
in the five years preceding the survey who know
about ORS for treatment of diarrhea, by
background characteristics, Cambodia 2014
Background
characteristic
Percentage
of women
who know
about ORS
Number of
women
Age
15-19 82.1 213
20-24 94.9 1,442
25-34 97.2 3,345
35-49 94.9 974
Residence
Urban 98.4 876
Rural 95.3 5,096
Province
Banteay Meanchey 95.1 219
Kampong Cham 92.8 819
Kampong Chhnang 100.0 203
Kampong Speu 95.6 395
Kampong Thom 100.0 279
Kandal 92.6 420
Kratie 90.7 214
Phnom Penh 99.2 535
Prey Veng 99.7 405
Pursat 98.0 245
Siem Reap 99.5 379
Svay Rieng 99.1 229
Takeo 96.3 321
Otdar Meanchey 95.3 116
Battambang/Pailin 98.5 460
Kampot/Kep 89.3 236
Preah Sihanouk/
Koh Kong 96.2 142
Preah Vihear/
Stung Treng 91.4 188
Mondul Kiri/
Ratanak Kiri 82.4 169
Education
No education 89.8 805
Primary 95.8 3,100
Secondary and
higher 98.0 2,068
Wealth quintile
Lowest 93.0 1,359
Second 93.9 1,215
Middle 96.0 1,133
Fourth 97.1 1,069
Highest 99.3 1,196
Total 95.8 5,973
ORS = Oral rehydration salts
164 • Child Health
children’s stools are disposed of hygienically: 39 percent are buried in the yard, 15 percent are disposed of
in a toilet or latrine, and 16 percent of children under age 5 use a toilet or latrine.
The stools of children less than age 6 months (47 percent) were less likely to be disposed of
hygienically than the stools of older children. There are significant differences in stool disposal practices
by mother’s level of education. Stools are disposed of hygienically (the child uses a toilet, the child’s stool
is thrown in a toilet or buried in the yard) for 75 percent of children whose mothers have a secondary
education or higher, as compared with 60 percent of children of mothers with no schooling.
Proper disposal of children’s stools does not differ between urban and rural areas. However, there
are large provincial variations in stool disposal practices. The percentage of children whose stools are
contained through safe disposal ranges from a low of 35 percent in Mondul Kiri/Ratanak Kiri and 46
percent in Kampot/Kep to a high of 91 percent in Kampong Chhnang.
Table 14.10 Disposal of children’s stools
Percent distribution of youngest children under age 5 living with their mother by the manner of disposal of the child’s last fecal matter, and percentage of children
whose stools are disposed of safely, according to background characteristics, Cambodia 2014
Manner of disposal of children’s stools
Total
Percentage
of children
whose
stools are
disposed of
safely1
Number of
children
Background
characteristic
Child used
toilet or
latrine
Put/rinsed
into toilet
or latrine Buried
Put/rinsed
into drain
or ditch
Thrown
into
garbage
Not
disposed
of, left in
the open Other Missing
Age in months
<6 1.5 14.8 30.8 16.6 16.4 19.4 0.3 0.2 100.0 47.0 717
6-11 4.3 17.9 41.1 7.2 11.0 18.5 0.0 0.0 100.0 63.3 745
12-23 7.5 18.5 43.7 3.7 6.1 20.3 0.1 0.1 100.0 69.7 1,398
24-35 15.5 19.0 41.7 2.4 3.2 18.2 0.0 0.0 100.0 76.2 1,142
36-47 25.9 9.5 42.6 1.3 0.6 19.9 0.0 0.1 100.0 78.1 949
48-59 42.0 9.8 31.3 1.6 0.2 15.1 0.0 0.0 100.0 83.1 874
Residence
Urban 31.0 33.4 6.9 4.2 20.4 4.1 0.0 0.0 100.0 71.3 836
Rural 13.6 12.3 44.8 4.9 3.2 21.2 0.1 0.1 100.0 70.6 4,988
Province
Banteay Meanchey 17.7 18.0 45.1 6.1 6.4 6.7 0.0 0.0 100.0 80.8 218
Kampong Cham 8.2 13.6 51.9 1.9 1.8 22.6 0.0 0.0 100.0 73.6 802
Kampong Chhnang 8.4 11.9 70.6 1.7 1.8 5.6 0.0 0.0 100.0 91.0 198
Kampong Speu 15.5 9.9 45.4 1.1 4.4 23.6 0.0 0.0 100.0 70.9 389
Kampong Thom 17.8 10.3 56.8 1.1 5.0 8.6 0.3 0.0 100.0 85.0 271
Kandal 28.5 16.4 38.8 4.8 2.5 8.9 0.0 0.0 100.0 83.7 412
Kratie 5.2 12.2 43.5 6.9 2.4 29.8 0.1 0.0 100.0 60.9 205
Phnom Penh 32.5 29.6 4.3 5.2 24.4 3.9 0.0 0.0 100.0 66.5 503
Prey Veng 16.5 5.3 46.9 1.0 0.1 30.3 0.0 0.0 100.0 68.7 397
Pursat 8.0 16.9 40.9 8.6 2.2 23.4 0.0 0.0 100.0 65.8 243
Siem Reap 9.7 12.4 57.8 11.2 6.2 2.2 0.0 0.4 100.0 80.0 370
Svay Rieng 25.8 8.5 29.4 6.7 2.1 27.5 0.0 0.0 100.0 63.7 223
Takeo 16.1 30.2 27.6 1.7 2.2 22.1 0.0 0.0 100.0 74.0 317
Otdar Meanchey 14.8 10.4 31.9 0.0 3.0 39.9 0.0 0.0 100.0 57.1 113
Battambang/Pailin 20.0 19.9 38.5 12.6 3.2 5.5 0.4 0.0 100.0 78.5 449
Kampot/Kep 7.4 7.2 31.5 6.2 14.5 32.7 0.0 0.5 100.0 46.1 232
Preah Sihanouk/
Koh Kong 21.2 26.4 15.2 5.2 16.5 15.0 0.0 0.5 100.0 62.8 136
Preah Vihear/
Stung Treng 2.9 12.5 34.6 4.6 2.8 42.6 0.0 0.0 100.0 50.0 183
Mondul Kiri/
Ratanak Kiri 18.0 6.9 10.1 4.6 5.5 54.5 0.4 0.0 100.0 35.0 164
Mother’s education
No education 8.4 5.4 46.2 4.5 1.6 34.0 0.1 0.0 100.0 59.9 774
Primary 14.3 11.6 44.7 5.7 3.9 19.7 0.0 0.1 100.0 70.6 3,041
Secondary and
higher 21.8 24.7 28.6 3.6 9.8 11.3 0.1 0.1 100.0 75.1 2,009
Wealth quintile
Lowest 1.5 1.3 57.3 4.7 1.9 33.1 0.0 0.1 100.0 60.2 1,327
Second 7.0 6.2 51.0 6.5 2.1 27.0 0.0 0.0 100.0 64.3 1,181
Middle 13.5 12.9 48.9 5.3 2.6 16.7 0.0 0.1 100.0 75.3 1,119
Fourth 26.2 25.2 28.3 4.8 5.1 10.2 0.2 0.0 100.0 79.8 1,050
Highest 35.6 34.1 7.2 2.7 17.1 3.2 0.1 0.0 100.0 76.9 1,147
Total 16.1 15.3 39.3 4.8 5.7 18.7 0.1 0.1 100.0 70.7 5,824
1 Children’s stools are considered to be disposed of safely if the child used a toilet or latrine, if the fecal matter was put/rinsed into a toilet or latrine, or if it was
buried.
Early Childhood Education and Development • 165
EARLY CHILDHOOD EDUCATION AND
DEVELOPMENT 15
Key Findings
• Fifteen percent of children age 36-59 months are attending an organized
early childhood education program.
• Fifty-nine percent of children engaged with an adult household member
(including parents) in four or more activities that promote learning and
school readiness during the three days before the survey.
• Only 4 percent of children under age 5 have at least three children’s
books.
• One in 10 children under age 5 had been left alone or left in the care of
other children under age 10 for one hour or more during the week
preceding the interview.
hildren are the foundation of sustainable development. The early years of life are crucial not only
for individual health and physical development, but also for cognitive and social-emotional
development. Events in the first few years of life are formative and play a vital role in building
human capital, breaking the cycle of poverty, promoting economic productivity, and eliminating social
disparities and inequities. This chapter provides key data on early childhood education and development
collected in the 2014 CDHS. These data will help the Cambodian government, civil society, communities,
and other stakeholders design and implement programs and policies that help young children reach their
full potential by supporting families and communities and increasing access to quality early childhood care
and education.
15.1 EARLY CHILDHOOD EDUCATION AND LEARNING
The readiness of children for primary school can be improved through early childhood education
programs such as preschools. Early childhood education programs include programs that have organized
learning components; they do not include those characterized primarily as baby-sitting or day-care
programs, which typically do not include organized learning activities. In the 2014 CDHS, women with a
child born in the five years before the survey were asked questions regarding early childhood education
and learning. In the case of women with more than one child under age 5, questions referred to the
youngest child.
The data show that 15 percent of children age 36-59 months are attending an organized early
childhood education program (Table 15.1). Children living in urban areas (36 percent) are much more
likely to attend an early childhood education program than children living in rural areas (11 percent).
Participation in early childhood education varies substantially by province, from a high of 40 percent
among children in Phnom Penh to a low of only 5 percent among children in Pursat. Considerable
differences are observed by mother’s education and household wealth quintile. Only 7 percent of children
whose mothers have no education attend an early childhood education program, as compared with 26
percent of children whose mothers have a secondary education or higher. Thirty-eight percent of children
living in the richest households attend an early childhood education program, compared with only 7
percent of children in the poorest households.
It is recognized that a period of rapid brain development occurs in the first three to four years of
life and that the quality of home care is the major determinant of a child’s development during this period.
In this context, the amount of “quality time” adults spend with children, the presence of children’s books in
C
166 • Early Childhood Education and Development
the home, opportunities for play to stimulate the imagination, and conditions of care are all important
indicators of quality of home care. Children should be physically healthy, mentally alert, emotionally
secure, socially competent, and ready to learn.
Information on a number of activities that support
early learning was collected for children age 3-4 who were
living with their mothers. The activities asked about
focused on the involvement of adults with children in the
following activities: reading books or looking at picture
books; telling stories; singing songs; taking children
outside the home, compound, or yard; playing with
children; and spending time with children naming,
counting, or drawing things.
Table 15.2 shows the percentage of children age
36-59 months who engaged with an adult household
member in activities that promote learning and school
readiness within the three days prior to the survey. Fiftynine percent of children engaged with an adult household
member (including parents) in four or more such activities.
The average number of activities in which adults engaged
with children was 4.6. Nearly all (92 percent) children age
36-59 months live with their biological fathers; of these
children, only 9 percent engaged with their father in four or
more early educational activities. The average number of
activities in which fathers involved themselves with
children was 1.1. The involvement of mothers in early
childhood learning activities was somewhat better than that
of fathers. Seventeen percent of children engaged with their
mothers in four or more such activities, with an average of
1.7 activities.
There was only a slight difference between boys
and girls with respect to adults’ engagement in activities
that promote learning and school readiness. A larger
percentage of children in urban areas (72 percent) than
rural areas (57 percent) engaged with adults in early
education activities. Strong differentials are observed by
educational level of the mother and father, as well as by
socioeconomic status. The percentage of children who have
an adult engage with them in four or more learning
activities rises steadily with increasing parents’ education
and increasing household wealth. For example, 73 percent
of children living in the richest households had an adult engage with them in four or more learning-related
activities, as opposed to 48 percent of those living in the poorest households. Patterns by background
characteristics in fathers’ and mothers’ involvement in such activities were similar.
Table 15.1 Early childhood education
Percentage of children age 36-59 months who are attending
an organized early childhood education program, according
to background characteristics, Cambodia 2014
Background
characteristic
Percentage of
children age 3659 months
attending early
childhood
education1
Number of
children age
36-59 months
Age in months
36-47 7.3 1,303
48-59 21.7 1,314
Child’s sex
Male 11.9 1,303
Female 17.1 1,314
Residence
Urban 36.4 348
Rural 11.2 2,269
Province
Banteay Meanchey 18.2 73
Kampong Cham 7.0 395
Kampong Chhnang 14.9 91
Kampong Speu 19.2 178
Kampong Thom 15.9 119
Kandal 12.0 181
Kratie 5.6 93
Phnom Penh 39.8 209
Prey Veng 11.4 188
Pursat 4.7 101
Siem Reap 15.1 184
Svay Rieng 9.7 102
Takeo 8.7 146
Otdar Meanchey 13.9 48
Battambang/Pailin 24.0 178
Kampot/Kep 8.3 104
Preah Sihanouk/
Koh Kong 21.2 60
Preah Vihear/
Stung Treng 11.1 83
Mondul Kiri/
Ratanak Kiri 7.4 85
Mother’s education
No education 7.2 413
Primary 10.3 1,423
Secondary and
higher 26.1 782
Wealth quintile
Lowest 6.6 661
Second 7.2 564
Middle 7.9 473
Fourth 16.4 423
Highest 38.1 497
Total 14.5 2,617
1 Not including baby-sitting or day care
Early Childhood Education and Development • 167
Table 15.2 Support for learning
Percentage of children age 36-59 months living with their mothers with whom adult household members engaged in four or more activities that promote learning
and school readiness during the last three days, the mean number of such activities, and engagement in such activities by biological fathers and mothers,
according to background characteristics, Cambodia 2014
Background
characteristic
Percentage
of children
with whom
adult
household
members1
have
engaged in
four or more
activities2
Mean
number of
activities
with adult
household
members
Percentage
of children
living with
their
biological
father
Number of
children age
36-59
months
Percentage
of children
with whom
biological
fathers have
engaged in
four or more
activities
Mean
number of
activities
with
biological
fathers
Number of
children age
36-59
months
living with
their
biological
fathers
Percentage
of children
with whom
biological
mothers
have
engaged in
four or more
activities
Mean
number of
activities
with
biological
mothers
Number of
children age
36-59
months
Age in months
36-47 59.0 4.5 93.3 1,303 8.3 1.1 1,216 16.0 1.7 1,303
48-59 59.7 4.7 90.4 1,314 9.0 1.2 1,187 18.0 1.7 1,314
Child’s sex
Male 56.5 4.4 90.9 1,303 7.5 1.1 1,185 15.7 1.6 1,303
Female 62.2 4.7 92.7 1,314 9.8 1.1 1,218 18.4 1.8 1,314
Residence
Urban 71.9 5.2 88.6 348 11.8 1.4 309 24.0 2.2 348
Rural 57.4 4.5 92.3 2,269 8.2 1.1 2,094 16.0 1.6 2,269
Province
Banteay Meanchey 57.3 4.2 92.0 73 8.8 0.9 67 14.9 1.7 73
Kampong Cham 78.9 5.5 92.2 395 12.4 1.6 365 18.5 2.2 395
Kampong Chhnang 74.7 6.1 86.6 91 7.9 1.3 79 29.3 2.5 91
Kampong Speu 35.6 2.8 95.4 178 3.8 1.0 170 6.3 1.1 178
Kampong Thom 64.8 5.0 97.3 119 4.8 0.8 115 7.4 0.9 119
Kandal 71.5 5.9 93.7 181 11.9 1.4 170 29.4 2.5 181
Kratie 32.1 2.6 94.9 93 1.2 0.5 88 6.7 1.0 93
Phnom Penh 79.9 5.6 88.8 209 10.7 1.6 185 24.1 2.3 209
Prey Veng 79.4 7.0 86.9 188 30.8 2.3 163 49.0 3.3 188
Pursat 55.5 4.2 95.2 101 7.7 1.0 96 17.5 1.9 101
Siem Reap 35.2 2.9 90.3 184 4.2 0.4 166 4.4 0.8 184
Svay Rieng 35.5 2.8 92.6 102 7.2 0.8 94 8.3 1.2 102
Takeo 57.0 4.1 89.4 146 2.4 0.7 131 11.6 1.1 146
Otdar Meanchey 70.2 5.6 95.8 48 10.3 1.1 46 10.5 1.3 48
Battambang/Pailin 45.3 3.0 89.5 178 0.0 0.3 159 1.3 0.4 178
Kampot/Kep 42.5 3.8 94.1 104 1.3 0.7 97 17.7 1.4 104
Preah Sihanouk/
Koh Kong 70.6 6.1 92.1 60 11.6 1.4 55 31.6 2.7 60
Preah Vihear/
Stung Treng 70.2 5.7 93.4 83 8.0 1.1 77 16.0 1.7 83
Mondul Kiri/
Ratanak Kiri 20.0 2.3 91.7 85 5.5 0.7 78 5.1 0.5 85
Mother’s education
No education 45.3 3.7 92.2 413 4.8 0.8 380 7.6 1.1 413
Primary 57.2 4.3 92.2 1,423 7.3 1.0 1,312 12.8 1.5 1,423
Secondary and higher 70.6 5.6 90.8 782 13.2 1.5 710 29.7 2.3 782
Father’s education
No education 42.6 3.3 100.0 241 1.0 0.6 241 6.9 1.1 241
Primary 55.8 4.2 100.0 1,145 5.2 0.9 1,145 13.5 1.5 1,145
Secondary and higher 68.2 5.3 100.0 1,016 14.3 1.5 1,016 22.4 2.0 1,016
Not living with father 55.1 4.2 0.0 214 0.0 0.0 0 21.6 1.8 214
Wealth quintile
Lowest 48.2 3.9 94.6 661 5.0 0.9 625 10.9 1.4 661
Second 53.7 4.1 92.5 564 5.7 0.9 521 15.3 1.4 564
Middle 60.7 4.6 89.5 473 9.4 1.1 423 17.2 1.7 473
Fourth 66.6 5.1 91.2 423 10.1 1.3 386 18.0 1.8 423
Highest 73.1 5.6 90.1 497 15.3 1.6 447 26.2 2.2 497
Total 59.3 4.6 91.8 2,617 8.6 1.1 2,403 17.0 1.7 2,617
1 Including parents or other adult members of the household
2 Including the following activities: reading books or looking at picture books; telling stories; singing songs; taking children outside the home, compound, or yard;
playing with children; and spending time with children naming, counting, or drawing things
Exposure to books in the early years not only provides children with a greater understanding of the
nature of print but may also give them opportunities to see others reading (e.g., older siblings doing
schoolwork). The presence of books is also important for later school performance. Mothers of children
age under age 5 were asked about the number of children’s books or picture books they have. By
stimulating the imagination, play also contributes to brain development. Mothers were asked what items
168 • Early Childhood Education and Development
children play with, including homemade toys, toys purchased from a shop, and other household objects or
objects found around or outside the home.
In Cambodia, only 4 percent of children under age 5 have at least three children’s books (Table
15.3). One factor that contributes to the relatively low figure is that questions were asked about the
woman’s youngest child under age 5. Consequently, Table 15.3 does not adequately reflect older children
in this age group but, rather, is disproportionally based on younger children.
No differences are observed between boys and girls. A higher percentage of urban than rural
children have access to three or more children’s books (11 percent and 3 percent, respectively).
Table 15.3 also shows that 34 percent of children under age 5 play with two or more types of
playthings: homemade toys (including dolls and cars), toys purchased from a store, and household objects
(such as pots and bowls) along with objects and materials found outside the home (such as sticks, rocks,
animal shells, and leaves). Nearly 1 in 2 children (48 percent) play with toys that come from a store, while
23 percent play with homemade toys. The percentage of children who play with two or more types of
playthings is higher in urban areas than in rural areas. This percentage increases with increasing mother’s
education and household wealth.
Table 15.3 Learning materials
Percentage of the youngest children under age 5 with three or more children’s books and percentage who play with various types of
playthings, according to background characteristics, Cambodia 2014
Percentage of
children who
have 3 or more
children’s books
Percentage of children who play with:
Background
characteristic Homemade toys
Toys from a
shop/
manufactured
toys
Household
objects/objects
found outside
Two or more
types of
playthings
Number of
children under
age 5
Age in months
0-23 1.6 16.4 37.4 21.5 21.4 2,859
24-59 6.1 29.4 57.7 50.5 45.5 2,964
Child’s sex
Male 3.9 24.1 50.7 35.9 34.8 2,912
Female 3.9 21.9 44.9 36.6 32.5 2,912
Residence
Urban 10.8 22.5 73.8 46.1 48.6 836
Rural 2.7 23.1 43.4 34.6 31.2 4,988
Province
Banteay Meanchey 6.3 57.0 51.1 47.1 54.3 218
Kampong Cham 4.5 15.1 53.4 29.3 27.7 802
Kampong Chhnang 1.5 34.8 27.2 16.9 17.5 198
Kampong Speu 2.5 17.3 57.0 50.1 42.9 389
Kampong Thom 0.2 26.8 41.1 50.2 36.2 271
Kandal 4.0 24.2 67.8 30.0 31.3 412
Kratie 1.5 3.7 46.4 14.2 11.8 205
Phnom Penh 11.0 6.9 78.8 57.0 54.3 503
Prey Veng 1.9 38.1 43.1 41.9 40.3 397
Pursat 1.9 32.0 36.6 42.0 33.8 243
Siem Reap 5.5 25.2 30.6 37.9 27.6 370
Svay Rieng 1.6 31.9 29.3 18.8 28.4 223
Takeo 4.3 17.7 28.2 20.3 22.1 317
Otdar Meanchey 6.3 35.6 33.0 41.0 38.0 113
Battambang/Pailin 3.6 8.9 52.6 43.3 33.1 449
Kampot/Kep 1.4 20.6 30.8 18.2 23.0 232
Preah Sihanouk/
Koh Kong 7.0 43.0 64.3 39.8 50.8 136
Preah Vihear/
Stung Treng 0.7 35.4 23.2 45.0 33.6 183
Mondul Kiri/
Ratanak Kiri 1.9 25.7 50.0 21.6 25.2 164
Mother’s education
No education 1.6 17.3 27.3 31.6 19.7 774
Primary 1.5 21.9 43.5 36.1 31.3 3,041
Secondary and
higher 8.4 26.8 62.0 38.3 42.6 2,009
Wealth quintile
Lowest 1.0 17.5 24.9 31.0 19.6 1,327
Second 1.4 22.1 32.8 32.7 26.4 1,181
Middle 1.3 22.7 46.8 33.7 31.0 1,119
Fourth 4.4 27.8 58.0 38.7 41.2 1,050
Highest 11.9 26.3 81.2 46.2 53.0 1,147
Total 3.9 23.0 47.8 36.2 33.7 5,824
Early Childhood Education and Development • 169
15.2 ADEQUATE CARE FOR YOUNG CHILDREN
Leaving children alone or only in the presence of other young children is known to increase the
risk of accidents. In the 2014 CDHS, mothers were asked two questions to establish whether their youngest
child age 0-59 months had been left alone during the week preceding the interview for one hour or more
and whether the child was left in the care of other children under age 10 for one hour or more.
Table 15.4 shows that 8 percent of children under age 5 had been left in the care of other children
under age 10. Five percent of children under age 5 were left completely alone (under the care of no one)
for at least one hour during the week preceding the interview. A child under age 5 left only in the care of
another child or left alone is considered inadequately cared for. According to the data, 1 in 10 children
under age 5 received inadequate care.
Table 15.4 Inadequate care
Percentage of youngest children under age 5 who were left alone or left in the care of another
child younger than age 10 for more than one hour at least once during the past week, according
to background characteristics, Cambodia 2014
Background
characteristic
Left alone in the
past week
Left in the care
of another child
younger than
age 10 in the
past week
Left with
inadequate care
in the past week
Number of
children under
age 5
Age in months
0-23 2.6 5.4 6.3 2,859
24-59 6.9 10.1 13.3 2,964
Child’s sex
Male 5.2 7.2 10.1 2,912
Female 4.4 8.4 9.6 2,912
Residence
Urban 2.5 3.2 4.8 836
Rural 5.2 8.6 10.7 4,988
Province
Banteay Meanchey 2.8 0.4 3.3 218
Kampong Cham 11.9 9.4 14.9 802
Kampong Chhnang 7.3 8.1 10.7 198
Kampong Speu 3.4 5.3 6.3 389
Kampong Thom 0.0 0.0 0.0 271
Kandal 1.5 7.4 7.6 412
Kratie 2.3 11.0 11.3 205
Phnom Penh 1.7 2.0 3.3 503
Prey Veng 0.7 0.2 0.7 397
Pursat 10.8 12.4 16.3 243
Siem Reap 7.9 12.6 16.7 370
Svay Rieng 3.8 4.6 5.9 223
Takeo 1.9 4.6 4.6 317
Otdar Meanchey 11.1 17.4 20.1 113
Battambang/Pailin 5.2 21.0 23.8 449
Kampot/Kep 1.9 9.0 9.0 232
Preah Sihanouk/
Koh Kong 4.7 13.2 14.7 136
Preah Vihear/
Stung Treng 3.2 8.0 9.9 183
Mondul Kiri/
Ratanak Kiri 3.1 5.0 5.5 164
Mother’s education
No education 10.5 14.5 19.9 774
Primary 4.9 8.5 10.1 3,041
Secondary and
higher 2.4 4.2 5.5 2,009
Wealth quintile
Lowest 8.0 12.1 15.6 1,327
Second 5.7 9.6 11.3 1,181
Middle 4.5 6.8 8.9 1,119
Fourth 3.8 6.1 7.9 1,050
Highest 1.3 3.6 4.4 1,147
Total 4.8 7.8 9.8 5,824
170 • Early Childhood Education and Development
Children age 24-59 months were twice as likely to be left without adequate care (13 percent) as
children age 0-23 months (6 percent). There was no variation in the proportion left with inadequate care by
sex of the child. A higher percentage of rural children (11 percent) than urban children (5 percent) received
inadequate care, and there were substantial differences by province. In addition, differences were observed
with regard to both the educational level of the mother and the socioeconomic status of the household. The
proportion of children who were left with inadequate care was three times higher among those whose
mothers had no education than among those whose mothers had a secondary education or higher (20
percent versus 6 percent). Similarly, 16 percent of children living in the poorest households were left with
inadequate care, as compared with 4 percent of children living in the wealthiest households.
15.3 EARLY CHILDHOOD DEVELOPMENT
Early child development is defined as an orderly, predictable process along a continuous path in
which a child learns to handle more complicated levels of moving, thinking, speaking, feeling, and relating
to others. Physical growth, literacy and numeracy skills, socio-emotional development, and readiness to
learn are vital domains of a child’s overall development, which is a basis for overall human development.
A 10-item module was used to calculate the Early Child Development Index (ECDI). The ECDI is
based on benchmarks that children are expected to reach if they are progressing in their development at a
pace similar to the majority of children in their age group. The primary purpose of the ECDI is to inform
public policy regarding the developmental status of children in Cambodia. Each of the 10 items is used in
one of four domains to determine whether children are developmentally on track in that domain. The
domains in question are as follows.
• Literacy-numeracy: Children are identified as being developmentally on track according to
whether they can identify/name at least 10 letters of the alphabet; whether they can read at
least four simple, popular words; and whether they know the names and recognize the
symbols of all numbers from 1 to 10. If at least two of these capabilities are observed, the
child is considered developmentally on track.
• Physical: If the child can pick up a small object such as a stick or a rock from the ground with
two fingers and/or the mother does not indicate that the child is sometimes too sick to play,
then the child is regarded as being developmentally on track in the physical domain.
• Social-emotional: A child is considered to be developmentally on track if two of the
following are true: the child gets along well with other children; the child does not kick, bite,
or hit other children; and the child does not become distracted easily.
• Learning: If the child follows simple directions on how to do something correctly and/or
when given something to do, and is able to do it independently, then the child is considered to
be developmentally on track in this domain.
The ECDI score is calculated as the percentage of children who are developmentally on track in at
least three of these four domains.
The percentages of children age 36-59 months who are developmentally on track in the literacynumeracy, physical, social-emotional, and learning domains, as well as ECDI scores, are presented in
Table 15.5. Analysis of the four domains of child development shows that at least 7 in 10 children are on
track in the physical, social-emotional, and learning domains (70-91 percent). However, only about 1 in 4
children age 36-59 months (27 percent) are developmentally on track in literacy-numeracy. There is
practically no difference in literacy-numeracy between boys and girls. A much higher proportion of urban
children than rural children are on track in the literacy-numeracy domain (43 percent versus 25 percent).
Forty-one percent of children whose mothers have a secondary education or higher are on track in the
literacy-numeracy domain, as compared with only 13 percent of children whose mothers have no
education. Nearly half of children (46 percent) in the richest households are on track in the literacynumeracy domain, compared with 18 percent of children in the poorest households.
Early Childhood Education and Development • 171
Table 15.5 Early Child Development Index
Percentage of children age 36-59 months who are developmentally on track in literacy-numeracy, physical, social-emotional, and
learning domains, and the Early Child Development Index score, according to background characteristics, Cambodia 2014
Percentage of children age 36-59 months who are developmentally on
track for indicated domains Early Child
Development
Index score2
Number of
children age
36-59 months
Background
characteristic
Literacynumeracy1 Physical1
Socialemotional1 Learning1
Age in months
36-47 21.0 89.2 70.1 88.5 64.7 1,303
48-59 33.6 93.5 69.6 90.8 71.7 1,314
Child’s sex
Male 26.6 91.2 69.0 89.7 67.1 1,303
Female 28.1 91.6 70.7 89.7 69.3 1,314
Residence
Urban 42.5 94.9 72.6 95.5 78.2 348
Rural 25.0 90.8 69.4 88.8 66.7 2,269
Province
Banteay Meanchey 55.9 98.8 82.5 98.8 88.7 73
Kampong Cham 28.8 88.3 73.1 93.9 68.4 395
Kampong Chhnang 59.1 100.0 79.5 85.6 85.8 91
Kampong Speu 7.7 97.6 67.5 74.6 49.1 178
Kampong Thom 32.0 85.1 78.6 93.9 69.3 119
Kandal 23.4 77.9 53.4 98.6 49.3 181
Kratie 14.3 81.2 66.3 83.5 55.1 93
Phnom Penh 48.0 97.7 77.3 98.1 84.2 209
Prey Veng 48.9 93.5 89.7 92.8 90.9 188
Pursat 14.7 97.6 70.8 88.7 67.4 101
Siem Reap 15.4 92.0 64.6 86.1 61.0 184
Svay Rieng 18.5 95.2 67.1 90.8 70.1 102
Takeo 25.4 85.3 58.8 76.4 60.0 146
Otdar Meanchey 17.7 75.6 54.1 81.9 48.6 48
Battambang/Pailin 8.3 97.0 76.1 97.5 80.3 178
Kampot/Kep 39.9 97.7 72.6 93.2 76.8 104
Preah Sihanouk/
Koh Kong 49.2 96.7 76.1 94.4 86.6 60
Preah Vihear/
Stung Treng 4.4 96.4 72.9 95.4 68.6 83
Mondul Kiri/
Ratanak Kiri 12.6 83.2 20.7 57.5 24.8 85
Mother’s education
No education 12.9 89.0 69.9 88.2 61.4 413
Primary 24.1 90.5 68.7 88.8 65.7 1,423
Secondary and
higher 40.8 94.1 71.9 92.0 76.3 782
Wealth quintile
Lowest 18.0 88.5 67.5 85.3 61.0 661
Second 21.4 92.6 70.5 89.9 67.3 564
Middle 23.7 91.5 69.2 89.7 66.2 473
Fourth 32.2 90.4 70.3 89.7 69.4 423
Highest 45.8 94.5 72.5 95.1 79.7 497
Total 27.3 91.4 69.8 89.7 68.2 2,617
1 See the text for the items included in each domain.
2 Percentage of children who are developmentally on track for at least three of the four domains
Seven in 10 children age 36-59 months (68 percent) are developmentally on track (i.e., on track in
at least three of the four domains). Urban children are more likely than rural children to be
developmentally on track (78 percent versus 67 percent). The proportion of children developmentally on
track varies substantially by province, from a low of 25 percent in Mondul Kiri/Ratanak Kiri to a high of
91 percent in Prey Veng. ECDI scores are positively associated with mother’s education and household
wealth (Table 15.5).
Nutrition of Children and Women • 173
NUTRITION OF CHILDREN AND WOMEN 16
Key Findings
• Thirty-two percent of children under age 5 are stunted, 10 percent are
wasted, and 24 percent are underweight.
• Breastfeeding is nearly universal in Cambodia. Ninety-six percent of
children born in the last two years have been breastfed.
• The median duration of breastfeeding among children born in the three
years before the survey is 18 months.
• Sixty-five percent of children less than age 6 months are exclusively
breastfed, and the median duration of exclusive breastfeeding is four
months.
• More than 8 in 10 (82 percent) children age 6-8 months (both breastfed
and nonbreastfed) are introduced to complementary foods at an
appropriate time.
• Overall, 30 percent of children age 6-23 months are fed appropriately
based on recommended infant and young child feeding (IYCF) practices.
• Fourteen percent of women age 15-49 are underweight, that is, they fall
below the body mass index (BMI) cutoff of 18.5. Eighteen percent of
women are overweight or obese. The percentage of women who are
overweight or obese has increased steadily over the last decade.
• Three-quarters (76 percent) of women age 15-49 with a birth in the last
five years took iron tablets or syrup during the pregnancy of their last birth
for more than 90 days, 72 percent took deworming medication during
their most recent pregnancy, and 49 percent received iron
supplementation postpartum.
utritional status is the result of complex interactions between food consumption and the overall
status of health and care practices. Numerous socioeconomic and cultural factors influence
decisions on patterns of feeding and nutritional status. Adequate nutrition is critical to child
development. The period from birth to age 2 is important to optimal growth, health, and development.
During this period, children who do not receive adequate nutrition can be susceptible to growth faltering,
micronutrient deficiencies, and common childhood illnesses such as diarrhea and acute respiratory
infections. Among women, malnutrition can result in reduced productivity, an increased susceptibility to
infections, slow recovery from illness, and a heightened risk of adverse pregnancy outcomes. A woman
who has poor nutritional status, as indicated by a low body mass index (BMI), short stature, anemia, or
other micronutrient deficiency, has a greater risk of obstructed labor, of having a baby with a low birth
weight, of producing lower quality breast milk, of mortality due to postpartum hemorrhage, and of
morbidity for both herself and her baby.
The 2014 CDHS asked questions about early initiation of breastfeeding, exclusive breastfeeding
during the first six months of life, continued breastfeeding until at least age 2, timely introduction of
complementary foods at age 6 months (with increasing frequency of feeding solid and semisolid foods),
and diet diversity. The height and weight of all children under age 5 and women age 15-49 were measured.
This chapter presents findings on infant feeding practices, maternal eating patterns, household testing of
salt for adequate levels of iodine, and the nutritional status of women and children.
N
174 • Nutrition of Children and Women
16.1 NUTRITIONAL STATUS OF CHILDREN
Nutritional status of children under age 5 is an important measure of children’s health. The
anthropometric data on height and weight collected in the 2014 CDHS permit the evaluation of the
nutritional status of young children in Cambodia.
16.1.1 Measurement of Nutritional Status among Young Children
In addition to questions about feeding practices of infants and young children, the 2014 CDHS
included an anthropometric component in which children under age 5 in a subsample of two-thirds of the
survey households were measured for height and weight. Weight measurements were taken using a
lightweight electronic SECA scale designed and manufactured under the guidance of the United Nations
Children’s Fund (UNICEF). The scale allowed for the weighing of very young children through an
automatic mother-child adjustment that eliminated the mother’s weight while she was standing on the scale
with her baby. Height measurements were carried out using a SECA measuring board also produced under
the guidance of UNICEF. Children younger than age 24 months were measured lying down (recumbent
length) on the board, whereas standing height was measured for older children. Based on these
measurements, three internationally accepted indices were constructed and are used to reflect the
nutritional status of children. These are:
• Height-for-age (stunting)
• Weight-for-height (wasting)
• Weight-for-age (underweight)
In the 2005 CDHS, children’s anthropometric measurements were compared with an international
reference population defined by the U.S. National Center for Health Statistics (NCHS) and accepted by the
U.S. Centers for Disease Control and Prevention (CDC). However, in the 2010 and 2014 CDHS surveys,
as recommended by the World Health Organization (WHO), the nutritional status of children in the survey
population was compared with the 2006 WHO child growth standards (WHO, 2006), which are based on
an international sample (from Brazil, Ghana, India, Norway, Oman, and the United States) of ethnically,
culturally, and genetically diverse healthy children living under optimum conditions conducive to
achieving a child’s full genetic growth potential. The 1977 NCHS/CDC/WHO reference was replaced with
the 2006 WHO child growth standards because of the prescriptive rather than descriptive nature of the
WHO standards versus the NCHS reference. Also, the 2006 WHO child growth standards identify the
breastfed child as the normative model for growth and development and document how children should
grow under optimum conditions and infant feeding and child health practices.
The use of the 2006 WHO child growth standards is based on the finding that well-nourished
children in all population groups for which data exist follow very similar growth patterns before puberty.
The internationally based standard population serves as a point of comparison, facilitating examination of
differences in the anthropometric status of subgroups in a population and of changes in nutritional status
over time.
The height-for-age index is an indicator of linear growth retardation and cumulative growth
deficits. Children whose height-for-age Z-score is below minus two standard deviations (-2 SD) from the
mean of the reference population are considered short for their age (stunted) and are chronically
malnourished. Children who are below minus three standard deviations (-3 SD) from the mean of the
reference population are considered severely stunted. Stunting reflects failure to receive adequate nutrition
over a long period of time and is also affected by recurrent and chronic illness. Height-for-age, therefore,
represents the long-term effects of malnutrition in a population and does not vary according to recent
dietary intake.
Nutrition of Children and Women • 175
The weight-for-height index measures body mass in relation to body length and describes current
nutritional status. Children whose Z-scores are below minus two standard deviations (-2 SD) from the
mean of the reference population are considered thin (wasted) for their height and are acutely
malnourished. Wasting represents the failure to receive adequate nutrition in the period immediately
preceding the survey and may be the result of inadequate food intake or a recent episode of illness causing
loss of weight and the onset of malnutrition. Children whose weight-for-height is below minus three
standard deviations (-3 SD) from the mean of the reference population are considered severely wasted.
Overweight and obesity are other forms of malnutrition that are becoming concerns for some children in
developing countries. Children whose Z-score values are more than two standard deviations (+2 SD) above
the median for weight-for-height are considered overweight.
Weight-for-age is a composite index of height-for-age and weight-for-height. It takes into account
both acute and chronic malnutrition. Children whose weight-for-age is below minus two standard
deviations (-2 SD) from the mean of the reference population are classified as underweight. Children
whose weight-for-age is below minus three standard deviations (-3 SD) from the mean of the reference
population are considered severely underweight.
A total of 5,120 children under age 5 were eligible to be measured for weight and height. Of these
children, 96 percent had complete data on their age and on their weight and height measurements. The
following analysis focuses on the 4,893 children for whom complete and valid anthropometric data were
collected.
16.1.2 Measures of Child Nutritional Status
Overall, 32 percent of Cambodian children under age 5 are stunted, and 9 percent are severely
stunted (Table 16.1 and Figure 16.1). Analysis by age group indicates that stunting is apparent even among
children less than age 6 months (16 percent). In general, stunting increases with the age of the child, rising
from 13 percent among children age 6-8 months to 40 percent among children age 36-47 months before
declining to 36 percent among children age 48-59 months. There is very little difference in the level of
stunting by gender. Stunting is highest when the birth interval is less than 24 months (37 percent). Size at
birth is an important indicator of children’s nutritional status. Nearly 2 in 3 children (63 percent) reported
to have been very small at birth are stunted. Children whose mothers are underweight are more likely to be
stunted (44 percent) than children of normal weight mothers (32 percent). The disparity in stunting
prevalence between rural and urban children is substantial: 34 percent of rural children are stunted, as
compared with 24 percent of urban children. Variation in the nutritional status of children by province is
quite evident, with stunting being highest in Preah Vihear/Stung Treng (44 percent) and Kampong
Chhnang (43 percent) and lowest in Phnom Penh (18 percent). Mother’s education and wealth quintile
have an inverse relationship with stunting levels. For example, the prevalence of stunting is higher among
children living in the poorest households (42 percent) than among children in the richest households (19
percent).
Ten percent of children under age 5 are wasted, and 2 percent are severely wasted. There is a
substantial correlation between wasting and size at birth. Babies who are very small and small at birth are
more likely to be wasted (24 percent and 17 percent, respectively) than those of average or larger size at
birth (9 percent). The prevalence of wasting among children of thin mothers (BMI below 18.5) is more
than twice that of children whose mothers are either normal weight or overweight/obese. Wasting is higher
among rural children than urban children (10 percent versus 8 percent) and is highest in Takeo and Otdar
Meanchey (15 percent each). Wasting prevalence varies inconsistently by age of the child and does not
differ substantially by sex. It is highest among children whose mothers have no education and those in the
lowest two wealth quintiles.
Overweight and obesity affect a very small proportion of children in Cambodia. Overall, 2 percent
of children below age 5 are overweight (weight-for-height more than +2 SD). Overweight among children
tends to decrease with increasing age. There are no substantial differences by other characteristics.
176 • Nutrition of Children and Women
Table 16.1 Nutritional status of children
Percentage of children under age 5 classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by
background characteristics, Cambodia 2014
Height-for-age1 Weight-for-height Weight-for-age
Number of
children
Background
characteristic
Percentage
below
-3 SD
Percentage
below
-2 SD2
Mean
Z-score
(SD)
Percentage
below
-3 SD
Percentage
below
-2 SD2
Percentage
above
+2 SD
Mean
Z-score
(SD)
Percentage
below
-3 SD
Percentage
below
-2 SD2
Percentage
above
+2 SD
Mean
Z-score
(SD)
Age in months
<6 6.1 16.1 (0.4) 5.4 12.8 6.0 (0.3) 3.2 11.5 1.3 (0.6) 426
6-8 1.2 13.1 (0.6) 2.3 6.5 4.8 (0.3) 1.9 8.5 2.2 (0.6) 252
9-11 3.9 16.6 (0.9) 2.3 14.2 3.1 (0.7) 3.0 15.4 0.5 (1.0) 225
12-17 6.4 28.1 (1.3) 3.1 10.6 3.5 (0.7) 2.6 21.2 1.0 (1.1) 515
18-23 11.3 33.8 (1.5) 2.8 10.9 0.7 (0.7) 5.4 19.6 0.3 (1.2) 545
24-35 10.8 38.5 (1.6) 1.8 8.0 1.8 (0.6) 4.3 24.9 0.9 (1.3) 1,013
36-47 10.9 39.8 (1.8) 1.9 9.3 0.7 (0.8) 7.1 31.4 0.1 (1.5) 978
48-59 9.4 36.0 (1.7) 1.2 8.7 0.5 (0.8) 5.1 30.9 0.2 (1.6) 939
Sex
Male 9.4 32.9 (1.4) 2.7 9.9 2.3 (0.6) 4.5 23.2 0.8 (1.2) 2,497
Female 8.4 31.9 (1.4) 1.9 9.3 1.6 (0.7) 4.8 24.6 0.5 (1.3) 2,395
Birth interval in months3
First birth4 8.3 30.2 (1.4) 2.3 9.6 2.1 (0.7) 3.3 24.3 0.7 (1.3) 1,683
<24 11.7 37.4 (1.5) 2.3 10.5 2.3 (0.8) 9.3 31.1 0.9 (1.4) 336
24-47 9.5 34.1 (1.5) 2.4 9.9 2.0 (0.7) 6.3 25.0 0.6 (1.3) 1,102
48+ 7.8 31.0 (1.3) 2.7 9.5 1.8 (0.7) 3.6 21.0 0.5 (1.2) 1,139
Size at birth3
Very small 25.6 63.1 (2.3) 3.6 23.6 4.8 (1.0) 16.5 58.9 2.6 (2.0) 96
Small 13.9 40.5 (1.7) 2.3 16.7 1.0 (0.9) 7.1 38.5 0.0 (1.6) 368
Average or larger 7.8 30.2 (1.4) 2.4 8.6 2.0 (0.7) 4.1 21.8 0.7 (1.2) 3,772
Mother’s interview status
Interviewed 8.7 32.0 (1.4) 2.4 9.7 2.0 (0.7) 4.6 24.1 0.6 (1.3) 4,261
Not interviewed but in
household 2.5 36.0 (1.2) 1.4 11.4 5.1 (0.5) 2.7 23.1 2.1 (1.0) 107
Not interviewed and not in
the household5 11.9 35.2 (1.5) 1.6 8.4 0.8 (0.5) 5.3 22.3 0.2 (1.2) 525
Mother’s nutritional
status6
Thin (BMI <18.5) 13.7 44.0 (1.8) 2.5 18.5 0.7 (1.0) 11.0 39.7 0.4 (1.7) 461
Normal (BMI 18.5-24.9) 8.5 31.8 (1.4) 2.3 8.6 2.4 (0.6) 4.0 23.9 0.7 (1.3) 2,726
Overweight/obese
(BMI ≥25) 6.2 26.2 (1.3) 2.0 6.7 1.7 (0.5) 2.5 15.7 0.9 (1.1) 671
Residence
Urban 5.9 23.7 (1.1) 2.0 7.5 3.1 (0.4) 2.6 14.8 1.9 (0.9) 674
Rural 9.4 33.8 (1.5) 2.4 9.9 1.8 (0.7) 5.0 25.4 0.4 (1.3) 4,219
Province
Banteay Meanchey 6.9 28.6 (1.3) 0.7 7.8 0.7 (0.5) 5.3 17.0 0.0 (1.1) 241
Kampong Cham 8.6 33.5 (1.4) 1.5 8.1 2.2 (0.7) 4.2 25.7 0.8 (1.3) 692
Kampong Chhnang 13.5 42.8 (1.7) 3.1 11.2 2.2 (0.9) 5.1 35.6 0.0 (1.5) 173
Kampong Speu 10.0 40.5 (1.7) 2.5 11.5 1.3 (0.8) 6.9 29.4 0.0 (1.5) 318
Kampong Thom 10.7 36.4 (1.3) 3.1 13.0 3.4 (0.8) 7.1 27.7 1.9 (1.3) 217
Kandal 3.5 28.1 (1.3) 3.2 9.2 0.2 (0.8) 4.7 26.2 0.0 (1.3) 298
Kratie 10.5 38.4 (1.6) 2.7 6.5 0.5 (0.7) 4.4 25.1 0.0 (1.4) 180
Phnom Penh 4.9 17.9 (0.9) 1.0 8.4 3.7 (0.4) 2.2 12.9 3.4 (0.8) 391
Prey Veng 8.7 32.7 (1.5) 2.9 8.6 1.8 (0.6) 3.4 22.2 0.3 (1.3) 379
Pursat 18.4 38.8 (1.8) 5.7 12.3 4.7 (0.6) 7.9 31.6 0.4 (1.4) 200
Siem Reap 11.3 35.9 (1.5) 2.3 9.5 1.0 (0.7) 6.9 26.2 0.4 (1.3) 323
Svay Rieng 8.2 32.8 (1.4) 2.7 7.6 3.6 (0.6) 3.6 20.8 0.5 (1.2) 190
Takeo 6.4 30.7 (1.3) 5.0 14.6 1.5 (0.8) 4.4 22.7 0.0 (1.3) 258
Otdar Meanchey 14.0 36.3 (1.3) 7.2 15.1 5.3 (0.7) 5.2 26.4 0.0 (1.3) 78
Battambang/Pailin 5.0 24.9 (1.2) 0.3 7.9 0.7 (0.6) 1.8 18.2 0.5 (1.1) 388
Kampot/Kep 8.3 25.2 (1.4) 0.9 8.2 1.9 (0.7) 3.5 21.1 0.7 (1.3) 195
Preah Sihanouk/
Koh Kong 10.4 33.4 (1.4) 3.1 10.5 1.8 (0.6) 6.5 22.0 0.0 (1.2) 105
Preah Vihear/
Stung Treng 14.0 44.3 (1.8) 1.3 13.8 2.3 (0.7) 5.9 30.7 0.1 (1.5) 142
Mondul Kiri/
Ratanak Kiri 14.6 39.8 (1.6) 1.4 8.2 1.2 (0.6) 6.0 26.2 0.3 (1.4) 125
Mother’s education7
No education 13.3 38.5 (1.6) 2.8 12.2 1.5 (0.7) 7.4 29.7 0.4 (1.4) 577
Primary 8.7 34.1 (1.5) 2.1 9.3 2.1 (0.7) 4.7 24.6 0.6 (1.3) 2,397
Secondary and higher 6.8 26.8 (1.3) 2.7 9.9 2.0 (0.7) 3.5 22.3 0.6 (1.2) 1,278
Wealth quintile
Lowest 14.1 41.9 (1.7) 2.8 11.0 1.1 (0.8) 7.1 31.0 0.0 (1.5) 1,182
Second 9.8 37.1 (1.6) 2.3 11.4 2.1 (0.7) 5.7 27.5 0.5 (1.4) 998
Middle 7.8 31.7 (1.4) 2.1 8.4 1.3 (0.7) 4.3 23.3 0.2 (1.3) 978
Fourth 6.9 29.1 (1.3) 2.5 9.3 2.4 (0.7) 3.5 22.0 0.8 (1.2) 844
Highest 4.1 18.5 (0.9) 1.9 7.4 3.3 (0.4) 1.7 13.0 2.1 (0.8) 891
Total 8.9 32.4 (1.4) 2.3 9.6 2.0 (0.7) 4.7 23.9 0.6 (1.3) 4,893
Note: Table is based on children who stayed in the household on the night before the interview. Each of the indices is expressed in standard deviation units (SD) from the median of the WHO
child growth standards adopted in 2006. The indices in this table are NOT comparable to those based on the previously used NCHS/CDC/WHO reference. Table is based on children with
valid dates of birth (month and year) and valid measurement of both height and weight. Total includes 25 cases with missing information on size at birth.
1 Recumbent length is measured for children under age 2 and in the few cases when the age of the child is unknown and the child is less than 85 cm; standing height is measured for all other
children.
2 Includes children who are below -3 standard deviations (SD) from the WHO child growth standards population median
3 Excludes children whose mothers were not interviewed
4 First-born twins (triplets, etc.) are counted as first births because they do not have a previous birth interval.
5 Includes children whose mothers are deceased
6 Excludes children whose mothers were not weighed and measured, children whose mothers were not interviewed, and children whose mothers are pregnant or gave birth within the
preceding 2 months. Mother’s nutritional status in terms of BMI (body mass index) is presented in Table 16.10.
7 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the Household Questionnaire.
Nutrition of Children and Women • 177
Twenty-four percent of children under age 5 are underweight (low weight-for-age), and 5 percent
are severely underweight. Figure 16.1 shows that the percentage of children underweight increases steadily
from 5 percent among children younger than age 2 months to more than 10 percent among children age 2-4
months, followed by a small decline among children age 6-8 months. The percentage then increases with
increasing age and peaks among children age 40-42 months. This may be due to inappropriate and/or
inadequate feeding practices because the percentage of underweight children begins to increase at the age
when normal complementary feeding starts. The prevalence of underweight is 10 percentage points higher
among rural children (25 percent) than among urban children (15 percent) (Table 16.1). More than half of
the provinces in Cambodia (11 of 19) have percentages of underweight children above the national
average. A mother’s wealth status and educational level are negatively correlated with the likelihood that
her child is underweight. Children born to mothers in the lowest wealth quintile are more than twice as
likely (31 percent) to be underweight as children born to mothers in the highest wealth quintile (13
percent).
Figure 16.1 Nutritional status of children by age
16.1.3 Trends in Children’s Nutritional Status
Trends in children’s nutritional status for the period 2000 to 2014 are shown in Figure 16.2. To
allow assessment of trends, the data for 2000 and 2005 were recalculated using the 2006 WHO child
growth standards. Figure 16.2 shows that there have been improvements in the nutritional status of
children in the past 14 years. The percentage of children stunted fell consistently from 50 percent in 2000
to 32 percent in 2014. The percentage of children wasted declined from 17 percent in 2000 to 8 percent in
2005 before increasing to 11 percent in 2010 and subsequently dropping slightly to 10 percent in 2014.
Underweight declined from 39 percent in 2000 to 28 percent in 2005 and 2010 and then decreased to 24
percent in 2014.
Although there have been improvements in the nutritional status of Cambodian children in the past
decade and a half, there is still a need for more intensive interventions.
0
5
10
15
20
25
30
35
40
45
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 54 56 58
Percentage
Age (months)
Note: Stunting reflects chronic malnutrition; wasting reflects acute malnutrition;
underweight reflects chronic or acute malnutrition or a combination of both.
Plotted values are smoothed by a five-month moving average.
Stunted
CDHS 2014
Underweight
Wasted
178 • Nutrition of Children and Women
Figure 16.2 Trends in nutritional status of children under age 5
16.2 INITIATION OF BREASTFEEDING
Early initiation of breastfeeding is encouraged for a number of reasons. Mothers benefit from
early suckling because it stimulates breast milk production and facilitates the release of oxytocin, which
helps the uterus contract and reduces postpartum blood loss. The first breast milk contains colostrum,
which is highly nutritious and has antibodies that protect the newborn from diseases. Early initiation of
breastfeeding also fosters bonding between mother and child.
Table 16.2 shows the percentage of all children born in the two years before the survey by
breastfeeding status and the timing of initial breastfeeding, according to background characteristics. In the
2010 CDHS, initial breastfeeding data were collected for children of the same age (0-2 years) as in the
2014 survey; however, in the 2000 and 2005 CDHS surveys, initial breastfeeding data were collected for
all children less than age 5, and thus caution should be exercised in comparing the results of the 2010 and
2014 surveys with previous survey results.
Ninety-six percent of children born in the two years preceding the survey were breastfed at some
point of time. Young children living in rural areas at the time of the survey are more likely to have ever
been breastfed than children living in urban areas. The proportion of children ever breastfed ranges from a
low of 91 percent in Phnom Penh to a high of over 99 percent in Mondul Kiri/Ratanak Kiri and Prey Veng.
Children in the lowest wealth quintile are more likely to have ever been breastfed (98 percent) than
children in the highest wealth quintile (92 percent).
Sixty-three percent of children are breastfed within one hour of birth, and 87 percent are breastfed
within one day of birth.
Several background characteristics have important influences on early breastfeeding practices. For
example, early initiation of breastfeeding is more common among children whose mothers delivered in a
heath facility and whose birth was assisted by a health professional than among children delivered at home
or by a traditional birth attendant. In addition, the proportion of children breastfed within one hour of birth
is highest in Kampong Thom (85 percent) and lowest in Mondul Kiri/Ratanak Kiri (16 percent). There is
no consistent association between early breastfeeding and mother’s education and wealth.
50
17
39
43
8
28
40
11
28
32
10
24
Stunted Wasted Underweight
Percentage
CDHS 2000 CDHS 2005 CDHS 2010 CDHS 2014
Nutrition of Children and Women • 179
Table 16.2 Initial breastfeeding
Among last-born children who were born in the two years preceding the survey, the percentage who were ever breastfed and the
percentages who started breastfeeding within one hour and within one day of birth, and among last-born children born in the two years
preceding the survey who were ever breastfed, the percentage who received a prelacteal feed, by background characteristics, Cambodia
2014
Among last-born children born in the past two years:
Among last-born children born in
the past two years who were ever
breastfed:
Background
characteristic
Percentage ever
breastfed
Percentage who
started
breastfeeding
within 1 hour of
birth
Percentage who
started
breastfeeding
within 1 day of
birth1
Number of lastborn children
Percentage who
received a
prelacteal feed2
Number of lastborn children
ever breastfed
Sex
Male 96.8 60.9 86.7 1,471 27.0 1,425
Female 95.6 64.2 87.8 1,473 28.3 1,409
Assistance at delivery
Health professional3 96.3 63.9 88.1 2,730 27.6 2,628
Traditional birth attendant 98.0 45.1 78.4 207 29.1 202
Place of delivery
Health facility 96.3 64.3 88.1 2,614 27.5 2,516
At home 96.8 49.1 81.0 325 28.6 314
Residence
Urban 91.7 50.6 79.1 414 50.2 380
Rural 97.0 64.5 88.6 2,531 24.2 2,454
Province
Banteay Meanchey 94.2 67.7 78.4 120 28.7 113
Kampong Cham 96.9 72.6 82.9 418 38.4 404
Kampong Chhnang 97.7 47.5 95.6 111 10.6 108
Kampong Speu 97.3 56.2 95.8 182 26.0 177
Kampong Thom 95.9 84.7 95.1 141 8.7 135
Kandal 95.5 69.5 86.1 193 39.8 184
Kratie 98.4 64.0 82.7 107 27.8 106
Phnom Penh 91.0 37.2 75.8 257 61.0 234
Prey Veng 99.4 65.8 94.1 194 22.0 193
Pursat 96.8 72.5 93.9 122 7.6 118
Siem Reap 97.2 65.6 86.2 182 23.7 177
Svay Rieng 93.3 68.8 82.5 108 25.8 101
Takeo 93.8 58.1 92.0 164 16.3 154
Otdar Meanchey 98.8 49.2 97.3 54 5.6 54
Battambang/Pailin 96.9 72.4 87.8 247 29.9 239
Kampot/Kep 96.1 37.9 85.3 116 24.6 112
Preah Sihanouk/
Koh Kong 96.9 76.6 89.8 61 24.7 60
Preah Vihear/
Stung Treng 98.9 77.3 97.7 92 8.4 91
Mondul Kiri/
Ratanak Kiri 99.7 15.9 76.2 75 17.3 75
Mother’s education
No education 96.7 58.4 86.1 366 21.6 354
Primary 96.3 66.6 88.3 1,491 23.2 1,436
Secondary and higher 96.0 58.4 86.2 1,088 35.9 1,044
Wealth quintile
Lowest 97.6 62.8 90.6 694 14.5 677
Second 96.1 62.2 86.0 589 20.7 566
Middle 97.7 71.0 89.9 565 25.7 552
Fourth 97.4 64.1 89.1 536 31.9 522
Highest 92.2 52.8 80.1 560 50.4 516
Total 96.2 62.6 87.3 2,944 27.7 2,834
Note: Table is based on last-born children born in the two years preceding the survey regardless of whether the children are living or dead
at the time of the interview. Total includes cases for which information on place of delivery and assistance at delivery is missing.
1 Includes children who started breastfeeding within one hour of birth
2 Children given something other than breast milk during the first three days of life
3 Doctor, nurse, or midwife
Twenty-eight percent of children receive a prelacteal feed, that is, something other than breast
milk during the first three days of life. The proportions of children who receive a prelacteal feed in the first
three days of life do not differ significantly by sex of the child, assistance at delivery, or place of delivery.
Children residing in urban areas are twice as likely as children residing in rural areas to receive a prelacteal
feed. More than 3 in 5 children living in Phnom Penh (61 percent) receive a prelacteal feed after birth.
Prelacteal feeding increases as the level of mother’s education and wealth increase. The percentage of
children who receive a prelacteal feed is lower among those whose mothers have no schooling (22 percent)
180 • Nutrition of Children and Women
than among those whose mothers have a primary education (23 percent) or a secondary education or higher
(36 percent). Fifteen percent of children in the lowest quintile receive a prelacteal feed, as compared with
50 percent of children in the highest wealth quintile.
16.3 BREASTFEEDING STATUS BY AGE
UNICEF and WHO recommend that children be exclusively breastfed during the first six months
of life and that children be given solid or semisolid complementary food in addition to continued
breastfeeding from six months to 24 months. Exclusive breastfeeding is recommended because breast milk
is uncontaminated and contains all of the nutrients necessary for children in the first few months of life. In
addition, the mother’s antibodies in breast milk provide immunity to disease. Early supplementation is
discouraged for several reasons. First, it exposes infants to pathogens and increases their risk of infection,
especially disease. Second, it decreases infants’ intake of breast milk and therefore suckling, which reduces
breast milk production. Third, in a harsh socioeconomic environment, supplementary food is often
nutritionally inferior.
Information on complementary feeding was obtained by asking mothers about the current
breastfeeding status of all children under age 2 and food (liquids or solids) given to the child the day and
night before the survey.
Table 16.3 Breastfeeding status by age
Percent distribution of youngest children under age 2 who are living with their mother by breastfeeding status and the percentage currently breastfeeding, and the
percentage of all children under age 2 using a bottle with a nipple, according to age in months, Cambodia 2014
Not breastfeeding
Breastfeeding status
Total
Percentage
currently
breastfeeding
Number of
youngest
children
under age 2
living with
their mother
Percentage
using a
bottle with a
nipple
Number of
all children
under age 2
Age in
months
Exclusively
breastfed
Breastfeeding and
consuming
plain water
only
Breastfeeding and
consuming
non-milk
liquids1
Breastfeeding and
consuming
other milk
Breastfeeding and
consuming
complementary
foods
0-1 3.6 79.9 5.6 0.4 7.6 2.9 100.0 96.4 210 8.6 213
2-3 6.6 67.1 14.7 2.1 6.2 3.3 100.0 93.4 257 16.2 262
4-5 9.4 50.9 12.5 0.3 7.9 18.9 100.0 90.6 249 32.5 260
6-8 7.2 9.0 5.8 0.4 1.7 75.8 100.0 92.8 396 38.4 403
9-11 11.4 0.4 1.3 0.8 1.9 84.3 100.0 88.6 349 38.3 357
12-17 22.2 0.3 0.6 0.2 0.4 76.2 100.0 77.8 673 34.1 689
18-23 60.3 0.0 0.0 0.0 0.2 39.4 100.0 39.7 724 33.0 771
0-3 5.2 72.9 10.6 1.3 6.9 3.1 100.0 94.8 467 12.8 475
0-5 6.7 65.2 11.3 1.0 7.2 8.6 100.0 93.3 717 19.8 736
6-9 8.8 7.1 4.5 0.3 1.3 78.0 100.0 91.2 514 38.8 523
12-15 20.0 0.4 0.6 0.4 0.6 78.0 100.0 80.0 461 34.9 467
12-23 42.0 0.1 0.3 0.1 0.3 57.2 100.0 58.0 1,398 33.5 1,460
20-23 62.9 0.0 0.0 0.0 0.1 37.0 100.0 37.1 484 32.3 519
Note: Breastfeeding status refers to a “24-hour” period (yesterday and last night). Children who are classified as breastfeeding and consuming plain water only
consumed no liquid or solid supplements. The categories of not breastfeeding, exclusively breastfed, and breastfeeding and consuming plain water, non-milk
liquids, other milk, and complementary foods (solids and semisolids) are hierarchical and mutually exclusive, and their percentages sum to 100 percent. Thus,
children who receive breast milk and non-milk liquids and who do not receive other milk and who do not receive complementary foods are classified in the nonmilk liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are
breastfeeding as well.
1 Non-milk liquids include juice, juice drinks, clear broth, or other liquids.
Table 16.3 shows the percent distribution of youngest children under age 2 living with their
mother by breastfeeding status and the percentage of all children under age 2 using a bottle with a nipple,
according to age in months. The data presented in Table 16.3 and Figure 16.3 show that, contrary to
WHO’s recommendations, not all children under age 6 months are exclusively breastfed. Seventy-three
percent of Cambodian children age 0-3 months are exclusively breastfed, and only 65 percent of children
age 0-5 months are exclusively breastfed.
Among children less than age 6 months, 11 percent consume breast milk and plain water and 7
percent consume other milk in addition to breast milk. Although 76 percent of children begin eating
Nutrition of Children and Women • 181
complementary foods at age 6-8 months, 9 percent of children continue to be exclusively breastfed and 6
percent receive just plain water in addition to breast milk. Only 37 percent of Cambodian children continue
to breastfeed until age 2 (Table 16.3), and thus 63 percent are deprived of valuable nutrients during this
period. Exclusive breastfeeding quickly declines from birth to age 6-8 months. Although other liquids are
not needed before six months, 12 percent of infants under age 6 months receive water or other liquids with
milk.
The prevalence of bottle feeding among Cambodian children age 6 months and above has
increased substantially in comparison with data from the 2010 CDHS. Thirty-four percent of children age
12-23 months were fed with a bottle in 2014, as compared with 25 percent in 2010. In Cambodia the bottle
is used for feeding breast milk substitutes (which are most often formula or sweetened condensed milk or
other canned milk usually thinned out with water) or very watery rice porridge (borbor), both of which are
contraindicated.
Figure 16.3 Infant feeding practices by age
16.4 DURATION OF BREASTFEEDING
Table 16.4 shows the median duration of breastfeeding by selected background characteristics.
The estimates of median and mean durations of breastfeeding are based on current status data, that is, the
proportion of last-born children in the three years preceding the survey who were being breastfed at the
time of the survey.
The median duration of any breastfeeding is 18.4 months, and the mean duration is 19.0 months.
There is little difference in duration of breastfeeding by sex of the child. Urban children are breastfed for a
much shorter duration than rural children (13.5 months versus 18.8 months). Highly educated mothers
breastfeed their children for about one month less than mothers with little or no education. Mothers from
the highest wealth quintile breastfeed their children for only 14 months, as compared with 19 months
among mothers in all other wealth quintiles.
The median duration of exclusive breastfeeding among Cambodian children is 3.7 months, and the
mean duration is 4.5 months. In comparison with the 2010 CDHS, the median durations of any
breastfeeding and exclusive breastfeeding have decreased by about one month.
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
<2 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23
Age (months)
Exclusively breastfed Breastfeeding and consuming plain water only
Breastfeeding and consuming non-milk liquids Breastfeeding and consuming other milk
Breastfeeding and consuming complementary foods Not breastfeeding
CDHS 2014
182 • Nutrition of Children and Women
Table 16.4 Median duration of breastfeeding
Median duration of any breastfeeding, exclusive breastfeeding, and
predominant breastfeeding among children born in the three years preceding
the survey, by background characteristics, Cambodia 2014
Background
characteristic
Median duration (months) of breastfeeding among
children born in the past three years1
Any
breastfeeding
Exclusive
breastfeeding
Predominant
breastfeeding2
Sex
Male 18.6 3.5 4.8
Female 18.1 3.9 4.8
Residence
Urban 13.5 a 1.6
Rural 18.8 4.0 5.0
Mother’s education
No education 19.3 3.7 5.0
Primary 18.4 3.8 4.8
Secondary and
higher 18.0 3.8 4.8
Wealth quintile
Lowest 19.3 4.3 5.0
Second 18.9 4.4 5.2
Middle 18.5 3.7 4.9
Fourth 18.9 4.0 5.2
Highest 14.1 (1.2) 2.8
Total 18.4 3.7 4.8
Mean for all children 19.0 4.5 5.4
Note: Median and mean durations are based on the distributions at the time of
the survey of the proportion of births by months since birth. Includes children
living and deceased at the time of the survey. Figures in parentheses are
based on 25-49 unweighted cases in the duration category in which the
median value fell.
a = Omitted because less than 50 percent of children were breastfed before
reaching the reference period
1 It is assumed that non-last-born children and last-born children not currently
living with their mother are not currently breastfeeding.
2 Either exclusively breastfed or received breast milk and plain water and/or
non-milk liquids only
Figure 16.4 presents a number of indicators summarizing the extent to which Cambodian children
are being fed according to recommended infant and young child feeding (IYCF) practices. The exclusive
breastfeeding indicators included in the figure highlight the fact that the majority of children are not
exclusively breastfed for the recommended six months. Overall, only 65 percent of all children under age 6
months are being exclusively breastfed, and at age 4-5 months only half of children (51 percent) are
receiving only breast milk.
Figure 16.4 IYCF indicators on breastfeeding status
31
78
65
37
82
80
51
65
IYCF 14: Bottle feeding (0-23 months)
IYCF 12: Predominant breastfeeding (0-5 months)
IYCF 11: Age-appropriate breastfeeding (0-23 months)
IYCF 10: Continued breastfeeding at 2 years
IYCF 4: Introduction of solid, semisolid, or soft foods (6-8
months)
IYCF 3: Continued breastfeeding at 1 year
Exclusive breastfeeding at 4-5 months
IYCF 2: Exclusive breastfeeding under 6 months
Percentage
CDHS 2014
Nutrition of Children and Women • 183
Figure 16.4 also provides information on the prevalence of predominant breastfeeding. Three
quarters of children (78 percent) under age 6 months are in this category, that is, they are exclusively
breastfed or they are breastfed and receive either plain water or non-milk liquids. In addition, Figure 16.4
includes data on the timely introduction of complementary feeding; as recommended, 82 percent of
children age 6-8 months are being given solid, semisolid, or soft food. The continued breastfeeding
indicators in Figure 16.4 show that breastfeeding continues well into the first year of life for most children.
However, by age 2, the majority of children are weaned. Although bottle feeding is discouraged, 31
percent of Cambodian children age 0-23 months are bottle fed.
Finally, the age-appropriate breastfeeding indicator in Figure 16.4 provides an overall measure of
the extent to which recommendations with respect to exclusive breastfeeding and timely introduction of
complementary foods are being observed. Children are classified as receiving age-appropriate
breastfeeding if they are age 0-5 months and exclusively breastfed or age 6-23 months and breastfeeding
and consuming complementary foods. Around two-thirds of Cambodian children (65 percent) are being
breastfed appropriately.
16.5 TYPES OF COMPLEMENTARY FOODS
UNICEF and WHO recommend the introduction of solid food to infants at approximately age 6
months because by that age breast milk alone is no longer sufficient to maintain a child’s optimal growth.
In the transition to eating the family diet, children from age 6 months should be fed small quantities of
solid and semisolid foods throughout the day. During this transition period (age 6-23 months), the
prevalence of malnutrition increases substantially in many countries because of increased infections and
poor feeding practices.
Table 16.5 provides information from mothers on the types of food given to their youngest child
under age 2 living with the mother on the day and night preceding the survey, according to breastfeeding
status. The data show that 7 percent and 13 percent of breastfeeding infants receive infant formula and any
other kinds of milk, respectively. However, 16 percent of younger breastfeeding infants (age 4-5 months)
are already consuming food made from grains; 3 percent consume food made from meat, fish, or poultry;
and 2 percent consume eggs.
Overall, two-thirds of breastfed children (68 percent) under age 2 received solid or semisolid
complementary foods in addition to breast milk. Consumption of foods made from grains (63 percent),
animal sources of food (meat, fish, and poultry) (50 percent), and fruits and vegetables rich in vitamin A
(38 percent) is high. Consumption of food made from roots or tubers is low (8 percent).
Comparing dietary intake of children by their breastfeeding status, a higher proportion of solid and
semisolid foods are being consumed by nonbreastfed children. Thirty-one percent of nonbreastfeeding
children receive infant formula and 32 percent receive other types of milk, both of which are essential
because these children are not benefiting from breast milk. A larger percentage of nonbreastfed children
under age 2 than breastfed children in the same age group are receiving grains, fruits and vegetables rich in
vitamin A, and meat, fish, poultry, and eggs.
184 • Nutrition of Children and Women
Table 16.5 Foods and liquids consumed by children in the day or night preceding the interview
Percentage of youngest children under age 2 who are living with their mother by type of foods consumed in the day or night preceding the interview, according to
breastfeeding status and age, Cambodia 2014
Liquids Solid or semisolid foods
Any solid
or semisolid food
Number
of children
Age in
months
Infant
formula
Other
milk1
Other
liquids2
Fortified
baby
foods
Food
made
from
grains3
Fruits and
vegetables rich
in vitamin
A4
Other
fruits and
vegetables
Food
made
from roots
and
tubers
Food
made
from
legumes
and nuts
Meat, fish,
poultry Eggs
Cheese,
yogurt,
other milk
products
BREASTFEEDING CHILDREN
0-1 8.1 2.8 2.3 0.7 1.4 1.3 1.3 1.3 1.3 1.3 0.7 2.3 3.0 203
2-3 4.0 3.0 3.1 0.7 3.5 0.9 0.7 0.7 0.7 0.9 0.7 0.0 3.5 240
4-5 10.0 3.9 4.9 2.1 16.0 3.0 0.7 1.3 0.0 3.4 2.2 0.4 20.9 226
6-8 10.0 8.5 20.8 3.4 74.3 28.4 8.6 5.7 3.5 37.8 19.5 1.1 81.7 367
9-11 5.5 10.8 30.7 2.6 89.2 51.7 17.9 9.8 4.5 71.0 34.0 1.4 95.1 309
12-17 6.4 21.2 41.0 4.6 94.9 66.6 30.0 14.3 8.1 83.6 42.4 3.3 98.0 524
18-23 5.1 27.1 51.0 3.6 93.6 70.5 42.4 15.0 10.2 90.5 47.2 3.9 99.3 287
6-23 6.8 17.1 35.8 3.7 88.4 54.8 24.6 11.4 6.6 71.0 35.9 2.5 93.6 1,488
Total 7.0 12.8 25.8 2.9 63.2 38.4 17.3 8.2 4.8 49.6 25.2 2.0 67.5 2,156
NONBREASTFEEDING CHILDREN
0-1 * * * * * * * * * * * * * 8
2-3 * * * * * * * * * * * * * 17
4-5 (85.2) (12.2) (14.7) (6.5) (16.9) (12.5) (0.0) (0.0) (7.6) (11.9) (4.3) (0.0) (27.6) 24
6-8 (80.1) (8.0) (28.2) (9.6) (66.3) (44.6) (26.2) (8.0) (0.0) (62.7) (41.1) (7.0) (79.9) 29
9-11 (65.4) (29.3) (30.7) (11.4) (85.0) (61.0) (45.2) (16.0) (2.7) (74.2) (49.2) (0.0) (91.5) 40
12-17 48.4 32.8 44.9 5.5 92.9 62.2 37.9 13.5 11.9 90.4 42.8 6.3 97.8 150
18-23 14.9 35.2 51.8 7.2 95.6 73.5 46.3 18.0 13.7 95.2 47.6 6.4 99.2 437
6-23 28.5 33.1 47.9 7.2 93.1 68.9 43.4 16.4 12.0 91.4 46.3 6.0 97.5 655
Total 31.3 31.5 45.2 6.9 88.1 65.3 40.8 15.5 11.8 86.3 43.9 5.8 92.6 703
Note: Breastfeeding status and food consumed refer to a “24-hour” period (yesterday and last night). Figures in parentheses are based on 25-49 unweighted cases. An
asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.
1 Other milk includes fresh, tinned, and powdered cow or other animal milk.
2 Does not include plain water
3 Includes fortified baby food
4 Includes pumpkin, carrots, squash or sweet potatoes that are yellow or orange inside, dark green leafy vegetables, mangoes, and papayas.
16.6 INFANT AND YOUNG CHILD FEEDING (IYCF) PRACTICES
Appropriate IYCF practices include timely initiation of feeding solid and semisolid foods from
age 6 months and increasing the amount and variety of foods and frequency of feeding as the child gets
older while maintaining frequent breastfeeding (WHO, 2008).
The age ranges of various indicators of IYCF practices presented in this chapter have been
updated based on the most recent definitions of breastfeeding and complementary feeding indicators
(WHO, 2010). Therefore, to compare results with the previous CDHS surveys, one needs to first check that
indicator definitions and age ranges of sampled children are the same across surveys.
Table 16.6 presents a summary indicator of IYCF practices. The indicator takes into account the
percentages of children for whom feeding practices meet minimum standards with respect to food diversity
(i.e., the number of food groups consumed), feeding frequency (i.e., the number of times the child is fed),
and consumption of breast milk or other types of milk or milk products (accounting for number of milk
feedings for nonbreastfed children). Breastfed children are considered to be fed within the minimum
standards if they consume at least four food groups and receive food other than breast milk two to three
times per day in the case of infants age 6-8 months and three to four times per day in the case of children
age 9-23 months (Arimond and Ruel, 2003). Nonbreastfed children are considered to be fed in accordance
with the minimum standards if they consume milk or milk products at least twice a day, are fed four food
groups each day, and are fed at least four to five times per day (including milk feeds). Meal frequency is
considered a proxy for energy intake from foods other than breast milk; therefore, the feeding frequency
indicator for nonbreastfed children includes both milk and solid and semisolid foods (WHO, 2008).
N
ut rit
io n of C
hi ld re n an d W
om en
1
85
Ta bl e 16
.6
I
nf an t a
nd y ou ng c hi ld fe ed in g (IY
C
F)
p ra ct ic es P
er ce nt ag e of y ou ng es t c
hi ld re n ag e 6-
23
m on th s liv
in g w ith
th ei r m
ot he r w
ho a re fe d ac co rd in g to th re e IY
C
F
fe ed in g pr ac tic
es b as ed o n br ea st fe ed in g st at us , n
um be r o
f f
oo d gr ou ps , a
nd ti m es th ey a re fe d du rin
g th e da y or n ig ht p re ce di ng th e su rv ey , b
y ba ck gr ou nd ch ar ac te ris
tic
s, C
am bo di a 20
14
A
m on g br ea st fe d ch ild
re n 6-
23
m on th s, p er ce nt ag e fe d: A
m on g no nbr ea st fe d ch ild
re n 6-
23
m on th s, p er ce nt ag e fe d: A
m on g al l c
hi ld re n 6-
23
m on th s, p er ce nt ag e fe d: B
ac kg ro un d ch ar ac te ris
tic
4+
fo od g ro up s1 M
in im um m ea l fre
qu en cy 2
B
ot h 4+
fo od gr ou ps a nd m in im um m ea l fre
qu en cy N
um be r o
f br ea st fe d ch ild
re n 6-
23
m on th s M
ilk
o r m
ilk
pr od uc ts 3
4+
fo od g ro up s1 M
in im um m ea l fre
qu en cy 4
W
ith
3
IY
C
F
pr ac tic
es 5
N
um be r o
f n
on -
br ea st fe d ch ild
re n 6-
23
m on th s B
re as t m
ilk
,
m ilk
, o
r m
ilk
pr od uc ts 6
4+
fo od g ro up s1 M
in im um m ea l fre
qu en cy 7
W
ith
3
IY
C
F
pr ac tic
es N
um be r o
f a
ll ch ild
re n 6-
23
m on th s A
ge in m on th s 6-
8
15
.0
71
.0
14
.8
36
7
(7
8.
2)
(5
5.
1)
(8
1.
7)
(3
0.
5)
29
98
.4
17
.9
71
.8
15
.9
39
6
9-
11
35
.5
68
.1
25
.3
30
9
(7
9.
8)
(6
5.
5)
(8
2.
8)
(3
9.
8)
40
97
.7
39
.0
69
.8
27
.0
34
9
12
-1
7
51
.2
77
.1
41
.0
52
4
64
.9
66
.3
76
.3
28
.8
15
0
92
.2
54
.6
76
.9
38
.3
67
3
18
-2
3
56
.1
79
.5
45
.9
28
7
37
.8
64
.8
62
.3
24
.1
43
7
62
.5
61
.4
69
.1
32
.7
72
4
Se x M
al e 39
.9
73
.6
31
.9
76
0
54
.1
67
.1
71
.6
25
.6
32
6
86
.2
48
.1
73
.0
30
.0
1,
08
6
Fe m al e 40
.0
74
.7
32
.6
72
7
42
.6
62
.5
63
.7
27
.2
32
9
82
.1
47
.0
71
.3
30
.9
1,
05
7
R
es id en ce U
rb an 54
.7
77
.5
47
.2
14
0
81
.5
83
.8
89
.3
49
.6
16
1
90
.1
70
.3
83
.9
48
.5
30
0
R
ur al 38
.4
73
.8
30
.7
1,
34
8
37
.5
58
.6
60
.5
18
.9
49
4
83
.2
43
.9
70
.2
27
.5
1,
84
2
Pr ov in ce B
an te a y
M
ea nc he y 44
.2
83
.9
43
.1
59
(5
1.
4)
(8
6.
4)
(9
1.
5)
(2
9.
7)
30
83
.6
58
.5
86
.5
38
.6
89
K
am po ng C
ha m 26
.7
67
.4
19
.8
21
5
(2
6.
1)
(4
4.
1)
(4
2.
3)
(1
4.
3)
77
80
.6
31
.2
60
.8
18
.4
29
2
K
am po ng C
hh na ng 39
.6
86
.1
35
.5
58
(2
0.
3)
(4
4.
2)
(5
6.
0)
(1
1.
1)
23
77
.7
40
.9
77
.7
28
.7
81
K
am po ng S
pe u 54
.9
81
.0
50
.5
10
4
(4
9.
3)
(5
8.
5)
(5
4.
2)
(2
1.
2)
42
85
.5
55
.9
73
.4
42
.1
14
6
K
am po ng T
ho m 45
.0
75
.7
38
.0
77
(3
0.
8)
(7
1.
6)
(4
2.
6)
(5
.1
)
30
80
.8
52
.4
66
.5
28
.8
10
7
K
an da l 43
.1
61
.6
25
.2
98
*
*
*
*
37
87
.0
43
.1
64
.3
23
.1
13
5
K
ra tie
20
.1
67
.5
14
.9
57
(1
1.
1)
(2
3.
7)
(5
4.
7)
(3
.4
)
19
77
.3
21
.0
64
.2
12
.0
76
P
hn om P
en h 69
.7
84
.9
59
.9
76
94
.7
91
.4
97
.2
61
.8
11
0
96
.9
82
.6
92
.2
61
.0
18
6
P
re y V
en g 31
.1
83
.6
29
.6
11
3
*
*
*
*
32
83
.9
34
.6
74
.4
25
.0
14
6
P
ur sa t 28
.0
83
.7
24
.0
69
(3
3.
0)
(3
8.
6)
(6
0.
9)
(1
2.
8)
27
81
.1
31
.0
77
.3
20
.8
96
S
ie m R
ea p 46
.5
83
.8
38
.6
77
(4
1.
1)
(7
7.
8)
(8
4.
2)
(3
2.
7)
52
76
.4
59
.1
84
.0
36
.2
12
9
S
va y R
ie ng 63
.3
59
.0
40
.5
55
(5
2.
7)
(7
2.
3)
(5
8.
8)
(3
1.
5)
19
87
.7
65
.7
59
.0
38
.1
75
Ta ke o 47
.3
89
.2
45
.6
84
(4
3.
6)
(8
1.
6)
(8
3.
8)
(3
2.
4)
37
82
.7
57
.8
87
.5
41
.6
12
1
O
td ar M
ea nc he y 37
.0
64
.5
30
.1
33
(2
1.
0)
(4
3.
7)
(3
5.
6)
(2
.0
)
9
83
.3
38
.4
58
.4
24
.2
42
B
at ta m ba ng /P
ai lin
40
.5
53
.9
22
.3
12
5
(5
6.
9)
(7
4.
2)
(6
4.
0)
(3
1.
4)
48
88
.1
49
.8
56
.7
24
.8
17
3
K
am po t/K
ep 30
.3
91
.2
30
.3
56
(3
5.
1)
(5
1.
3)
(7
2.
0)
(4
.6
)
26
79
.2
37
.0
85
.0
22
.0
82
P
re ah S
ih an ou k/ K
oh K
on g 54
.2
80
.1
46
.6
31
(5
3.
0)
(6
4.
5)
(7
2.
3)
(1
8.
3)
15
84
.6
57
.6
77
.5
37
.3
46
P
re ah V
ih ea r/ S
tu ng T
re ng 20
.3
74
.3
16
.8
54
(3
7.
7)
(6
6.
7)
(6
0.
5)
(1
4.
6)
10
89
.9
27
.8
72
.0
16
.5
65
M
on du l K
iri
/
R
at an ak K
iri
37
.7
51
.3
24
.1
45
(4
5.
8)
(6
9.
5)
(4
1.
9)
(2
5.
2)
12
88
.7
44
.3
49
.3
24
.4
57
M
ot he r’s
e du ca tio
n N
o ed uc at io n 28
.9
71
.1
23
.2
20
0
22
.9
49
.0
53
.7
12
.1
70
80
.0
34
.1
66
.6
20
.3
27
0
P
rim
ar y 36
.6
72
.8
28
.6
80
6
44
.6
63
.9
64
.4
21
.7
29
0
85
.3
43
.8
70
.6
26
.7
1,
09
7
S
ec on da ry a nd h ig he r 50
.3
77
.7
42
.1
48
1
58
.1
69
.4
74
.1
34
.4
29
5
84
.1
57
.5
76
.3
39
.2
77
6
W
ea lth
q ui nt ile
Lo w es t 29
.1
72
.5
22
.5
38
2
17
.2
45
.2
42
.9
7.
5
13
2
78
.8
33
.2
64
.9
18
.6
51
4
S
ec on d 37
.4
72
.5
30
.8
32
4
25
.1
53
.5
59
.0
10
.8
10
3
82
.0
41
.3
69
.2
26
.0
42
7
M
id dl e 39
.7
76
.0
30
.2
28
9
36
.2
56
.0
66
.1
13
.4
10
9
82
.5
44
.1
73
.3
25
.6
39
7
Fo ur th 47
.6
75
.5
37
.9
27
6
51
.7
71
.6
65
.5
29
.5
10
5
86
.7
54
.2
72
.7
35
.6
38
2
H
ig he st 53
.8
75
.3
46
.8
21
6
84
.4
84
.0
89
.5
51
.4
20
7
92
.4
68
.6
82
.2
49
.1
42
3
To ta l 40
.0
74
.2
32
.2
1,
48
8
48
.3
64
.8
67
.6
26
.4
65
5
84
.2
47
.6
72
.2
30
.4
2,
14
3
N
ot e: F
ig ur es in p ar en th es es a re b as ed o n 25
-4
9
un w ei gh te d ca se s. A
n as te ris
k in di ca te s th at a fi gu re is b as ed o n fe w er th an 2
5
un w ei gh te d ca se s an d ha s be en s up pr es se d. 1 F
oo d gr ou ps : a
. i
nf an t f
or m ul a, m ilk
o th er th an b re as t m
ilk
, c
he es e or y og ur t o
r o
th er m ilk
p ro du ct s; b . f
oo ds m ad e fro
m g ra in s, ro ot s, a nd tu be rs , i
nc lu di ng p or rid
ge a nd fo rti
fie
d ba by fo od fr om g ra in s; c . v
ita
m in A
-ri
ch fr ui ts a nd v eg et ab le s (a nd re d pa lm o il)
; d
. o
th er fru
its
a nd v eg et ab le s; e . e
gg s; f. m ea t, po ul try
, f
is h, a nd s he llf
is h (a nd o rg an m ea ts );
g. le gu m es a nd n ut s. 2 F
or b re as tfe
d ch ild
re n, m in im um m ea l f
re qu en cy is re ce iv in g so lid
o r s
em is ol id fo od a t l
ea st tw ic e a da y fo r i
nf an ts a ge 6
-8
m on th s an d at le as t t
hr ee ti m es a d ay fo r c
hi ld re n ag e 9-
23
m on th s. 3 I
nc lu de s tw o or m or e fe ed in gs o f c
om m er ci al in fa nt fo rm ul a; fr es h, ti nn ed , a
nd p ow de re d an im al m ilk
; a
nd y og ur t 4 F
or n on br ea st fe d ch ild
re n ag e 6-
23
m on th s, m in im um m ea l f
re qu en cy is re ce iv in g so lid
o r s
em is ol id fo od o r m
ilk
fe ed s at le as t f
ou r t
im es a d ay .
5 N
on br ea st fe d ch ild
re n ag e 6-
23
m on th s ar e co ns id er ed to b e fe d w ith
a m in im um s ta nd ar d of th re e IY
C
F
pr ac tic
es if th ey re ce iv e ot he r m
ilk
o r m
ilk
p ro du ct s at le as t t
w ic e a da y, re ce iv e th e m in im um m ea l f
re qu en cy , a
nd re ce iv e so lid
o r s
em is ol id fo od s fro
m a t l
ea st fo ur fo od g ro up s no t i
nc lu di ng th e m ilk
o r m
ilk
p ro du ct s fo od g ro up .
6 B
re as tfe
ed in g, o r n
ot b re as tfe
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.
Nutrition of Children and Women • 185
186 • Nutrition of Children and Women
According to the results presented in Table 16.6, 40 percent of breastfed children age 6-23 months
were given foods from four or more food groups in the 24 hours preceding the survey, and 74 percent were
fed the minimum number of times in the preceding 24 hours. Almost 1 in 3 (32 percent) breastfed children
fell into both categories; that is, their feeding practices met minimum standards with respect to food
diversity as well as feeding frequency.
Among nonbreastfed children age 6-23 months, 48 percent were given milk or milk products, 65
percent were given food from at least four food groups, and 68 percent were fed four or more times per
day. However, only about 1 in 4 children (26 percent) were fed in accordance with all three IYCF
practices. Appropriate feeding practices were more common among breastfed children than nonbreastfed
children.
Overall, 30 percent of Cambodian children age 6-23 months met the minimum standard with
respect to all three IYCF feeding practices (Table 16.6). Eighty-four percent of all children age 6-23
months received breast milk or other milk or milk products during the 24-hour period before the survey,
and 72 percent were fed the minimum number of times in the preceding 24 hours. The most common
problem with feeding practices was an inadequate number of food groups; only 48 percent of children
received foods from the minimum number of food groups for their age.
The proportion of children age 6-23 months meeting all three recommended IYCF standards
increased from 15 percent among children age 6-8 months to 38 percent among those age 12-17 months
and then fell to 33 percent among those age 18-23 months. The proportions of children who met the
criteria did not vary by sex of the child. Urban children were more likely to be fed according to all of the
IYCF practices than rural children (49 percent versus 28 percent). There were large regional differences in
feeding practices. Children residing in Phnom Penh were most likely to be fed according to the
recommended IYCF practices (61 percent), whereas children in Kratie were least likely to be fed according
to the recommendations (12 percent). The proportions of children fed in accordance with the IYCF criteria
were highest among children of mothers with a secondary education or higher (39 percent) and those in the
highest wealth quintile (49 percent).
Figure 16.5 presents a comparison of the IYCF data from the 2010 and 2014 CDHS surveys. Since
2010, there have been improvements in infant and young child feeding practices. The percentage of
children fed according to the IYCF practices increased from 24 percent to 30 percent between 2010 and
2014, with larger improvements observed among nonbreastfed than breastfed children (Figure 16.5).
Figure 16.5 Trends in infant and young child feeding (IYCF) practices
28
11
24
32
26
30
Breastfed Nonbreastfed All 6-23 months
Percentage
CDHS 2010 CDHS 2014
Nutrition of Children and Women • 187
16.7 PREVALENCE OF ANEMIA IN CHILDREN
Common causes of anemia, characterized by a low level of hemoglobin in the blood, include
inadequate intake of iron, folate, vitamin B12, and other nutrients. Anemia can also result from
thalassemia, sickle cell disease, malaria, and intestinal worm infestation. Anemia may be an underlying
cause of maternal mortality, spontaneous abortion, premature birth, and low birth weight. Iron and folic
acid supplementation and antimalarial prophylaxis for pregnant women, promotion of the use of
insecticide-treated bednets by pregnant women and children under age 5, and six-month deworming for
children are some important measures used to reduce anemia prevalence among vulnerable groups.
Table 16.7 shows the prevalence of anemia among children age 6 to 59 months according to
selected background characteristics. Unadjusted (i.e., measured) values of hemoglobin were obtained using
the HemoCue instrument. Given that hemoglobin requirements differ substantially depending on altitude,
an adjustment to sea-level equivalents is typically made before classifying children by level of anemia.
Based on the altitude information derived from the clusters surveyed for the 2014 CDHS, no adjustment
was required in the measured hemoglobin values.
The results show that anemia is a critical public health problem in Cambodia, where more than
half (56 percent) of children age 6-59 months are anemic, with 30 percent mildly anemic, 25 percent
moderately anemic, and less than 1 percent severely anemic. Anemia is highest among children age 9-11
months (83 percent) and declines gradually among older children, reaching a low of 40 percent among
children age 48-59 months. Rural children are more likely (57 percent) to be anemic than urban children
(43 percent). The prevalence of anemia in the different provinces ranges from 40 percent among children
in Banteay Meanchey to 69 percent among children in Preah Vihear/Stung Treng. Children residing in the
poorest households are more likely than other children to be anemic. For example, 64 percent of children
in the lowest wealth quintile are anemic, as compared with 43 percent of children in the highest wealth
quintile. Children whose mothers have a secondary education or higher are less likely to be anemic than
other children.
188 • Nutrition of Children and Women
Table 16.7 Prevalence of anemia in children
Percentage of children age 6-59 months classified as having anemia, by background characteristics, Cambodia 2014
Anemia status by hemoglobin level
Background
characteristic
Any anemia
(<11.0 g/dl)
Mild anemia
(10.0-10.9 g/dl)
Moderate
anemia
(7.0-9.9 g/dl)
Severe anemia
(<7.0 g/dl)
Number of
children
Age in months
6-8 77.2 30.3 46.3 0.6 244
9-11 82.8 31.4 50.7 0.7 230
12-17 76.4 29.1 45.8 1.5 515
18-23 68.5 30.2 37.7 0.5 542
24-35 50.5 28.2 21.9 0.4 1,013
36-47 45.3 31.0 14.0 0.3 976
48-59 40.3 29.9 10.3 0.1 936
Sex
Male 56.7 28.8 27.4 0.5 2,280
Female 54.2 30.8 23.0 0.5 2,176
Mother’s interview status
Interviewed 56.6 29.7 26.4 0.5 3,836
Not interviewed but in
household 54.8 30.6 24.1 0.0 103
Not interviewed and not in
the household1 47.7 30.4 16.7 0.6 516
Residence
Urban 43.4 25.7 17.5 0.2 591
Rural 57.4 30.4 26.4 0.5 3,864
Province
Banteay Meanchey 39.7 21.1 17.2 1.4 222
Kampong Cham 62.7 40.3 22.4 0.0 625
Kampong Chhnang 59.2 27.9 31.2 0.0 161
Kampong Speu 63.9 35.2 27.8 0.9 301
Kampong Thom 66.0 36.2 29.3 0.4 197
Kandal 58.6 24.9 33.7 0.0 267
Kratie 50.2 28.5 21.7 0.0 157
Phnom Penh 41.0 24.5 16.5 0.0 335
Prey Veng 51.3 26.5 24.2 0.5 345
Pursat 64.8 25.7 36.8 2.3 192
Siem Reap 52.3 29.1 22.8 0.4 306
Svay Rieng 49.8 22.9 26.3 0.6 168
Takeo 53.1 29.0 23.5 0.6 245
Otdar Meanchey 64.3 37.1 27.3 0.0 77
Battambang/Pailin 49.0 26.8 22.2 0.0 344
Kampot/Kep 57.3 31.8 25.0 0.5 177
Preah Sihanouk/
Koh Kong 58.1 29.4 27.5 1.2 92
Preah Vihear/
Stung Treng 68.8 27.1 41.0 0.7 128
Mondul Kiri/
Ratanak Kiri 57.7 30.3 25.8 1.6 117
Mother’s education2
No education 56.6 28.1 27.4 1.2 537
Primary 58.8 30.5 28.0 0.4 2,192
Secondary and higher 52.4 28.6 23.5 0.3 1,116
Wealth quintile
Lowest 64.1 31.0 32.4 0.6 1,104
Second 60.6 32.9 26.9 0.8 929
Middle 53.5 27.3 25.8 0.3 890
Fourth 51.9 29.9 21.5 0.5 756
Highest 43.2 27.0 16.1 0.1 777
Total 55.5 29.8 25.2 0.5 4,456
Note: Table is based on children who stayed in the household on the night before the interview and who were tested for
anemia. Prevalence of anemia, based on hemoglobin levels, is adjusted for altitude using formulas in CDC, 1998.
Hemoglobin is in grams per deciliter (g/dl).
1 Includes children whose mothers are deceased
2 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose
mothers are not listed in the Household Questionnaire.
A comparison with earlier CDHS surveys shows that the prevalence of anemia decreased between
2005 and 2010 but has remained relatively unchanged over the past four years (Figure 16.6).
Nutrition of Children and Women • 189
Figure 16.6 Trends in anemia status among children under age 5
16.8 MICRONUTRIENT INTAKE AMONG CHILDREN
A serious contributor to childhood morbidity and mortality is micronutrient deficiency. Children
can receive micronutrients from foods, food fortification, and direct supplementation. Table 16.8 looks at
measures relating to intake of several key micronutrients among children.
Vitamin A is an essential micronutrient for the immune system and plays an important role in
maintaining the epithelial tissue in the body. Severe vitamin A deficiency (VAD) can cause eye damage.
VAD can also increase the severity of infections such as measles and diarrheal diseases in children and
slows recovery from illness. Vitamin A is found in breast milk, other milks, liver, eggs, fish, butter, red
palm oil, mangoes, papayas, carrots, pumpkins, and dark green leafy vegetables. The liver can store an
adequate amount of the vitamin for four to six months. Periodic dosing (usually every six months) of
vitamin A supplements is one method of ensuring that children at risk do not develop VAD.
In 2009, the National Nutrition Program developed a National Vitamin A Policy that ensures
uniform provision of vitamin A to children age 6-59 months. Mebendazol, a deworming drug, is also given
to children age 12-59 months. Currently, the vitamin A capsules, together with the Mebendazol, are
distributed through outreach sessions held twice annually in May and November. The provisions of iodine
and iron are made through salt that is iodized and in fish sauce, soy milk, and common children’s snacks
that are fortified with iron.
The CDHS collected information on the consumption of foods rich in vitamin A and iron and on
the coverage of supplements. Table 16.8 shows that 85 percent of last-born children age 6-23 months
living with their mother consumed foods rich in vitamin A in the 24-hour period before the survey.
Consumption of foods rich in vitamin A increases from 50 percent among children age 6-8 months to 98
percent among children age 18-23 months. There is no gender difference in the consumption of foods rich
in vitamin A. Nonbreastfeeding children are more likely to consume foods rich in vitamin A than
breastfeeding children (95 percent versus 80 percent). At least 90 percent of children living in Kampong
Chhnang, Kampong Speu, Kampong Thom, Kratie, and Phnom Penh consumed foods rich in vitamin A
the day or night preceding the survey. Vitamin A consumption was lowest in Kampong Cham (73 percent).
Eighty-two percent of children consume foods rich in iron. The differences in consumption of
iron-rich foods by background characteristics are similar to those seen for consumption of foods rich in
vitamin A.
62
29
32
1
55
28 26
1
56
30
25
1
Total Mild Moderate Severe
Percentage
CDHS 2005 CDHS 2010 CDHS 2014
190 • Nutrition of Children and Women
Table 16.8 Micronutrient intake among children
Among youngest children age 6-23 months who are living with their mother, the percentages who consumed vitamin A-rich and iron-rich foods in the day or night
preceding the survey; among all children age 6-59 months, the percentages who were given vitamin A supplements in the six months preceding the survey, who were
given iron supplements in the past seven days, and who were given deworming medication in the six months preceding the survey; and among all children age 6-59
months who live in households that were tested for iodized salt, the percentage who live in households with iodized salt, by background characteristics, Cambodia 2014
Among youngest children age 6-23 months
living with their mother: Among all children age 6-59 months:
Among children age 6-59
months living in households
tested for iodized salt:
Background
characteristic
Percentage
who
consumed
foods rich in
vitamin A in
last 24 hours1
Percentage
who
consumed
foods rich in
iron in last 24
hours2
Number of
children
Percentage
given vitamin
A supplements
in last 6
months
Percentage
given iron
supplements
in last 7 days
Percentage
given
deworming
medication in
last 6 months3
Number of
children
Percentage
living in
households
with iodized
salt4
Number of
children
Age in months
6-8 49.9 45.5 396 39.3 3.6 11.7 403 59.8 389
9-11 81.1 77.5 349 58.9 4.6 29.6 357 70.8 357
12-17 93.1 89.8 673 70.0 7.3 44.9 689 69.1 684
18-23 97.5 95.9 724 71.1 5.9 62.6 771 68.2 762
24-35 na na na 72.6 8.1 65.3 1,368 70.7 1,349
36-47 na na na 74.6 6.6 70.3 1,343 67.6 1,330
48-59 na na na 72.2 4.7 67.1 1,376 69.7 1,365
Sex
Male 85.2 82.3 1,086 70.8 6.1 59.7 3,170 68.6 3,133
Female 84.0 81.1 1,057 68.4 6.3 57.8 3,139 68.8 3,103
Breastfeeding status
Breastfeeding 80.1 76.3 1,488 60.1 7.0 40.9 1,720 65.5 1,693
Not breastfeeding 94.9 93.9 655 73.1 5.9 65.4 4,578 69.9 4,533
Mother’s age at birth
15-19 77.7 75.7 110 57.4 4.4 33.7 158 65.2 153
20-29 84.2 81.1 1,299 69.3 6.2 58.1 3,426 66.8 3,391
30-39 87.1 84.1 666 71.8 6.9 62.0 2,373 71.0 2,343
40-49 79.1 78.0 67 62.8 2.0 54.4 351 73.2 348
Residence
Urban 90.3 88.5 300 63.7 3.5 49.5 929 82.0 920
Rural 83.7 80.6 1,842 70.6 6.6 60.3 5,379 66.4 5,316
Province
Banteay Meanchey 82.2 79.7 89 84.5 2.4 71.3 220 90.1 217
Kampong Cham 73.0 70.2 292 67.2 3.7 51.1 865 33.5 855
Kampong Chhnang 94.6 92.4 81 85.5 2.9 77.7 210 68.6 210
Kampong Speu 89.5 89.5 146 58.7 6.0 47.1 424 89.3 412
Kampong Thom 92.3 89.0 107 90.8 8.4 81.5 299 87.5 299
Kandal 77.4 77.4 135 66.2 18.5 54.3 450 84.6 449
Kratie 93.0 86.5 76 57.6 0.2 52.6 225 90.4 224
Phnom Penh 95.8 94.7 186 60.2 3.5 44.0 554 77.5 546
Prey Veng 85.4 79.6 146 69.6 20.1 55.1 435 63.3 433
Pursat 77.1 70.8 96 77.9 2.8 75.2 272 47.3 268
Siem Reap 86.6 81.4 129 73.4 3.1 59.5 419 77.4 406
Svay Rieng 84.0 82.5 75 67.0 3.6 55.7 223 94.9 223
Takeo 85.1 81.3 121 85.8 10.5 79.1 335 87.2 331
Otdar Meanchey 79.6 75.6 42 65.2 1.2 56.1 122 77.9 120
Battambang/Pailin 85.6 82.6 173 75.1 2.1 67.9 471 46.8 467
Kampot/Kep 89.2 86.5 82 51.1 0.3 49.3 240 14.7 237
Preah Sihanouk/
Koh Kong 81.5 80.1 46 72.6 1.9 62.5 149 95.9 147
Preah Vihear/
Stung Treng 78.6 75.1 65 73.6 13.1 62.2 205 81.0 199
Mondul Kiri/
Ratanak Kiri 85.8 83.4 57 46.1 0.0 44.6 192 81.6 191
Mother’s education
No education 82.8 78.8 270 65.1 4.5 54.9 887 64.1 871
Primary 83.5 80.5 1,097 70.5 6.4 60.0 3,322 67.2 3,271
Secondary and
higher 86.9 84.4 776 70.0 6.5 58.4 2,099 73.0 2,094
Wealth quintile
Lowest 82.0 78.4 514 68.9 4.2 57.5 1,526 61.9 1,499
Second 86.5 83.3 427 68.9 4.7 58.6 1,258 63.6 1,238
Middle 86.8 82.6 397 69.9 8.8 60.6 1,179 64.3 1,173
Fourth 82.7 80.5 382 73.6 8.3 63.9 1,068 75.9 1,060
Highest 85.7 84.3 423 67.5 5.7 54.4 1,277 79.8 1,266
Total 84.6 81.7 2,143 69.6 6.2 58.7 6,308 68.7 6,236
Note: Information on vitamin A is based on both mother’s recall and the immunization card (where available). Information on iron supplements and deworming
medication is based on the mother’s recall. Total includes 10 cases for which information on breastfeeding is missing.
na = Not applicable
1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, dark green leafy vegetables, mango,
papaya, and other locally grown fruits and vegetables that are rich in vitamin A
2 Includes meat (and organ meat), fish, poultry, and eggs
3 Deworming for intestinal parasites is commonly done for helminthes and for schistosomiasis.
4 Excludes children in households in which salt was not tested
Nutrition of Children and Women • 191
Seventy percent of children age 6-59 months received a vitamin A supplement in the six months
before the survey, about the same percentage observed in the 2010 CDHS (71 percent). The difference in
consumption of vitamin A supplements between boys and girls is small (71 percent versus 68 percent).
Children who were not breastfeeding were more likely to receive vitamin A supplements (73 percent) than
children who were breastfeeding (60 percent). Seventy-one percent of rural children received vitamin A
supplements, as compared with 64 percent of urban children. The proportion of children who received
vitamin A supplements was lowest in Mondul Kiri/Ratanak Kiri (46 percent) and highest in Kampong
Thom (91 percent).
Only 6 percent of children age 6-59 months received iron supplementation in the seven days
preceding the survey. However, 59 percent of children received deworming medication in the six months
before the survey.
Inadequate amounts of iodine in the diet are related to serious health risks for young children. The
2014 CDHS results show that 69 percent of children age 6-59 months live in households using iodized salt.
Differences are sizable by area of residence; 82 percent of urban children live in households with iodized
salt, as compared with 66 percent of rural children. At least 90 percent of children living in Banteay
Meanchey, Kratie, Svay Rieng, and Preah Sihanouk/Koh Kong live in households using iodized salt.
Children whose mothers have a secondary education or higher are more likely to live in households with
iodized salt (73 percent) than are children whose mothers do not have any formal schooling (64 percent).
The percentage of children living in households with iodized salt is positively associated with wealth
quintile.
16.9 USE OF IODIZED SALT
Iodine is an important micronutrient. Dietary iodine deficiencies are a major public health concern
worldwide. A lack of sufficient iodine is known to cause goiter, cretinism (a severe form of neurological
defect), spontaneous abortion, premature birth, infertility, stillbirth, and increased child mortality. Iodine
deficiency disorder is the most common cause of preventable mental retardation and brain damage in the
world.
In the 2014 CDHS, a rapid test was used to determine the presence or absence of iodine in the salt
used for cooking in the household.
Table 16.9 shows the percentage of households using iodized salt. Overall, 69 percent of
households have salt with some iodine. This figure is substantially lower than that found in 2010 (83
percent) but is only slightly lower than the figure reported in the 2005 CDHS (73 percent). A higher
percentage of urban households (82 percent) than rural households (67 percent) are using iodized salt. The
consumption of iodized salt is lowest in Kampot/Kep (14 percent) and Kampong Cham (34 percent).
Households in the highest wealth quintile are more likely (82 percent) than households in the lower wealth
quintiles to use salt that is adequately iodized.
192 • Nutrition of Children and Women
Table 16.9 Presence of iodized salt in household
Among all households, the percentage with salt tested for iodine content and the percentage with no salt in the
household, and among households with salt tested, the percentage with iodized salt, according to background
characteristics, Cambodia 2014
Among all households:
Among households
with tested salt:
Background
characteristic
Percentage with
salt tested
Percentage with
no salt in the
household
Number of
households
Percentage with
iodized salt
Number of
households
Residence
Urban 98.9 1.1 2,284 82.3 2,257
Rural 98.8 1.2 13,541 66.6 13,376
Province
Banteay Meanchey 99.2 0.8 670 86.4 664
Kampong Cham 98.3 1.7 1,997 33.6 1,964
Kampong Chhnang 99.7 0.3 608 64.1 607
Kampong Speu 98.6 1.4 973 89.4 959
Kampong Thom 100.0 0.0 801 85.5 801
Kandal 99.5 0.5 1,259 87.8 1,253
Kratie 99.2 0.8 451 92.3 448
Phnom Penh 98.2 1.8 1,293 80.7 1,270
Prey Veng 98.2 1.8 1,228 62.0 1,206
Pursat 98.8 1.2 611 45.1 603
Siem Reap 98.2 1.8 1,000 79.4 982
Svay Rieng 99.7 0.3 678 94.5 676
Takeo 98.7 1.3 1,011 87.2 998
Otdar Meanchey 98.4 1.6 271 80.5 267
Battambang/Pailin 99.0 1.0 1,222 48.6 1,209
Kampot/Kep 98.4 1.6 762 14.1 750
Preah Sihanouk/Koh Kong 99.3 0.7 320 95.9 318
Preah Vihear/Stung Treng 97.7 2.3 361 85.3 352
Mondul Kiri/Ratanak Kiri 99.0 1.0 309 79.8 306
Wealth quintile
Lowest 98.2 1.8 3,208 59.0 3,149
Second 98.5 1.5 3,320 63.6 3,271
Middle 99.1 0.9 3,147 67.3 3,119
Fourth 99.0 1.0 3,176 74.0 3,146
Highest 99.1 0.9 2,975 81.6 2,949
Total 98.8 1.2 15,825 68.9 15,633
16.10 NUTRITIONAL STATUS OF WOMEN
The height and weight of women age 15-49 were measured among a two-thirds subsample of
households selected in the 2014 CDHS. In this report, two indicators of nutritional status are presented:
height and body mass index.
The height of a woman is associated with past socioeconomic status and nutrition during
childhood and adolescence. A woman’s height is used to predict the risk of difficulty in delivery because
small stature is often associated with small pelvis size and the potential for obstructed labor. The risk of
giving birth to a low birth weight baby is influenced by the mother’s nutritional status. The cutoff point for
the height at which mothers can be considered at risk varies between populations but normally falls
between 140 and 150 centimeters. As in other DHS surveys, a cutoff point of 145 cm was used for the
2014 CDHS.
The index used to measure thinness or obesity is known as the body mass index, or the Quetelet
index. BMI is defined as weight in kilograms divided by height squared in meters (kg/m2). A BMI of 18.5
or lower indicates thinness or acute undernutrition, a BMI of 25.0-29.9 indicates overweight, and a BMI of
30.0 or higher indicates obesity.
Table 16.10 presents the mean values of the two indicators of nutritional status and the proportions
of women falling into high-risk categories, according to background characteristics. Women for whom
there was no information on height and/or weight and for whom a BMI could not be estimated are
excluded from this analysis. The BMI data analysis is based on 10,624 women, whereas the height analysis
is based on 11,380 women.
Nutrition of Children and Women • 193
Table 16.10 Nutritional status of women
Among women age 15-49, the percentage with height under 145 cm, mean body mass index (BMI), and the percentage with specific BMI levels, by background
characteristics, Cambodia 2014
Height Body mass index1
Background
characteristic
Percentage
below
145 cm
Number of
women Mean BMI
18.5-24.9
(total
normal)
<18.5 (total
thin)
17.0-18.4
(mildly thin)
<17
(moderately and
severely
thin)
≥25.0 (total
overweight
or obese)
25.0-29.9
(overweight)
≥30.0
(obese)
Number of
women
Age
15-19 5.9 1,826 19.9 69.6 27.5 18.4 9.1 2.9 2.8 0.1 1,724
20-29 4.5 3,927 21.3 72.0 17.1 12.8 4.3 10.9 9.3 1.6 3,458
30-39 6.2 3,085 22.9 68.8 7.2 5.6 1.5 24.0 20.2 3.8 2,917
40-49 5.3 2,543 23.4 60.3 8.4 5.4 3.0 31.3 26.1 5.2 2,526
Residence
Urban 3.8 2,187 22.3 64.0 13.5 9.9 3.6 22.5 18.4 4.2 2,056
Rural 5.7 9,194 21.9 68.9 14.1 10.0 4.1 17.0 14.5 2.5 8,569
Province
Banteay Meanchey 4.0 448 23.0 62.9 10.7 8.3 2.4 26.4 21.3 5.1 418
Kampong Cham 8.8 1,252 22.2 70.0 10.2 7.4 2.8 19.8 16.9 2.9 1,176
Kampong Chhnang 6.8 418 21.4 67.5 18.0 14.3 3.8 14.5 12.6 1.9 389
Kampong Speu 7.3 793 21.1 68.4 20.9 14.5 6.4 10.7 10.0 0.7 737
Kampong Thom 2.3 568 22.0 71.2 12.5 8.7 3.8 16.4 13.6 2.8 526
Kandal 4.4 867 21.7 65.1 17.9 14.0 4.0 17.0 14.5 2.5 807
Kratie 4.7 320 21.7 71.5 15.8 11.1 4.6 12.7 10.7 2.0 287
Phnom Penh 3.2 1,342 22.2 65.6 14.0 10.3 3.7 20.4 17.3 3.1 1,269
Prey Veng 4.3 758 22.2 69.1 12.5 7.8 4.7 18.4 15.2 3.2 708
Pursat 5.6 419 21.7 70.5 13.1 8.5 4.6 16.4 15.6 0.9 384
Siem Reap 5.4 731 22.1 71.4 11.6 8.3 3.4 17.0 14.0 3.0 686
Svay Rieng 5.7 430 22.0 67.7 13.1 9.3 3.8 19.2 17.9 1.3 405
Takeo 4.2 688 21.9 65.8 13.9 8.1 5.8 20.3 17.5 2.8 653
Otdar Meanchey 3.4 191 22.0 72.0 12.8 11.4 1.4 15.2 11.7 3.5 170
Battambang/Pailin 3.8 848 22.7 65.7 11.9 9.6 2.4 22.4 17.1 5.2 800
Kampot/Kep 4.4 481 21.6 69.1 17.0 10.0 7.0 14.0 12.0 2.0 455
Preah Sihanouk/
Koh Kong 4.5 274 22.4 60.5 15.6 11.3 4.4 23.8 18.6 5.2 254
Preah Vihear/
Stung Treng 8.0 314 21.1 73.7 16.4 11.2 5.2 9.9 8.9 1.0 282
Mondul Kiri/
Ratanak Kiri 16.8 240 22.2 70.6 10.4 8.8 1.6 18.9 15.6 3.4 219
Education
No education 8.5 1,479 22.6 66.7 10.9 7.8 3.1 22.5 18.2 4.3 1,396
Primary 5.6 5,379 22.3 67.2 12.4 9.1 3.2 20.4 17.2 3.2 5,030
Secondary and
higher 4.1 4,523 21.4 69.3 17.0 11.8 5.2 13.7 11.9 1.8 4,198
Wealth quintile
Lowest 7.6 2,060 21.4 73.7 15.3 10.3 5.0 11.0 9.7 1.3 1,917
Second 6.6 2,118 21.9 68.8 14.6 10.4 4.2 16.6 14.2 2.4 1,944
Middle 5.5 2,168 21.9 67.7 14.3 10.0 4.3 18.0 14.9 3.1 2,026
Fourth 4.3 2,308 22.1 66.6 13.5 10.2 3.3 20.0 17.4 2.5 2,168
Highest 3.6 2,728 22.5 64.5 12.7 9.2 3.5 22.7 18.5 4.3 2,569
Total 5.4 11,380 22.0 68.0 14.0 10.0 4.0 18.0 15.2 2.8 10,624
Note: Body mass index is expressed as the ratio of weight in kilograms to the square of height in meters (kg/m2).
1 Excludes pregnant women and women with a birth in the preceding 2 months
Overall, 5 percent of women are shorter than 145 cm. A larger percentage of women in Mondul
Kiri/Ratanak Kiri are below 145 cm (17 percent) than women in other provinces. As expected, women
with no schooling and those in the lowest wealth quintile are more likely to be shorter than 145 cm.
Table 16.10 shows that 14 percent of women are underweight or thin (BMI less than 18.5), and 18
percent are overweight or obese (BMI 25.0 or higher). There are large differentials across background
characteristics in the percentage of women assessed as thin and overweight or obese. For example, the
proportion of women who are thin generally decreases with age group, while the proportion who are
overweight or obese increases with age. The percentage of overweight or obese women is higher in urban
areas (23 percent) than in rural areas (17 percent). Comparisons across provinces show that Kampong Speu
(21 percent), Kampong Chhnang (18 percent), and Kandal (18 percent) have the highest percentages of
undernourished women, whereas the lowest proportion of undernourished women is found in Kampong
Cham (10 percent). The percentage of overweight or obese women in the highest wealth quintile is more
than two times that of the lowest quintile (23 percent versus 11 percent).
194 • Nutrition of Children and Women
A comparison with the previous CDHS surveys shows that the proportion of undernourished
women in the reproductive age group has declined more substantially between the most recent two surveys
than the previous ones. However, the prevalence of overweight and obesity, another form of malnutrition,
has increased remarkably (Figure 16.7).
Figure 16.7 Trends in nutritional status among women age 15-49
16.11 PREVALENCE OF ANEMIA IN WOMEN
Table 16.11 shows the prevalence of anemia among women age 15-49, adjusted for smoking
status. Forty-five percent of Cambodian women are anemic, including 38 percent with mild anemia and 7
percent with moderate anemia. Less than 1 percent of women suffer from severe anemia.
Anemia shows a U-shaped pattern with respect to age, with younger and older women more likely
to be anemic than their counterparts in the other age groups. A similar pattern is seen according to number
of children. The prevalence of anemia is higher among women who have only a primary education or less,
those who are pregnant, and those who live in poorer households. Also, the prevalence is higher among
rural women (47 percent) than urban women (39 percent). Women residing in Banteay Meanchey have the
lowest prevalence of anemia (31 percent), and women residing in Kampong Chhnang, Kampong Speu, and
Preah Vihear/Stung Treng have the highest prevalence (53-54 percent). Anemia prevalence is higher
among women who smoke (52 percent) than among women who do not smoke (45 percent) and is slightly
higher among women who use an IUD than those who do not.
21
6
20
10
19
11
14
18
Undernutrition (BMI <18.5) Overnutrition (BMI ≥25.0)
Percentage
CDHS 2000 CDHS 2005 CDHS 2010 CDHS 2014
Nutrition of Children and Women • 195
Table 16.11 Prevalence of anemia in women
Percentage of women age 15-49 with anemia, by background characteristics, Cambodia 2014
Anemia status by hemoglobin level
Background
characteristic Any anemia Mild anemia
Moderate
anemia
Severe
anemia
Number of
women
Age
15-19 49.4 42.1 6.9 0.4 1,811
20-29 42.5 36.6 5.7 0.2 3,897
30-39 44.3 37.4 6.8 0.1 3,055
40-49 48.2 39.6 8.1 0.4 2,524
Number of children ever
born
0 46.5 39.3 6.9 0.3 3,585
1 44.7 37.5 6.9 0.4 1,865
2-3 43.2 37.5 5.4 0.2 3,653
4-5 46.4 38.4 7.7 0.3 1,541
6+ 51.2 40.6 10.6 0.0 641
Maternity status
Pregnant 53.2 30.4 22.4 0.4 615
Breastfeeding 51.5 44.6 6.8 0.2 1,566
Neither 43.8 37.9 5.6 0.3 9,106
Using IUD
Yes 49.4 43.3 6.1 0.0 334
No 45.2 38.2 6.7 0.3 10,952
Smoking status
Smokes cigarettes/tobacco 51.5 41.2 9.5 0.8 631
Does not smoke 45.0 38.2 6.6 0.2 10,655
Residence
Urban 39.4 34.9 4.3 0.2 2,156
Rural 46.8 39.2 7.3 0.3 9,130
Province
Banteay Meanchey 30.5 26.3 3.7 0.6 450
Kampong Cham 52.0 42.2 9.6 0.2 1,226
Kampong Chhnang 53.0 45.2 6.9 0.9 418
Kampong Speu 53.3 44.2 9.1 0.0 784
Kampong Thom 44.6 36.6 7.2 0.8 567
Kandal 49.4 41.3 7.9 0.2 867
Kratie 46.2 36.3 8.8 1.0 318
Phnom Penh 41.7 37.4 4.0 0.3 1,316
Prey Veng 46.9 39.8 7.1 0.0 749
Pursat 46.6 37.6 8.8 0.2 418
Siem Reap 41.1 34.3 6.3 0.4 722
Svay Rieng 45.7 38.2 7.3 0.3 427
Takeo 35.4 32.2 3.2 0.0 693
Otdar Meanchey 48.3 40.7 7.6 0.0 189
Battambang/Pailin 42.5 38.2 4.3 0.0 843
Kampot/Kep 44.1 39.1 4.7 0.3 479
Preah Sihanouk/Koh Kong 43.7 37.4 6.2 0.1 267
Preah Vihear/Stung Treng 53.7 41.4 12.2 0.0 313
Mondul Kiri/Ratanak Kiri 41.7 34.4 7.2 0.1 239
Education
No education 47.8 38.8 8.4 0.5 1,473
Primary 47.5 39.5 7.8 0.3 5,337
Secondary and higher 42.0 37.0 4.9 0.2 4,476
Wealth quintile
Lowest 53.3 42.2 10.5 0.6 2,055
Second 48.9 40.1 8.6 0.1 2,103
Middle 44.5 39.1 5.3 0.2 2,157
Fourth 43.1 36.7 6.3 0.1 2,292
Highest 39.1 35.1 3.8 0.2 2,680
Total 45.4 38.4 6.7 0.2 11,286
Note: Prevalence is adjusted for altitude and for smoking status if known using formulas in CDC, 1998.
196 • Nutrition of Children and Women
Figure 16.8 indicates that the overall prevalence of anemia has remained more or less the same
since the 2005 CDHS. This persistence of a high level of anemia requires more rigorous study to identify
the causes and effective interventions.
Figure 16.8 Trends in anemia status among women age 15-49
16.12 MICRONUTRIENT INTAKE AMONG MOTHERS
Adequate micronutrient intake by women has important benefits for both women and their
children. Breastfeeding children benefit from micronutrient supplementation that mothers receive. Iron
supplementation of women during pregnancy protects the mother and infant against anemia, which results
in an increased risk of premature delivery and low birth weight. Finally, iodine deficiency is also related to
a number of adverse pregnancy outcomes.
The Ministry of Health has developed and adopted a number of policies and guidelines addressing
micronutrient deficiencies in women, including the National Guidelines for the Use of Iron/Folate
Supplementation to Prevent and Treat Anemia in Pregnant and Postpartum Women (2007 revision).
Iron/folate supplementation is provided to women during pregnancy (for 90 days) and in the postpartum
period (for 42 days). In addition, Mebendazol is given to pregnant women during a prenatal care visit.
Table 16.12 presents the extent to which women receive iron supplements following delivery.
Forty-nine percent of women reported that they had received iron/folate supplements in the six-week
period following the delivery of their last-born child. With regard to iron supplementation during
pregnancy, 94 percent of women who gave birth during the five-year period before the 2014 CDHS
reported that they had taken iron tablets or syrup during the pregnancy preceding their last live birth; 76
percent indicated that they took the supplements for 90 days or more, which is recommended. The
prevalence of iron supplement intake for 90 days or more varies little by area of residence. The lowest
level of recommended iron supplementation was in Kratie (39 percent), and the highest level was in
Kampong Chhnang (94 percent). The percentage of women who took iron supplements for the
recommended 90 days increased with increasing education and wealth.
Almost three-quarters of women reported that they took deworming medicine (drugs for intestinal
parasites) during pregnancy. Deworming medicine was more commonly used by rural than urban women
and by women in Kampong Chhnang. The proportion of women who took drugs for intestinal parasites
during pregnancy increases with increasing education; however, it shows no steady pattern by wealth
quintile.
47
35
10
1
44
37
7
<1
45
38
7
<1
Total Mild Moderate Severe
Percentage
CDHS 2005 CDHS 2010 CDHS 2014
Nutrition of Children and Women • 197
As was the case among children, about 7 in 10 mothers (69 percent) live in households with
iodized salt. Women in Kampot/Kep (13 percent) are least likely to be living in households consuming
iodized salt.
Table 16.12 Micronutrient intake among mothers
Among women age 15-49 with a child born in the past five years, the percentage who received iron tablets in the first six weeks after the birth of the
last child, the percent distribution by number of days they took iron tablets or syrup during the pregnancy of the last child, and the percentage who
took deworming medication during the pregnancy of the last child, and among women age 15-49 with a child born in the past five years and who
live in households that were tested for iodized salt, the percentage who live in households with iodized salt, by background characteristics,
Cambodia 2014
Percentage
who
received
iron
postpartum1
Number of days women took iron tablets or syrup
during pregnancy of last birth
Percentage
of women
who took
deworming
medication
during
pregnancy
of last birth
Number of
women
Among women with a
child born in the last five
years who live in
households that were
tested for iodized salt:
Background
characteristic None <60 60-89 90+
Don’t
know/
missing
Percentage
living in
households
with iodized
salt2
Number of
women
Age
15-19 42.1 5.7 13.7 6.7 74.0 0.0 71.8 213 63.1 207
20-29 49.0 3.2 7.7 11.1 76.5 1.6 74.1 3,227 67.5 3,193
30-39 50.0 4.4 8.2 9.2 76.2 2.1 70.5 2,175 70.9 2,151
40-49 43.6 14.2 9.6 8.9 64.2 3.1 64.3 357 74.6 351
Residence
Urban 47.2 2.5 8.0 9.3 77.7 2.6 62.0 876 80.8 867
Rural 49.0 4.7 8.2 10.3 75.2 1.6 73.9 5,096 67.0 5,035
Province
Banteay Meanchey 38.0 0.8 3.8 4.4 88.3 2.8 72.1 219 88.7 216
Kampong Cham 34.6 2.7 14.3 17.5 65.5 0.0 64.3 819 36.2 802
Kampong Chhnang 84.9 0.7 0.9 2.7 94.4 1.3 96.6 203 64.7 203
Kampong Speu 30.4 1.8 8.9 6.9 79.2 3.3 71.7 395 88.7 387
Kampong Thom 82.2 5.3 6.1 10.2 78.3 0.0 90.6 279 88.2 279
Kandal 45.0 5.0 11.4 4.5 79.0 0.0 71.1 420 84.6 419
Kratie 29.9 23.0 24.9 13.6 38.5 0.0 57.0 214 91.4 212
Phnom Penh 44.5 2.1 7.3 10.4 79.2 1.0 53.6 535 76.7 526
Prey Veng 59.0 1.1 1.8 9.3 87.8 0.0 84.5 405 63.2 404
Pursat 63.4 4.5 6.0 7.8 80.6 1.0 89.2 245 49.2 241
Siem Reap 62.7 3.1 9.2 13.2 73.1 1.4 74.3 379 79.3 370
Svay Rieng 31.5 1.9 6.6 12.0 78.2 1.2 70.1 229 95.4 229
Takeo 72.4 2.1 2.8 5.5 86.7 2.9 71.1 321 86.9 318
Otdar Meanchey 62.9 4.0 6.1 12.5 76.8 0.7 82.0 116 78.8 114
Battambang/Pailin 43.7 2.5 2.1 6.3 80.0 9.0 78.4 460 46.9 456
Kampot/Kep 37.8 7.1 8.4 13.4 66.7 4.5 72.7 236 13.3 234
Preah Sihanouk/
Koh Kong 62.7 3.2 11.1 8.2 74.5 3.0 66.1 142 95.9 141
Preah Vihear/
Stung Treng 38.8 9.8 13.4 12.9 63.3 0.6 59.6 188 82.3 183
Mondul Kiri/
Ratanak Kiri 42.5 22.3 6.9 14.8 55.9 0.1 72.0 169 81.4 168
Education
No education 44.4 12.2 11.9 11.3 63.0 1.6 63.0 805 64.8 788
Primary 48.0 4.3 9.2 10.5 73.7 2.2 72.8 3,100 67.4 3,054
Secondary and
higher 51.7 1.4 5.2 9.1 83.1 1.2 74.8 2,068 73.1 2,059
Wealth quintile
Lowest 46.4 8.8 12.3 12.5 65.0 1.3 70.5 1,359 62.0 1,332
Second 50.9 4.8 9.5 9.5 74.8 1.5 71.6 1,215 65.1 1,198
Middle 48.0 3.5 6.3 11.8 76.7 1.7 76.3 1,133 64.7 1,127
Fourth 51.1 1.7 6.4 8.5 81.3 2.2 74.4 1,069 75.7 1,061
Highest 48.0 2.0 5.7 8.0 81.9 2.3 68.7 1,196 79.0 1,185
Total 48.8 4.4 8.2 10.1 75.5 1.8 72.2 5,973 69.0 5,902
1 In the first six weeks after delivery of last birth
2 Excludes women in households where salt was not tested
Micronutrients • 199
MICRONUTRIENTS 17
Key Findings
• Lack of iron storage is relatively rare in Cambodia. Only 3 percent each of
mothers age 15-49 and their children born since January 2009 are
affected.
• Nineteen percent of mothers and 10 percent of children are infected with
at least one intestinal parasite. Hookworm is the most commonly found
intestinal parasite, present in 15 percent of mothers and 7 percent of
children.
• Three percent of mothers and 9 percent of children have vitamin A
deficiency.
• Insufficient urinary iodine concentrations were found in 78 percent of
mothers and 66 percent of children.
icronutrient data at the national level for women and their children were collected for the first
time in the 2014 CDHS. Micronutrient data collection and analysis were implemented with
support and collaboration from UNICEF; the Institut de Recherche pour le Développement; the
International Life Science Institute; World Vision; the World Food Programme; the Cambodian Fisheries
Administration of the Ministry of Agriculture, Forestry and Fisheries; and ICF International. Data on
micronutrients were collected in a subsample of one in every six clusters selected for the main survey (102
of the overall 611 clusters). All children in the selected households who were born after January 2009 and
their mothers were eligible. It was estimated that this sampling design would allow collection of biological
samples for approximately 1,000 mothers and 1,000 children under age 5. The samples collected from the
women and children were a venous blood sample, a spot urine sample, and a stool sample. In order not to
disrupt the CDHS survey procedures, collection of specimens was planned as a follow-on activity in which
households were revisited after the DHS team had left the clusters. Due to logistic complications, the
micronutrient teams were able to revisit the clusters only about one to three months after the DHS team
had left. During the DHS data collection, all households in the eligible clusters were asked for consent to
be revisited for the micronutrient survey. Informed consent was obtained from women and from the parent
or adult responsible for the children before the collection of micronutrient samples.
Blood samples were tested for iron status (plasma ferritin and plasma soluble transferrin receptor
concentrations), vitamin A status (plasma retinol-binding protein concentration), vitamin D status (plasma
25-hydroxy vitamin D3 concentration), calcium status (plasma calcium concentration), vitamin B9 (plasma
folate concentration) and vitamin B12 (plasma vitamin B12 concentration), and type of hemoglobin. Urine
samples were tested for iodine status (urinary iodine concentration). Stool samples were tested for
intestinal parasites (egg counts).
Iron status and vitamin A status were analyzed at the VitMin laboratory in Germany using the
sandwich ELISA technique. Vitamin D, calcium, vitamin B9, and vitamin B12 were analyzed at the
Institut Pasteur in Phnom Penh, Cambodia, using electrochemiluminescence immunoassay with a Cobas
system. Urinary iodine concentrations were analyzed at the laboratory of the Mahidol University Institute
of Nutrition in Bangkok, Thailand, using spectrophotometry. Stool samples were analyzed for intestinal
parasite eggs at the National Centre for Malaria and Parasitology in Phnom Penh Cambodia, using the
Flotac technique.
M
200 • Micronutrients
17.1 COVERAGE OF MICRONUTRIENT TESTING
The survey identified 1,048 mothers and 1,358 children who were eligible for the micronutrient
study. However, about one in four mothers and their children (27 percent and 24 percent, respectively)
refused to participate in the micronutrient survey (Table 17.1). Refusal rates were considerably higher in
urban areas than in rural areas for both mothers and children.
Table 17.1 Coverage of micronutrient testing by residence
Among mothers age 15-49 who have at least one child born since January 2009 and children born since
January 2009, percent distribution by biological specimen testing status (unweighted), according to
residence, Cambodia 2014
Specimen
Mothers age 15-49 Children under age 5
Urban Rural Total Urban Rural Total
Stool
Tested with results 52.5 64.6 61.6 52.5 63.6 60.8
Tested, no results 8.5 12.0 11.2 13.3 16.1 15.4
Blood1
Tested with results 57.5 73.8 69.8 48.7 61.0 58.0
Tested, no results 3.5 2.9 3.1 17.1 18.7 18.3
Blood2
Tested with results 57.9 73.9 69.9 49.3 62.6 59.3
Tested, no results 3.1 2.8 2.9 16.5 17.1 16.9
Urinary iodine
Tested with results 58.3 74.1 70.2 59.3 73.5 70.0
Tested, no results 3.1 1.8 2.1 5.3 5.6 5.5
Not tested
Refused 39.0 22.8 26.8 34.2 20.0 23.6
Absent/missing 0.0 0.5 0.4 0.0 0.3 0.2
Total 100.0 100.0 100.0 100.0 100.0 100.0
Number 259 789 1,048 339 1,019 1,358
1 Tests for vitamins and calcium
2 Tests for ferritin and soluble transferrin receptors
Moreover, the quantity and/or quality of the specimens were not always sufficient for the
laboratory analyses, especially in the case of children. For example, 15 percent of children’s stool
specimens and 17-18 percent of their blood specimens were not testable or were tested without valid
results (Table 17.1). Thus, the analyses are based on only about 60-70 percent of eligible respondents.
17.2 IRON, HEMOGLOBIN, AND PARASITIC INFECTIONS
It has generally been assumed that, in Cambodia, the majority of anemia is associated with
insufficient iron intake. However, preliminary data suggested that, in the Cambodian context, factors other
than iron deficiency might play an important role in the pathogenesis of anemia (Karakochuk et al., 2015;
George et al., 2012), prompting an in-depth assessment of iron status as well as other micronutrients. Iron
deficiency can be assessed via serum ferritin concentrations (indicating iron stores) and soluble transferrin
receptor (sTfR) concentrations (indicating tissue iron needs). A serum ferritin concentration of less than 15
µg/L in women and less than 12 µg/L in children is a highly specific indicator of iron deficiency. Normal
sTfR concentrations are 8.3 mg/L or below, and an sTfR above 8.3 mg/L indicates tissue iron deficiency.
Micronutrients • 201
17.2.1 Anemia and Iron Status in Mothers
The data indicate that more than 4 in 10 mothers
are anemic (Table 17.2). Iron deficiency was relatively
rare among mothers (Table 17.2), with only 3 percent
having no iron storage (ferritin concentrations <15 μg/L).
In contrast, 34 percent of women showed tissue iron
deficiency, as indicated by elevated sTfR concentrations
(>8.3 mg/L). Caution is needed in interpreting this
indicator, however, as the cutoff level is currently being
discussed among experts and has not yet been formally
established. Also, other factors such as hemoglobin
disorders (hemoglobinopathy) might influence this
indicator.
Hemoglobin is the oxygen-transporting protein
in red blood cells. Hemoglobin A1 is the normal form of
hemoglobin. A person who has an HbA1 level above 95
percent is considered to have normal hemoglobin.
However, many genetic disorders induce different types
of hemoglobin. Some of these disorders, such as hemoglobin E (HbE), result in a structurally different
hemoglobin protein, leading to shorter red blood cell life spans and lower hemoglobin concentrations.
Other disorders, such as α- and β-thalassemia, are caused by deletion of part of the protein and result in
lower production of hemoglobin. A combination of different disorders, such as HbE and β-thalassemia, is
also possible and even quite common in Cambodia. HbE can be present in one of the two genes
(heterozygote HbE) or in both genes (homozygote HbE). Heterozygote HbE is expected when HbE levels
are between 20 percent and 30 percent of total Hb. Homozygote HbE is expected when levels are above 80
percent of total Hb.
The results showed that 41 percent of mothers had HbA1 levels above 95 percent, indicating that
they had normal hemoglobin, and 28 percent had heterozygote HbE (Table 17.3). Another 6 percent had
homozygote HbE. Other forms of hemoglobin were found among 23percent of mothers.
Table 17.3 Type of hemoglobin among mothers by residence
Among mothers age 15-49 who have at least one child born since
January 2009, percent distribution by type of hemoglobin, according
to residence, Cambodia 2014
Type of hemoglobin Urban Rural Total
Normal hemoglobin1 46.6 39.6 40.5
Heterozygote hemoglobin E2 25.5 28.4 28.0
Homozygote hemoglobin E3 7.9 5.7 6.0
Other forms of hemoglobin4 19.3 23.2 22.7
Missing 0.8 3.1 2.8
Total 100.0 100.0 100.0
Number 96 643 739
1 Hemoglobin A1 >95 percent
2 Hemoglobin E between 20 percent and 30 percent
3 Hemoglobin E >80 percent
4 Any other forms of hemoglobin spectrum
17.2.2 Anemia and Iron Status in Children
The overall prevalence of iron deficiency among children (3 percent) is about the same as among
mothers (Table 17.4). The prevalence of iron deficiency is very low relative to the high prevalence of
anemia (53 percent) among children. Again, as for mothers, the prevalence of tissue iron deficiency was
much higher, with nearly half (48 percent) of the children affected. However, the same caution as
Table 17.2 Anemia, iron status, and soluble transferrin
receptors among mothers
Among mothers aged 15-49 years who have at least one child
born since January 2009, percentage with anemia, no iron
storage (low ferritin) and tissue iron deficiency (high soluble
transferrin receptor [sTfR] concentration), according to urbanrural residence, Cambodia 2014
Urban Rural Total
Hemoglobin level
Anemia1 46.23 43.50 43.89
Number of mothers 71 415 485
Ferritin <15 mg/L 3.61 2.40 2.55
sTfR >8.3 mg/L 31.57 34.23 33.89
Number of mothers 96 642 738
1All pregnant mothers with hemoglobin <11.0 gram per deciliter
(g/dl) and all nonpregnant mothers with hemoglobin <12.0 g/dl,
after adjustments for altitude and for smoking status, if known,
using formulas in CDC (1998), are classified as anemic. The
hemoglobin level was measured in two-thirds of the
households in each cluster during the main DHS data
collection. This is why the number of women in the table is
lower for hemoglobin level.
202 • Micronutrients
mentioned above concerning use of the sTfR cutoff in this population is needed when interpreting these
data. The prevalence of children with no iron stores (a ferritin concentration <12 μg/L) was highly
dependent on age, with the prevalence being higher among children age 6-11 months (9 percent) and age
12-23 months (12 percent) than among children age 2 and older (1 percent) (Table 17.5). Tissue iron
deficiency (as indicated by an sTfR >8.3 mg/L) showed a similar pattern, with a higher prevalence of
deficiency among children less than age 2 than among older children.
Table 17.4 Anemia, iron status, and soluble transferrin
receptors (sTfRs) among children born since January 2009
Percentage of children born since 2009 according to their
anemia status (hemoglobin concentration <11.0 g/dl) and
iron status (ferritin concentration <15 μg/L; soluble
transferrin receptor [sTfR] concentration <8.3 mg/L), by
residence, Cambodia 2014
Urban Rural Total
Hemoglobin level
Anemia1 42.2 55.1 53.4
Number of children 87 573 659
Ferritin <12 μg/L 5.0 3.1 3.3
sTfR >8.3 mg/L 44.0 47.9 47.5
Number of children 88 705 793
1 All children with hemoglobin levels below 11.0 g/dl (after
adjustment for altitude using formulas in CDC, 1998) are
classified as anemic. Hemoglobin levels were tested in twothirds of the households in each cluster during the main
DHS data collection.
Table 17.5 Iron status among children by age
Among children born since 2009, percentage with no iron storage (low ferritin) and
tissue iron deficiency (high sTfR) according to age group, Cambodia 2014
6-11
months
12-23
months
24-59
months
60+
months Total
Ferritin <12 μg/L 8.6 12.3 1.3 1.2 3.3
sTfR >8.3 mg/L 59.4 60.3 45.7 39.1 47.5
Number of children 53 110 491 139 793
Hemoglobin patterns among children were more or less similar to those among mothers, with the
majority of children (32 percent) having normal hemoglobin (HbA1), 24 percent having heterozygote HbE,
and approximately 3 percent having homozygote HbE (Table 17.6). Another 23 percent of children have
other forms of hemoglobinopathy. Being a carrier of the HbE gene is usually strongly associated with
anemia.
Table 17.6 Type of hemoglobin among children born since January
2009 by residence
Among children born since January 2009, percent distribution by
type of hemoglobin, according to residence, Cambodia 2014
Type of hemoglobin Urban Rural Total
Normal hemoglobin1 31.8 32.0 32.0
Heterozygote hemoglobin2 27.6 23.6 24.1
Homozygote hemoglobin3 3.7 2.8 2.9
Other hemoglobin4 15.6 24.3 23.3
Missing 21.2 17.2 17.7
Total 100.0 100.0 100.0
Number of children 88 705 793
1 Hemoglobin A1 >95 percent
2 Hemoglobin E between 20 percent and 30 percent
3 Hemoglobin E >80 percent
4 Any other forms of hemoglobin spectrum
Micronutrients • 203
17.2.3 Intestinal Parasite Infection
The data showed that nearly 1 in 5 mothers (19 percent) were infected with at least one intestinal
parasite, approximately twice the proportion found among children (10 percent). By far the most prevalent
intestinal parasite infection was hookworm, present in 15 percent of mothers and 7 percent of children
(Table 17.7). The prevalence of hookworm infection among both mothers and children was much higher in
rural areas than in urban areas.
Table 17.7 Intestinal parasitic infection in women and children
Among mothers age 15-49 who have at least one child born since 2009 and all children born since
2009, percentage with various intestinal parasitic infections, according to residence, Cambodia 2014
Type of intestinal
parasitic infection
Mothers age 15-49 Children born since 2009
Urban Rural Total Urban Rural Total
Any infection 9.6 19.7 18.5 2.3 11.4 10.4
Ascaris 0.0 0.1 0.1 1.6 0.8 0.9
Trichuris 0.0 0.3 0.2 0.0 0.1 0.1
Hookworm 6.8 16.6 15.4 1.8 7.8 7.1
Enterobius 0.0 0.9 0.8 0.2 2.3 2.1
Taenia 0.0 0.0 0.0 0.0 0.2 0.2
Hymenolepis nana 1.8 1.2 1.3 0.0 0.8 0.7
Other 1.0 1.1 1.0 0.0 0.9 0.8
Number 77 555 632 93 719 811
17.3 VITAMIN AND CALCIUM DEFICIENCY
17.3.1 Vitamin and Calcium Deficiency among Mothers
Serum retinol is commonly used as an
indicator of vitamin A status. Retinol is
transported in a one-to-one complex with retinolbinding protein (RBP). Studies have shown a high
correlation between concentrations of RBP and
concentrations of retinol. Marginal vitamin A
status is assumed when retinol or RBP
concentrations are below 1.05 μmol/L, and
vitamin A deficiency is assumed when retinol or
RBP concentrations are below 0.70 μmol/L.
Table 17.8 shows that 9 percent of
mothers were classified as having marginal
vitamin A status, while 3 percent had vitamin A
deficiency. The prevalence of vitamin B12
deficiency (<150 pmol/L) and calcium deficiency
(<1.15 mmol/L) was low, with approximately 1
percent of women affected by each deficiency. In
contrast, almost 1 in 5 women had folic acid (also
known as vitamin B9) deficiency. Folic acid
deficiency in pregnancy is linked to neural tube defects and cleft palate. The prevalence of vitamin D
deficiency was also high among women, depending on the cutoff used. Overall, 31 percent and 60 percent
of women had vitamin D levels less than 50 nmol/L and 70 nmol/L, respectively.
17.3.2 Vitamin and Calcium Deficiency among Children
Among children, the overall prevalence of vitamin A deficiency (RBP <0.70 μmol/L) is 9 percent,
just below the threshold for a major public health problem (Table 17.9.1). Moreover, the high prevalence
of children with marginal vitamin A status (29 percent) is a significant public health concern. Similar to
Table 17.8 Blood level of vitamins A, B12, B9, and D and calcium in
mothers
Among mothers age 15-49 who have at least one child born since 2009,
percentage with deficiencies of vitamin A, vitamin B12, vitamin B9,
vitamin D, and calcium, according to residence, Cambodia 2014
Urban Rural Total
Vitamin A deficiency
Deficient (RBP <0.70 μmol/L) 4.6 3.0 3.2
Marginal (RBP <1.05 μmol/L) 9.8 8.6 8.7
Vitamin B12 deficiency
Deficient (<150 pmol/L) 1.7 1.0 1.1
Vitamin B9 deficiency
Deficient (<10 nmol/L) 19.1 19.2 19.2
Vitamin D deficiency
<50 nmol/L 26.6 31.6 30.9
<70 nmol/L 51.5 61.1 59.9
Calcium deficiency
<1.15 mmol/L 0.3 0.9 0.8
<0.90 mmol/L 0.0 0.2 0.2
Number of mothers 96 643 739
Note: Blood level of RBP is measured in micromoles per liter (μmol/L),
vitamin B12 in picomoles per liter (pmol/L), vitamin B9 and vitamin D in
nanomoles per liter (nmol/L), and calcium in millimoles per liter
(mmol/L).
204 • Micronutrients
mothers, the prevalence of vitamin B12 and calcium deficiency was low (2 percent and 1 percent,
respectively). In contrast, 8 percent of children suffer from folic acid (vitamin B9) deficiency. The
prevalence of folic acid deficiency among children is higher in urban areas (18 percent) than rural areas (7
percent). The prevalence of vitamin D deficiency is also high, with 15 percent of children having a vitamin
D level below 50 nmol/L and 33 percent having a level below 70 nmol/L.
Table 17.9.1 Blood level of vitamins A, B12, B9, and D and calcium in
children
Among children born since January 2009, percentage with deficiencies
of vitamin A, vitamin B12, vitamin B9, vitamin D, and calcium, according
to residence, Cambodia 2014
Urban Rural Total
Vitamin A deficiency
Deficient (RBP <0.70 μmol/L) 13.7 8.7 9.2
Marginal (RBP <1.05 μmol/L) 39.9 27.9 29.2
Vitamin B12 deficiency
Deficient (<150 pmol/L) 0.8 1.8 1.7
Vitamin B9 deficiency
Deficient (<10 nmol/L) 17.5 6.8 8.0
Vitamin D deficiency
<50 nmol/L 17.9 15.0 15.3
<70 nmol/L 36.7 32.7 33.1
Calcium deficiency
<1.15 mmol/L 0.4 0.6 0.6
<0.90 mmol/L 0.4 0.5 0.5
Number of children 87 688 775
Note: Blood level of vitamin A is measured in micromoles per liter
(μmol/L), vitamin B12 in picomoles per liter (pmol/L), vitamin B9 and
vitamin D in nanomoles per liter (nmol/L), and calcium in millimoles per
liter (mmol/L).
Table 17.9.2 presents levels of deficiency for different vitamins among children by age. The
prevalence of vitamin B12 deficiency and calcium deficiency is substantially higher among children age 611 months than among children age 12 months and older. In contrast, the proportion of children with
vitamin D deficiency increases with age (Table 17.9.2). The proportions of children who suffer from
vitamin A and folic acid deficiency vary only slightly by age.
Table 17.9.2 Blood level of vitamins A, B12, B9, and D and calcium in children by age
Among children born since January 2009, percentage with deficiencies of vitamin A, vitamin B12,
vitamin B9, vitamin D, and calcium, according to age group, Cambodia 2014
6-11
months
12-23
months
24-59
months
60+
months Total
Vitamin A deficiency
Deficient (RBP <0.70 μmol/L) 11.1 8.8 9.3 8.7 9.2
Marginal (RBP <1.05 μmol/L) 33.8 26.1 27.7 35.5 29.2
Vitamin B12 deficiency
Deficient (<150 pmol/L) 11.4 1.0 1.3 0.3 1.7
Vitamin B9 deficiency
Deficient (<10 nmol/L) 8.4 4.3 7.8 11.3 8.0
Vitamin D deficiency
<50 nmol/L 9.1 12.9 14.8 21.2 15.3
<70 nmol/L 9.1 27.4 34.9 39.5 33.1
Calcium deficiency
<1.15 mmol/L 4.2 1.1 0.3 0.0 0.6
<0.90 mmol/L 4.2 0.4 0.3 0.0 0.5
Number of children 46 105 486 138 775
Note: Blood level of vitamin A is measured in micromoles per liter (μmol/L), vitamin B12 in
picomoles per liter (pmol/L), vitamin B9 and vitamin D in nanomoles per liter (nmol/L), and calcium
in millimoles per liter (mmol/L).
Micronutrients • 205
17.4 URINE IODINE CONCENTRATION
Urinary iodine concentration (UIC) is the prime indicator of nutritional iodine status and is used to
evaluate population-based iodine supplementation. A UIC of less than 100 μg/L indicates insufficient
iodine in urine, and a value below 50 μg/L indicates a severe insufficiency. A UIC of more than 300 μg/L
is considered excessive. The data show high levels of insufficiency among both mothers and children, with
78 percent of mothers and 66 percent of children having a urinary iodine concentration below 100 μg/L
(Table 17.10). Severely insufficient iodine concentrations (<50 μg/L) are more prevalent among children
and mothers who live in rural areas than among those who live in urban areas.
Excess iodine concentrations were found in 4 percent of children and 1 percent of mothers.
Table 17.10 Urinary iodine excretion in mothers and children by residence
Percent distribution of mothers age 15-49 and children born since January 2009 by urinary iodine
concentration, according to residence, Cambodia 2014
Urinary iodine1
Mothers age 15-49 Children born since January 2009
Urban Rural Total Urban Rural Total
<50 μg/L 27.8 44.8 42.7 19.2 40.8 38.2
50-99 μg/L 36.7 35.2 35.3 24.8 28.4 28.0
100-299 μg/L 34.7 18.6 20.5 51.2 27.0 29.9
≥300 μg/L 0.9 1.5 1.4 4.7 3.9 4.0
Total 100.0 100.0 100.0 100.0 100.0 100.0
Number 90 648 737 114 840 953
1 Iodine status was assessed via UIC as recommended by WHO. Targets differ according to age
(WHO-VMNIS, 2013).
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 207
HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES,
AND BEHAVIOR 18
Key Findings
• Knowledge of HIV/AIDS in Cambodia is universal; almost all women and
men age 15-49 have heard of AIDS.
• Overall, 39 percent of women and 48 percent of men age 15-49 have
comprehensive knowledge about HIV/AIDS.
• Women are more aware than men that HIV can be transmitted through
breastfeeding and that this risk can be reduced by taking special drugs
(60 percent versus 51 percent).
• Women age 15-49 are less likely to have multiple sexual partners than
their male counterparts (less than 1 percent versus 3 percent).
• Eighteen percent of women and 5 percent of men age 18-24 reported
having sexual intercourse before age 18.
• Among never-married youth age 15-24, only 1 percent of young women
and 7 percent of young men reported that they had sexual intercourse in
the past 12 months.
• Only two-thirds (66 percent) of young men age 15-24 who had sexual
intercourse in the past 12 months reported using a condom during their
last sexual encounter.
his chapter presents current levels of HIV/AIDS knowledge, attitudes, and related behaviors for the
general adult population. The chapter then focuses on HIV/AIDS knowledge and patterns of sexual
activity among young people. The findings in this chapter will assist the AIDS control program in
Cambodia to identify particular groups of people most in need of information and services and most
vulnerable to the risk of HIV infection.
18.1 KNOWLEDGE OF HIV/AIDS AND OF TRANSMISSION AND PREVENTION METHODS
18.1.1 Awareness of AIDS
Ninety-eight percent of women and men age 15-49 have heard of AIDS (Table 18.1), almost
identical to the 99 percent found in 2010. Knowledge of AIDS exceeds 95 percent among women and men
in all age groups, in all marital status categories, and by urban and rural residence. However, only 94
percent of women and 93 percent of men with no schooling have heard of AIDS. Women in Mondul
Kiri/Ratanak Kiri (75 percent) and men in Preah Vihear/Stung Treng (83 percent) are least likely to be
aware of AIDS.
T
208 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
Table 18.1 Knowledge of AIDS
Percentage of women and men age 15-49 who have heard of AIDS, by background
characteristics, Cambodia 2014
Women Men
Background
characteristic
Has heard of
AIDS
Number of
respondents
Has heard of
AIDS
Number of
respondents
Age
15-24 97.9 5,910 96.8 1,760
15-19 97.0 2,893 95.2 926
20-24 98.8 3,017 98.5 835
25-29 98.5 2,836 99.0 815
30-39 98.6 4,886 98.6 1,463
40-49 97.5 3,947 98.8 1,152
Marital status
Never married 97.8 4,428 96.8 1,663
Ever had sex 99.1 56 99.6 303
Never had sex 97.7 4,372 96.2 1,360
Married/living together 98.2 11,898 98.7 3,405
Divorced/separated/
widowed 97.9 1,252 99.1 122
Residence
Urban 99.6 3,251 99.4 869
Rural 97.7 14,327 97.8 4,321
Province
Banteay Meanchey 99.5 689 100.0 192
Kampong Cham 95.6 2,021 97.9 663
Kampong Chhnang 100.0 662 100.0 182
Kampong Speu 99.9 1,196 99.6 323
Kampong Thom 100.0 851 100.0 232
Kandal 99.0 1,330 96.9 413
Kratie 99.3 488 97.0 143
Phnom Penh 99.9 1,994 99.8 550
Prey Veng 99.7 1,188 98.6 342
Pursat 99.7 631 99.5 184
Siem Reap 97.6 1,137 98.3 337
Svay Rieng 99.4 654 100.0 183
Takeo 98.9 1,082 98.0 334
Otdar Meanchey 89.0 294 99.4 99
Battambang/Pailin 99.2 1,333 99.6 405
Kampot/Kep 99.8 770 97.4 241
Preah Sihanouk/
Koh Kong 99.2 422 100.0 120
Preah Vihear/
Stung Treng 92.7 462 83.3 112
Mondul Kiri/
Ratanak Kiri 74.7 372 85.3 134
Education
No education 93.7 2,250 92.5 324
Primary 98.1 8,281 97.1 2,167
Secondary and higher 99.5 7,047 99.6 2,699
Wealth quintile
Lowest 95.8 3,143 93.7 901
Second 96.6 3,314 97.7 954
Middle 98.6 3,381 98.9 1,040
Fourth 99.2 3,612 99.5 1,124
Highest 99.6 4,128 99.7 1,171
Total 98.1 17,578 98.1 5,190
18.1.2 HIV Prevention Methods
HIV/AIDS prevention programs focus their messages and efforts on two important aspects of
behavior: limiting the number of sexual partners or staying faithful to one partner and use of condoms. To
ascertain whether programs have effectively communicated these messages, the 2014 CDHS prompted
respondents with specific questions about HIV/AIDS prevention methods (limiting sexual intercourse to
one uninfected faithful sexual partner and using condoms).
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 209
Table 18.2 presents knowledge of these HIV/AIDS prevention methods among women and men
age 15-49, by background characteristics. Eighty-five percent of women and 93 percent of men are aware
that the chances of contracting the AIDS virus can be reduced by limiting sex to one uninfected partner
who has no other partners; women (84 percent) and men (90 percent) are somewhat less likely to know that
using condoms can prevent transmission of the AIDS virus. Overall, 77 percent of women and 87 percent
of men have knowledge of both HIV prevention methods. These levels are slightly higher than those found
in the 2010 CDHS (75 percent of women and 80 percent of men).
Table 18.2 Knowledge of HIV prevention methods
Percentage of women and men age 15-49 who, in response to prompted questions, say that people can reduce the risk of getting the AIDS virus by
using condoms every time they have sexual intercourse and by having one sex partner who is not infected and has no other partners, by background
characteristics, Cambodia 2014
Women Men
Background
characteristic
Using
condoms1
Limiting sexual
intercourse to
one uninfected
partner2
Using
condoms and
limiting sexual
intercourse to
one uninfected
partner1,2
Number of
women
Using
condoms1
Limiting sexual
intercourse to
one uninfected
partner2
Using
condoms and
limiting sexual
intercourse to
one uninfected
partner1,2
Number of
men
Age
15-24 83.2 84.5 76.2 5,910 88.1 90.6 84.1 1,760
15-19 80.1 81.0 72.4 2,893 86.0 88.0 82.0 926
20-24 86.2 87.9 79.9 3,017 90.3 93.5 86.5 835
25-29 86.6 87.5 80.4 2,836 93.2 96.8 91.4 815
30-39 85.2 86.4 78.6 4,886 90.9 94.3 88.0 1,463
40-49 80.6 82.5 73.7 3,947 88.9 94.3 86.3 1,152
Marital status
Never married 81.9 83.1 75.6 4,428 88.9 90.7 85.0 1,663
Ever had sex 87.2 85.7 80.8 56 94.9 95.0 90.6 303
Never had sex 81.8 83.1 75.6 4,372 87.6 89.8 83.8 1,360
Married/living together 84.7 85.9 77.8 11,898 90.2 94.8 87.7 3,405
Divorced/separated/
widowed 81.3 84.3 74.0 1,252 92.8 93.4 89.6 122
Residence
Urban 90.4 91.1 85.7 3,251 96.8 97.4 95.2 869
Rural 82.2 83.7 75.0 14,327 88.5 92.6 85.2 4,321
Province
Banteay Meanchey 56.9 40.1 33.3 689 85.7 87.7 79.2 192
Kampong Cham 74.5 77.9 66.4 2,021 93.7 89.6 87.6 663
Kampong Chhnang 88.8 99.0 88.6 662 93.6 98.4 92.5 182
Kampong Speu 80.6 85.9 73.3 1,196 86.7 90.7 80.2 323
Kampong Thom 96.3 93.7 90.5 851 96.7 99.6 96.5 232
Kandal 92.1 93.3 87.3 1,330 83.2 95.6 82.8 413
Kratie 84.4 87.1 76.9 488 75.4 83.7 68.3 143
Phnom Penh 95.7 97.0 93.7 1,994 98.7 99.0 98.4 550
Prey Veng 84.4 91.6 81.5 1,188 94.9 97.3 93.7 342
Pursat 73.7 71.4 62.0 631 87.6 96.9 87.6 184
Siem Reap 79.8 80.6 70.0 1,137 68.9 89.5 63.8 337
Svay Rieng 81.0 90.8 76.5 654 87.2 93.0 84.0 183
Takeo 84.9 91.0 81.6 1,082 93.1 89.3 85.8 334
Otdar Meanchey 69.7 70.3 62.4 294 97.5 98.9 96.9 99
Battambang/Pailin 91.2 87.8 83.5 1,333 97.5 99.6 97.5 405
Kampot/Kep 93.4 90.5 86.9 770 90.1 94.3 88.3 241
Preah Sihanouk/
Koh Kong 86.1 83.6 77.2 422 98.2 97.1 95.4 120
Preah Vihear/
Stung Treng 74.8 68.1 61.1 462 81.1 79.9 77.7 112
Mondul Kiri/
Ratanak Kiri 61.7 66.5 57.4 372 76.6 80.8 74.1 134
Education
No education 70.9 74.6 63.1 2,250 70.1 84.8 66.6 324
Primary 82.7 83.0 74.8 8,281 87.1 90.3 82.6 2,167
Secondary and higher 89.1 90.8 84.0 7,047 94.5 97.0 92.7 2,699
Wealth quintile
Lowest 76.8 78.2 68.4 3,143 78.2 87.6 74.8 901
Second 79.5 82.2 72.3 3,314 86.6 90.7 82.2 954
Middle 82.2 83.6 74.5 3,381 93.3 94.4 89.7 1,040
Fourth 86.3 86.5 79.3 3,612 93.0 94.8 89.7 1,124
Highest 91.3 92.5 87.4 4,128 95.5 98.0 94.6 1,171
Total 83.7 85.1 77.0 17,578 89.9 93.4 86.9 5,190
1 Using condoms every time they have sexual intercourse
2 Partner who has no other partners
210 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
Knowledge of both HIV prevention methods is higher among women age 20-29 (80 percent) than
among younger or older women. Men age 25-29 are somewhat more likely to have knowledge about
prevention of HIV/AIDS than men in other age groups. There is little variation in knowledge of the two
HIV prevention methods by marital status, although knowledge is slightly higher among women and men
who have never been married but have had sex (81 percent and 91 percent, respectively) and among
formerly married men (90 percent).
Knowledge of HIV prevention methods is higher among respondents in urban than rural areas, and
there is considerable variability across provinces. Among women, knowledge of the two HIV prevention
methods is highest in Phnom Penh (94 percent) and lowest in Banteay Meanchey (33 percent). Among
men, knowledge of the two methods is highest in Kampong Thom, Phnom Penh, Otdar Meanchey,
Battambang/Pailin, and Preah Sihanouk/Koh Kong (95 percent or higher) and lowest in Siem Reap (64
percent).
Level of educational attainment strongly relates to a respondent’s knowledge of HIV prevention
methods. Women and men with higher levels of schooling are more likely than those with less schooling to
be aware of various preventive methods. The data also show that men and women in the higher wealth
quintiles are more likely than those in the lower quintiles to be aware of ways to prevent transmission of
the HIV virus.
18.1.3 Knowledge about Transmission
The 2014 CDHS included questions on common misconceptions about AIDS and HIV
transmission. Respondents were asked whether they think it is possible for a healthy-looking person to
have the AIDS virus and whether a person can contract AIDS from mosquito bites, by supernatural means,
or by sharing food with a person who has AIDS.
The results in Tables 18.3.1 and 18.3.2 indicate that many Cambodian adults lack accurate
knowledge about the ways in which the AIDS virus can and cannot be transmitted. Particularly critical is
the fact that only 62 percent of women and 66 percent of men know that a healthy-looking person can have
(and thus transmit) the virus that causes AIDS. Many women and men also erroneously believe that AIDS
can be transmitted by mosquito bites; only 70 percent of women and 73 percent of men reject this common
misconception. Larger proportions of women and men are aware that the AIDS virus cannot be transmitted
by supernatural means (89 percent and 93 percent, respectively) or by sharing food with a person who has
AIDS (88 percent and 90 percent, respectively). Overall, only about half of women (46 percent) and men
(51 percent) are able to reject two of the more common misconceptions about AIDS—that AIDS can be
transmitted by mosquito bites and that a person can become infected with the AIDS virus by sharing food
with someone who is infected—and know that a healthy-looking person can have the AIDS virus.
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 211
Table 18.3.1 Comprehensive knowledge about AIDS: Women
Percentage of women age 15-49 who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject
local misconceptions about transmission or prevention of the AIDS virus, and the percentage with comprehensive knowledge about AIDS, by background
characteristics, Cambodia 2014
Percentage of respondents who say that:
Percentage who
say that a healthylooking person can
have the AIDS
virus and who
reject the two most
common local
misconceptions1
Percentage with
comprehensive
knowledge about
AIDS2
Number of
women
Background
characteristic
A healthy-looking
person can have
the AIDS virus
The AIDS virus
cannot be
transmitted by
mosquito bites
The AIDS virus
cannot be
transmitted by
supernatural
means
A person cannot
become infected by
sharing food with a
person who has
AIDS
Age
15-24 61.6 69.0 89.0 84.1 44.1 37.6 5,910
15-19 57.0 66.1 86.0 80.3 39.6 32.7 2,893
20-24 66.0 71.8 91.8 87.7 48.4 42.4 3,017
25-29 65.3 77.5 91.0 92.0 53.2 45.9 2,836
30-39 64.4 71.7 91.2 91.3 48.6 41.7 4,886
40-49 58.4 62.7 86.1 85.3 39.6 33.0 3,947
Marital status
Never married 62.0 72.0 89.4 85.1 46.9 40.0 4,428
Ever had sex 65.7 70.5 89.0 85.9 47.2 42.5 56
Never had sex 61.9 72.1 89.5 85.1 46.9 40.0 4,372
Married/living together 62.4 69.0 89.5 88.7 45.5 38.8 11,898
Divorced/separated/
widowed 61.7 67.8 86.4 86.9 45.1 38.0 1,252
Residence
Urban 79.0 83.1 95.1 93.4 66.2 59.2 3,251
Rural 58.4 66.7 88.0 86.3 41.2 34.5 14,327
Province
Banteay Meanchey 52.1 64.4 86.7 87.5 36.4 8.9 689
Kampong Cham 58.3 61.9 89.1 85.1 39.2 26.9 2,021
Kampong Chhnang 49.3 96.9 98.8 99.0 46.7 44.7 662
Kampong Speu 46.2 63.5 85.1 85.4 30.0 25.5 1,196
Kampong Thom 71.5 91.9 98.8 97.1 64.8 59.3 851
Kandal 54.3 70.8 93.0 87.7 38.7 36.4 1,330
Kratie 73.5 56.0 82.4 81.6 44.1 39.3 488
Phnom Penh 90.6 83.0 96.3 92.3 74.5 71.2 1,994
Prey Veng 48.3 70.1 91.2 88.3 34.1 29.0 1,188
Pursat 57.1 77.9 90.8 93.1 44.3 29.7 631
Siem Reap 51.9 61.5 85.9 87.4 36.7 29.8 1,137
Svay Rieng 45.7 61.3 90.2 87.0 25.5 21.4 654
Takeo 79.2 75.9 92.4 90.8 63.1 54.5 1,082
Otdar Meanchey 33.3 64.2 69.1 73.2 28.6 24.8 294
Battambang/Pailin 81.2 69.2 87.7 89.4 58.1 52.9 1,333
Kampot/Kep 72.0 60.3 91.9 89.6 44.1 40.9 770
Preah Sihanouk/
Koh Kong 53.2 71.1 93.4 91.3 42.3 36.2 422
Preah Vihear/
Stung Treng 46.0 42.5 64.1 62.0 25.0 20.7 462
Mondul Kiri/
Ratanak Kiri 47.1 51.0 61.9 59.8 35.4 32.1 372
Education
No education 47.3 49.8 75.3 74.8 27.3 21.6 2,250
Primary 59.0 64.3 87.9 86.2 39.7 32.9 8,281
Secondary and higher 70.9 82.4 95.4 93.4 58.8 51.9 7,047
Wealth quintile
Lowest 51.3 56.3 79.7 79.3 32.1 25.8 3,143
Second 54.8 62.1 86.2 84.6 35.5 28.1 3,314
Middle 57.5 67.1 89.4 86.8 39.9 32.5 3,381
Fourth 65.3 75.8 93.1 92.0 50.7 43.7 3,612
Highest 77.8 82.8 95.5 93.3 65.1 59.3 4,128
Total 62.2 69.7 89.3 87.6 45.8 39.1 17,578
1 Two most common local misconceptions: the AIDS virus can be transmitted by mosquito bites and a person can become infected by sharing food with a person
who has AIDS.
2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce
the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions
about AIDS transmission or prevention.
212 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
Table 18.3.2 Comprehensive knowledge about AIDS: Men
Percentage of men age 15-49 who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local
misconceptions about transmission or prevention of the AIDS virus, and the percentage with comprehensive knowledge about AIDS, by background
characteristics, Cambodia 2014
Percentage of respondents who say that:
Percentage who
say that a healthylooking person can
have the AIDS
virus and who
reject the two most
common local
misconceptions1
Percentage with
comprehensive
knowledge about
AIDS2
Number of
men
Background
characteristic
A healthy-looking
person can have
the AIDS virus
The AIDS virus
cannot be
transmitted by
mosquito bites
The AIDS virus
cannot be
transmitted by
supernatural
means
A person cannot
become infected by
sharing food with a
person who has
AIDS
Age
15-24 63.2 72.0 90.7 85.7 48.8 45.9 1,760
15-19 59.1 70.2 87.4 81.9 45.2 42.4 926
20-24 67.7 74.1 94.4 90.0 52.9 49.9 835
25-29 70.0 80.4 95.3 94.1 57.5 55.4 815
30-39 67.0 74.3 93.7 92.6 52.5 50.2 1,463
40-49 65.9 67.4 91.7 89.6 47.9 44.9 1,152
Marital status
Never married 64.4 74.4 91.3 86.5 51.7 49.2 1,663
Ever had sex 79.2 79.4 96.3 90.2 66.8 64.5 303
Never had sex 61.1 73.3 90.1 85.7 48.4 45.8 1,360
Married/living together 66.3 72.4 93.0 91.6 50.6 47.9 3,405
Divorced/separated/
widowed 76.5 70.4 95.5 86.4 54.8 52.7 122
Residence
Urban 80.6 87.9 97.0 93.9 72.3 70.2 869
Rural 63.0 70.0 91.6 89.0 46.8 44.0 4,321
Province
Banteay Meanchey 66.3 60.9 92.9 83.1 41.3 36.8 192
Kampong Cham 74.0 58.8 89.6 87.8 48.2 47.2 663
Kampong Chhnang 81.3 68.1 97.3 83.9 55.2 52.3 182
Kampong Speu 66.7 69.8 86.4 87.1 47.7 43.7 323
Kampong Thom 85.0 97.9 98.0 99.3 83.4 81.4 232
Kandal 6.7 67.6 90.9 85.7 4.0 3.2 413
Kratie 48.6 63.8 82.1 84.2 33.4 29.3 143
Phnom Penh 91.2 90.0 98.0 95.0 82.0 81.3 550
Prey Veng 93.1 69.8 97.3 95.4 67.6 66.6 342
Pursat 80.9 80.1 96.0 91.9 61.7 54.6 184
Siem Reap 63.7 55.8 91.8 85.6 38.4 27.9 337
Svay Rieng 64.2 61.0 89.0 88.7 47.7 45.2 183
Takeo 72.2 76.0 92.1 90.3 57.2 54.6 334
Otdar Meanchey 3.5 80.3 95.6 96.2 3.2 2.5 99
Battambang/Pailin 73.7 88.5 99.3 96.7 67.3 66.4 405
Kampot/Kep 50.4 84.7 94.2 96.2 44.4 39.6 241
Preah Sihanouk/
Koh Kong 76.3 82.8 98.3 96.1 64.3 63.2 120
Preah Vihear/
Stung Treng 22.7 70.2 74.4 73.1 18.6 18.3 112
Mondul Kiri/
Ratanak Kiri 47.4 58.1 73.5 71.1 39.7 38.0 134
Education
No education 50.4 40.9 74.8 75.5 24.2 21.9 324
Primary 58.9 62.4 88.8 85.2 39.3 36.7 2,167
Secondary and higher 73.4 85.3 97.6 95.3 63.7 61.0 2,699
Wealth quintile
Lowest 53.0 56.8 84.2 81.3 33.7 30.4 901
Second 63.5 66.8 90.3 86.2 45.7 42.4 954
Middle 64.5 70.8 93.9 89.7 47.4 45.6 1,040
Fourth 67.4 77.3 94.4 93.6 53.6 50.5 1,124
Highest 77.8 88.2 97.7 95.8 69.4 67.6 1,171
Total 65.9 73.0 92.5 89.8 51.0 48.4 5,190
1 Two most common local misconceptions: the AIDS virus can be transmitted by mosquito bites and a person can become infected by sharing food with a person
who has AIDS.
2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce
the chance of getting the AIDS virus, knowing that a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions
about AIDS transmission or prevention.
Tables 18.3.1 and 18.3.2 also provide an assessment of the level of comprehensive knowledge of
HIV/AIDS prevention and transmission. People are considered to have comprehensive knowledge about
AIDS when they know that both condom use and limiting sex partners to one uninfected person are
HIV/AIDS prevention methods, they are aware that a healthy-looking person can have HIV, and they
reject the two most common local misconceptions. In Cambodia, 39 percent of women and 48 percent of
men have comprehensive knowledge of HIV/AIDS prevention and transmission, very close to the figures
reported in 2010 (41 percent and 44 percent, respectively).
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 213
Tables 18.3.1 and 18.3.2 show that there is considerable variation in HIV/AIDS knowledge by
background characteristics. Sexually active, never-married respondents tend to be slightly more
knowledgeable than those in other marital status categories. For all indicators, the proportion of women
and men with correct knowledge about HIV/AIDS prevention and transmission is much higher in urban
than rural areas and among women and men with higher levels of schooling. Similarly, men and women in
the higher wealth quintiles are more likely than those in the lower quintiles to have comprehensive
knowledge about HIV/AIDS. Variations in knowledge levels by province are marked among both women
and men, with the highest levels of comprehensive knowledge about AIDS observed among women and
men from Kampong Thom (59 percent and 81 percent, respectively) and Phnom Penh (71 percent and 81
percent, respectively).
18.1.4 Knowledge of Mother-to-Child Transmission
Educating people about the ways in which HIV can be transmitted from mother to child during
pregnancy, delivery, and breastfeeding is critical to reducing mother-to-child transmission (MTCT) of
HIV. To obtain information on these issues, respondents were asked whether the virus that causes AIDS
can be transmitted from a mother to a child during pregnancy, delivery, or breastfeeding and whether a
mother who is infected with HIV can reduce the risk of transmission of the virus to the baby by taking
certain drugs (antiretrovirals) during pregnancy (see Table 18.4).
Although 86 percent of women and 84 percent of men know that HIV can be transmitted by
breastfeeding, only 62 percent of women and 54 percent of men know that the risk of MTCT can be
reduced through the use of certain drugs during pregnancy. Sixty percent of women and 51 percent of men
are aware of both aspects of MTCT. This represents an increase from the figures reported in the 2010
CDHS.
MTCT knowledge is slightly higher among women and men age 25-29 and those who are
currently in a union. There is considerable variation by education and wealth among both women and men,
with MTCT knowledge increasing as education and wealth increase. Among women, MTCT knowledge
does not differ markedly by pregnancy status or by urban-rural residence. However, male urban residents
have higher levels of knowledge about mother-to-child transmission than their rural counterparts. Most
respondents know that HIV can be transmitted by breastfeeding; lack of knowledge about antiretrovirals
accounts for most of the variation by background characteristics. More than 4 of 5 women living in
Kampong Thom and Prey Veng have comprehensive knowledge of MTCT. Kampong Thom also has the
highest percentage of men with comprehensive MTCT knowledge (91 percent).
Particularly notable is the comparatively low level of knowledge among pregnant women; just 3 in
5 pregnant women are aware that HIV can be transmitted from mother to child during breastfeeding and
that mother-to-child transmission can be reduced by taking certain drugs during pregnancy. This indicates
incomplete coverage of MTCT counseling during prenatal care visits in Cambodia.
214 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
Table 18.4 Knowledge of prevention of mother-to-child transmission of HIV
Percentage of women and men age 15-49 who know that HIV can be transmitted from mother to child by breastfeeding and that the risk of mother-to-child
transmission (MTCT) of HIV can be reduced by the mother taking special drugs during pregnancy, by background characteristics, Cambodia 2014
Women Men
Background
characteristic
HIV can be
transmitted by
breastfeeding
Risk of MTCT
can be reduced
by mother taking
special drugs
during
pregnancy
HIV can be
transmitted by
breastfeeding
and risk of MTCT
can be reduced
by mother taking
special drugs
during
pregnancy
Number of
women
HIV can be
transmitted by
breastfeeding
Risk of MTCT
can be reduced
by mother taking
special drugs
during
pregnancy
HIV can be
transmitted by
breastfeeding
and risk of MTCT
can be reduced
by mother taking
special drugs
during
pregnancy
Number of
men
Age
15-24 83.3 56.9 53.5 5,910 80.2 51.7 47.9 1,760
15-19 81.0 51.1 47.4 2,893 78.0 48.8 45.7 926
20-24 85.5 62.5 59.3 3,017 82.7 55.0 50.5 835
25-29 87.0 67.1 64.1 2,836 84.1 58.3 54.1 815
30-39 88.2 65.7 63.4 4,886 86.4 55.2 51.8 1,463
40-49 86.2 63.2 60.6 3,947 86.3 54.4 51.6 1,152
Marital status
Never married 81.5 54.5 50.5 4,428 81.4 52.2 48.5 1,663
Ever had sex 82.2 56.3 50.6 56 84.3 52.5 47.4 303
Never had sex 81.5 54.5 50.5 4,372 80.7 52.1 48.7 1,360
Married/living together 87.6 65.4 62.9 11,898 85.3 55.6 52.2 3,405
Divorced/separated/
widowed 85.3 61.6 59.7 1,252 79.0 49.7 44.2 122
Currently pregnant
Pregnant 85.3 63.9 60.4 934 na na na na
Not pregnant or not
sure 86.0 62.3 59.5 16,644 na na na na
Residence
Urban 85.7 64.8 60.2 3,251 87.8 61.0 58.3 869
Rural 86.0 61.8 59.4 14,327 83.2 53.0 49.3 4,321
Province
Banteay Meanchey 88.5 63.1 61.1 689 84.8 46.2 43.9 192
Kampong Cham 86.0 54.9 52.7 2,021 82.1 62.4 56.3 663
Kampong Chhnang 95.7 77.8 76.2 662 93.1 65.5 65.0 182
Kampong Speu 90.9 58.9 56.4 1,196 77.3 29.2 25.1 323
Kampong Thom 97.8 87.4 87.2 851 99.0 91.2 90.7 232
Kandal 84.1 63.5 59.8 1,330 66.3 45.6 40.1 413
Kratie 93.8 53.1 51.1 488 72.7 20.5 18.4 143
Phnom Penh 84.1 61.5 55.8 1,994 91.4 62.6 61.0 550
Prey Veng 93.1 85.3 84.7 1,188 91.3 61.9 58.4 342
Pursat 89.6 62.3 60.8 631 91.8 32.3 31.5 184
Siem Reap 86.9 57.5 53.8 1,137 74.2 47.1 42.7 337
Svay Rieng 91.2 70.5 69.0 654 83.8 24.5 21.6 183
Takeo 74.6 62.6 61.2 1,082 81.6 40.7 35.8 334
Otdar Meanchey 76.5 50.8 49.0 294 97.5 74.9 74.1 99
Battambang/Pailin 81.6 55.6 49.8 1,333 89.4 64.8 61.7 405
Kampot/Kep 87.7 65.4 61.7 770 93.7 78.2 76.5 241
Preah Sihanouk/
Koh Kong 83.2 58.7 55.8 422 85.3 46.8 42.4 120
Preah Vihear/
Stung Treng 71.7 33.6 30.9 462 62.7 67.4 52.7 112
Mondul Kiri/
Ratanak Kiri 57.1 35.3 34.0 372 78.2 47.3 47.3 134
Education
No education 80.6 53.8 52.8 2,250 79.2 46.4 45.0 324
Primary 87.0 62.1 59.9 8,281 80.9 49.9 46.5 2,167
Secondary and higher 86.3 65.4 61.3 7,047 86.9 58.9 55.0 2,699
Wealth quintile
Lowest 85.4 56.1 54.5 3,143 79.1 47.1 43.9 901
Second 85.1 61.2 59.2 3,314 85.2 50.1 48.4 954
Middle 86.7 61.8 59.5 3,381 86.5 54.1 49.8 1,040
Fourth 86.6 64.8 61.6 3,612 79.9 55.2 49.8 1,124
Highest 85.8 66.6 61.9 4,128 88.2 62.8 60.0 1,171
Total 85.9 62.4 59.6 17,578 83.9 54.3 50.8 5,190
na = Not applicable
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 215
18.2 STIGMA ASSOCIATED WITH AIDS AND ATTITUDES RELATED TO HIV/AIDS
Knowledge and beliefs about HIV infection affect how people treat those they know to be living
with HIV or AIDS. In the 2014 CDHS, a number of questions were posed to respondents to measure their
attitudes towards HIV-infected people, including questions about their willingness to buy vegetables from
an infected shopkeeper, to let others know the HIV status of family members, and to take care of relatives
who have the AIDS virus in their own household. They were also asked whether an HIV-positive female
teacher who is not sick should be allowed to continue teaching. Tables 18.5.1 and 18.5.2 show the
percentages of women and men who have heard of HIV/AIDS and who express positive attitudes towards
people with HIV, by background characteristics.
Table 18.5.1 Accepting attitudes toward those living with HIV/AIDS: Women
Among women age 15-49 who have heard of AIDS, percentage expressing specific accepting attitudes toward people with HIV/AIDS, by
background characteristics, Cambodia 2014
Percentage of respondents who:
Percentage
expressing
accepting attitudes
on all four
indicators
Number of
respondents who
have heard of AIDS
Background
characteristic
Are willing to care
for a family
member with AIDS
in the respondent’s
home
Would buy fresh
vegetables from a
shopkeeper who
has the AIDS virus
Say that a female
teacher who has
the AIDS virus but
is not sick should
be allowed to
continue teaching
Would not want to
keep secret that a
family member got
infected with the
AIDS virus
Age
15-24 89.1 76.5 88.7 40.9 25.8 5,786
15-19 87.2 70.7 85.7 38.7 22.1 2,806
20-24 90.9 82.0 91.4 42.9 29.4 2,979
25-29 91.0 88.0 94.3 44.4 33.0 2,794
30-39 89.4 82.7 91.8 47.6 33.6 4,816
40-49 86.8 71.5 85.8 51.8 28.5 3,847
Marital status
Never married 88.9 77.3 89.7 39.1 24.9 4,328
Ever had sex 90.0 83.9 94.3 42.8 32.1 55
Never had sex 88.9 77.2 89.7 39.1 24.8 4,273
Married/living together 89.1 79.7 90.1 48.1 31.6 11,689
Divorced/separated/
widowed 87.8 77.9 87.5 46.9 28.8 1,226
Residence
Urban 93.1 88.9 95.0 37.4 29.8 3,238
Rural 88.0 76.7 88.6 47.7 29.7 14,005
Province
Banteay Meanchey 72.4 76.8 82.4 36.7 16.7 686
Kampong Cham 90.6 72.1 91.3 54.2 35.3 1,933
Kampong Chhnang 88.6 95.1 98.3 36.4 26.7 662
Kampong Speu 95.2 80.0 92.2 44.2 32.5 1,194
Kampong Thom 98.8 83.6 93.9 31.3 20.1 851
Kandal 92.5 74.2 89.7 50.4 35.9 1,317
Kratie 82.9 62.2 76.3 51.8 27.4 485
Phnom Penh 94.4 89.0 95.1 32.4 26.7 1,992
Prey Veng 64.0 82.2 93.6 67.6 27.7 1,184
Pursat 89.6 86.8 92.5 30.5 20.1 629
Siem Reap 80.1 68.6 87.0 61.4 32.3 1,110
Svay Rieng 97.6 69.0 88.1 26.7 13.2 651
Takeo 93.1 86.7 90.4 38.8 30.8 1,070
Otdar Meanchey 90.2 69.5 77.0 29.8 13.3 262
Battambang/Pailin 97.8 86.5 93.0 57.2 48.0 1,323
Kampot/Kep 86.5 77.1 87.1 66.1 46.8 768
Preah Sihanouk/
Koh Kong 96.5 91.7 96.0 38.9 33.0 419
Preah Vihear/
Stung Treng 77.2 41.1 56.7 45.1 11.6 428
Mondul Kiri/
Ratanak Kiri 92.9 77.9 76.8 12.8 5.6 278
Education
No education 84.4 64.6 80.5 48.1 23.6 2,108
Primary 88.2 76.0 87.8 48.1 29.4 8,122
Secondary and higher 91.3 86.9 94.9 42.4 32.0 7,013
Wealth quintile
Lowest 85.2 66.0 82.3 46.6 22.4 3,010
Second 86.7 73.9 87.9 47.0 27.5 3,202
Middle 88.0 78.3 89.9 49.7 31.9 3,334
Fourth 90.8 83.2 92.3 47.9 34.2 3,585
Highest 92.8 89.4 94.5 39.1 31.2 4,112
Total 89.0 79.0 89.8 45.8 29.8 17,243
216 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
The large majority of women and men age 15-49 (90 percent each) say that an HIV-positive
female teacher should be allowed to continue teaching. Comparatively fewer (79 percent of women and 82
percent of men) would buy fresh food from a shopkeeper with the AIDS virus. Although 89 percent of
women and 95 percent of men say they would be willing to care for a family member with the AIDS virus
in their home, only 46 percent of women and 49 percent of men would not want to keep secret that a
family member has HIV. Overall, 3 in 10 women (30 percent) and nearly 4 in 10 men (37 percent) express
accepting attitudes on all four indicators, approximately the same figures reported in 2010 (34 percent of
women and 35 percent of men).
Table 18.5.2 Accepting attitudes toward those living with HIV/AIDS: Men
Among men age 15-49 who have heard of HIV/AIDS, percentage expressing specific accepting attitudes toward people with HIV/AIDS, by
background characteristics, Cambodia 2014
Percentage of respondents who:
Percentage
expressing
accepting attitudes
on all four
indicators
Number of
respondents who
have heard of AIDS
Background
characteristic
Are willing to care
for a family
member with AIDS
in the respondent’s
home
Would buy fresh
vegetables from a
shopkeeper who
has the AIDS virus
Say that a female
teacher who has
the AIDS virus but
is not sick should
be allowed to
continue teaching
Would not want to
keep secret that a
family member got
infected with the
AIDS virus
Age
15-24 94.6 78.1 88.9 40.6 28.9 1,703
15-19 92.4 73.8 86.6 42.0 27.3 881
20-24 96.9 82.7 91.2 39.2 30.7 822
25-29 95.4 90.3 94.2 46.0 39.2 806
30-39 94.8 86.0 92.2 54.6 44.4 1,444
40-49 94.4 76.4 87.7 56.1 38.5 1,138
Marital status
Never married 94.6 80.0 90.1 40.8 30.9 1,610
Ever had sex 94.8 88.9 93.1 39.7 33.2 302
Never had sex 94.5 78.0 89.3 41.1 30.3 1,309
Married/living together 94.8 82.8 90.5 52.6 40.0 3,360
Divorced/separated/
widowed 94.2 81.9 90.4 53.5 37.4 121
Residence
Urban 95.3 93.0 94.5 42.1 34.9 864
Rural 94.6 79.6 89.6 50.3 37.5 4,227
Province
Banteay Meanchey 88.6 77.0 88.1 39.3 29.4 192
Kampong Cham 97.8 65.9 93.2 51.1 32.2 649
Kampong Chhnang 100.0 81.6 84.9 56.0 45.9 182
Kampong Speu 94.4 73.2 83.8 52.2 35.9 322
Kampong Thom 99.4 98.4 99.8 61.3 59.5 232
Kandal 80.0 84.4 85.6 51.9 31.9 400
Kratie 86.7 51.2 71.3 35.6 10.5 139
Phnom Penh 96.1 95.3 96.1 37.6 32.0 548
Prey Veng 99.4 76.4 86.9 44.9 36.1 337
Pursat 97.5 85.5 93.1 48.7 38.8 183
Siem Reap 87.6 85.0 89.6 61.3 40.6 331
Svay Rieng 98.5 71.4 76.6 44.4 33.3 183
Takeo 98.5 88.5 87.9 38.5 32.5 327
Otdar Meanchey 100.0 88.4 95.4 48.4 40.0 99
Battambang/Pailin 94.8 94.8 100.0 71.0 65.7 403
Kampot/Kep 97.9 81.3 94.0 43.2 31.9 235
Preah Sihanouk/
Koh Kong 95.4 90.5 91.8 38.4 31.5 120
Preah Vihear/
Stung Treng 94.4 86.3 86.0 67.6 52.8 93
Mondul Kiri/
Ratanak Kiri 100.0 73.5 92.8 9.3 5.9 114
Education
No education 90.1 65.9 80.0 51.1 27.0 300
Primary 93.9 76.2 87.3 49.3 34.5 2,104
Secondary and higher 95.9 88.1 93.9 48.4 40.2 2,687
Wealth quintile
Lowest 94.2 69.5 84.8 49.3 30.4 844
Second 95.5 80.7 89.4 51.5 38.8 932
Middle 94.5 76.7 89.5 48.6 35.7 1,029
Fourth 93.7 84.0 91.5 51.5 40.3 1,118
Highest 95.7 94.3 94.9 44.4 38.6 1,168
Total 94.7 81.9 90.4 48.9 37.1 5,091
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 217
In general, urban residents are more willing to buy fresh vegetables from a shopkeeper who has
the AIDS virus than their rural counterparts. However, they are less likely to say that they would not want
to keep secret that a family member is HIV positive. Overall, better educated respondents are more likely
to express accepting attitudes on all four measures. There is no significant variation in accepting attitudes
on all four measures by urban-rural residence, and there is no linear relationship with wealth.
Tables 18.5.1 and 18.5.2 document considerable variation in accepting attitudes by province.
Forty-eight percent of women in Battambang/Pailin and 47 percent in Kampot/Kep express accepting
attitudes on all four measures, as compared with only 6 percent in Mondul Kiri/Ratanak Kiri. Among men,
66 percent in Battambang/Pailin and 60 percent in Kampong Thom express accepting attitudes on all four
measures, compared with only 6 percent in Mondul Kiri/Ratanak Kiri.
18.3 ATTITUDES TOWARDS NEGOTIATING SAFER SEX
Knowledge about HIV transmission and ways to prevent it is useless if people feel powerless to
negotiate safer sex practices with their partners. To gauge attitudes towards safer sex, respondents in the
2014 CDHS were asked whether they think a woman is justified in refusing to have sex with her husband
if she knows he has sex with other women. They were also asked whether they think that a woman is
justified in asking her husband to use a condom if she knows that he has a sexually transmitted infection
(STI). The results from these questions are shown in Table 18.6.
Seventy-two percent of women and 70 percent of men believe that a woman is justified in refusing
to have sex with her husband if she knows he has sex with other women, and 95 percent of women and 98
percent of men believe that a woman is justified in asking her husband to use a condom if he has an STI.
Although a large majority of respondents in all groups support a woman’s right to refuse to have
sex with her husband if she knows he has sex with other women, some differences by background
characteristics stand out. For example, among both women and men, the percentage who agree with a
woman’s right to refuse to have sex with her husband is lower in urban areas than in rural areas; this
percentage is also lower among those with a secondary education or higher than among those with a
primary education or less. The percentage of women who support a woman’s right to refuse to have sex
with her husband if she knows he has sex with other women ranges from a low of 52 percent in Preah
Sihanouk/Koh Kong to a high of 90 percent in Prey Veng. Among men, support for a woman’s right to
refuse sex when her husband has sex with other women is lowest in Preah Vihear/Stung Treng (6 percent)
and highest in Mondul Kiri/Ratanak Kiri (97 percent).
There are only small differences by background characteristics in support for a woman’s right to
propose using a condom if she knows that her husband has an STI. For example, the percentage of women
and men supporting this is somewhat lower in the 15-19 age group than in the other age groups. Also, the
higher a respondent’s educational attainment and wealth quintile, the more likely he or she is to say that a
woman can propose using a condom.
218 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
Table 18.6 Attitudes toward negotiating safer sexual relations with husband
Percentage of women and men age 15-49 who believe that a woman is justified in refusing to have sexual intercourse with her
husband if she knows that he has sexual intercourse with other women, and percentage who believe that a woman is justified in asking
that they use a condom if she knows that her husband has a sexually transmitted infection (STI), by background characteristics,
Cambodia 2014
Women Men
Background
characteristic
Refusing to have
sexual
intercourse with
her husband if
she knows he
has sex with
other women
Asking that they
use a condom if
she knows that
her husband has
an STI
Number of
women
Refusing to have
sexual
intercourse with
her husband if
she knows he
has sex with
other women
Asking that they
use a condom if
she knows that
her husband has
an STI
Number of
men
Age
15-24 68.2 91.3 5,910 68.2 96.1 1,760
15-19 65.7 86.3 2,893 69.6 94.5 926
20-24 70.7 96.1 3,017 66.7 97.8 835
25-29 73.6 96.9 2,836 68.5 98.1 815
30-39 75.8 97.0 4,886 72.0 98.6 1,463
40-49 73.6 94.5 3,947 71.0 98.5 1,152
Marital status
Never married 63.9 87.9 4,428 66.4 96.0 1,663
Ever had sex 65.2 92.2 56 55.0 98.4 303
Never had sex 63.9 87.9 4,372 69.0 95.5 1,360
Married/living together 75.2 97.1 11,898 71.8 98.5 3,405
Divorced/separated/
widowed 75.9 93.6 1,252 66.1 96.7 122
Residence
Urban 64.7 97.6 3,251 57.1 98.7 869
Rural 74.1 93.8 14,327 72.5 97.4 4,321
Province
Banteay Meanchey 54.9 95.3 689 77.8 99.3 192
Kampong Cham 72.3 93.9 2,021 67.2 97.3 663
Kampong Chhnang 86.8 99.1 662 61.6 99.0 182
Kampong Speu 75.8 93.8 1,196 66.5 92.8 323
Kampong Thom 79.9 97.1 851 93.4 93.0 232
Kandal 79.4 96.1 1,330 80.9 96.8 413
Kratie 76.4 97.0 488 56.4 92.0 143
Phnom Penh 61.1 99.0 1,994 44.0 99.8 550
Prey Veng 89.5 96.4 1,188 52.4 99.7 342
Pursat 72.0 93.7 631 83.1 96.8 184
Siem Reap 66.3 94.3 1,137 88.8 97.3 337
Svay Rieng 72.2 96.8 654 60.7 98.5 183
Takeo 68.3 82.2 1,082 76.0 97.7 334
Otdar Meanchey 78.4 83.2 294 88.3 99.4 99
Battambang/Pailin 71.1 97.3 1,333 91.6 100.0 405
Kampot/Kep 81.4 97.1 770 60.4 99.6 241
Preah Sihanouk/
Koh Kong 52.1 92.7 422 81.2 99.2 120
Preah Vihear/
Stung Treng 74.0 88.2 462 5.7 96.2 112
Mondul Kiri/
Ratanak Kiri 61.5 82.8 372 96.7 98.1 134
Education
No education 72.2 90.3 2,250 73.4 95.6 324
Primary 74.4 95.0 8,281 73.8 96.8 2,167
Secondary and higher 70.1 95.3 7,047 66.4 98.5 2,699
Wealth quintile
Lowest 75.1 91.5 3,143 69.4 94.3 901
Second 76.2 93.4 3,314 72.8 97.0 954
Middle 73.6 94.0 3,381 72.9 98.1 1,040
Fourth 72.6 95.0 3,612 74.4 98.8 1,124
Highest 66.1 97.7 4,128 61.2 99.2 1,171
Total 72.4 94.5 17,578 69.9 97.6 5,190
18.4 MULTIPLE SEXUAL PARTNERSHIPS
Given that most HIV infections in Cambodia are contracted through heterosexual contact,
information on sexual behavior is important when designing and monitoring intervention programs to
control the spread of the epidemic. In the context of HIV/AIDS prevention, limiting the number of sexual
partners and encouraging protected sex are crucial to combating the epidemic. The 2014 CDHS included
questions on respondents’ lifetime sexual partners as well as the partners respondents had in the 12 months
preceding the survey. Male respondents were also asked whether they had paid for sex in the 12 months
preceding the interview. Information on use of condoms during the last sexual encounter with each of these
types of partners was collected from both women and men. Given that questions about sexual activity are
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 219
sensitive, it is important to remember that respondents’ answers are likely subject to at least some reporting
bias when interpreting the results in this section.
Tables 18.7.1 and 18.7.2 show the percentages of women and men age 15-49 who had engaged in
sexual intercourse with more than one partner in the past 12 months along with their mean number of
lifetime sexual partners. Table 18.7.2 also shows the percentage of men who used a condom during their
most recent intercourse (among those with more than one partner in the past 12 months). Because the
number of women reporting more than one partner in the past 12 months is very small, condom use among
these women is not presented.
Table 18.7.1 Multiple sexual partners: Women
Among all women age 15-49, the percentage who had sexual intercourse with more
than one sexual partner in the past 12 months and the mean number of sexual partners
during their lifetime for women who ever had sexual intercourse, by background
characteristics, Cambodia 2014
Among all women:
Among women who ever had
sexual intercourse1:
Background
characteristic
Percentage who
had 2+ partners
in the past 12
months
Number of
women
Mean number of
sexual partners
in lifetime
Number of
women
Age
15-24 0.1 5,910 1.2 2,443
15-19 0.0 2,893 1.0 490
20-24 0.3 3,017 1.2 1,953
25-29 0.1 2,836 1.1 2,411
30-39 0.0 4,886 1.1 4,561
40-49 0.0 3,947 1.2 3,762
Marital status
Never married 0.0 4,428 1.4 48
Married/living together 0.0 11,898 1.1 11,883
Divorced/separated/
widowed 0.4 1,252 1.4 1,246
Residence
Urban 0.2 3,251 1.3 2,095
Rural 0.0 14,327 1.1 11,082
Province
Banteay Meanchey 0.0 689 1.1 541
Kampong Cham 0.0 2,021 1.1 1,624
Kampong Chhnang 0.0 662 1.1 453
Kampong Speu 0.2 1,196 1.1 933
Kampong Thom 0.2 851 1.1 638
Kandal 0.0 1,330 1.1 987
Kratie 0.0 488 1.1 383
Phnom Penh 0.3 1,994 1.5 1,248
Prey Veng 0.0 1,188 1.1 995
Pursat 0.0 631 1.1 454
Siem Reap 0.0 1,137 1.1 858
Svay Rieng 0.0 654 1.1 525
Takeo 0.0 1,082 1.2 781
Otdar Meanchey 0.0 294 1.1 229
Battambang/Pailin 0.0 1,333 1.1 960
Kampot/Kep 0.0 770 1.1 616
Preah Sihanouk/
Koh Kong 0.1 422 1.1 293
Preah Vihear/
Stung Treng 0.0 462 1.1 354
Mondul Kiri/
Ratanak Kiri 0.1 372 1.1 306
Education
No education 0.1 2,250 1.2 2,034
Primary 0.1 8,281 1.2 7,032
Secondary and higher 0.0 7,047 1.1 4,111
Wealth quintile
Lowest 0.0 3,143 1.1 2,555
Second 0.0 3,314 1.1 2,620
Middle 0.0 3,381 1.1 2,601
Fourth 0.0 3,612 1.1 2,645
Highest 0.2 4,128 1.3 2,756
Total 0.1 17,578 1.1 13,177
1 Means are calculated excluding respondents who gave non-numeric responses.
220 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
The data show that almost no women and less than 3 percent of men reportedly had two or more
sexual partners during the 12 months preceding the survey. Among men, the proportion with multiple
sexual partners increases as age increases, from less than 1 percent among those age 15-19 to 4 percent
among those age 40-49. Men who are married and divorced, separated, or widowed and those living in
urban areas and in households in the highest wealth quintiles are more likely than other respondents to
have had multiple partners over the past year. There is no clear association between educational level and
having multiple partners over the past year. The percentage of men who report having had two or more
sexual partners in the past 12 months varies according to province. One in 10 men in Kratie and Phnom
Penh reported having had multiple partners over the past year.
Among men with two or more partners in the past 12 months, 30 percent report having used a
condom during their last encounter. Condom use is more pronounced among urban than rural men (48
percent and 16 percent, respectively).
On average, men report having 3.5 lifetime sexual partners, more than three times the average
reported by women (1.1 partners). Among women, there is almost no variation according to background
characteristics. Never-married men report 4.7 lifetime sexual partners, as compared with 3.4 among
currently married men and 2.8 among formerly married men. The number of sexual partners is also higher
among urban than rural men (8.0 versus 2.7). More educated and well-off men report a higher number of
sexual partners. Men with no schooling report an average of 1.4 partners, as compared with 4.8 partners
among men with a secondary education or higher, and the average number of lifetime partners ranges from
1.9 among men in the lowest wealth quintile to 7.0 in the highest quintile.
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 221
Table 18.7.2 Multiple sexual partners: Men
Among all men age 15-49, the percentage who had sexual intercourse with more than one sexual partner in the past 12
months; among those having more than one partner in the past 12 months, the percentage reporting that a condom was
used at last intercourse; and the mean number of sexual partners during their lifetime for men who ever had sexual
intercourse, by background characteristics, Cambodia 2014
All men
Among men who had 2+
partners in the past 12
months:
Among men who ever had
sexual intercourse1:
Background
characteristic
Percentage who
had 2+ partners
in the past 12
months
Number of
men
Percentage who
reported using a
condom during
last sexual
intercourse
Number of
men
Mean number of
sexual partners
in lifetime
Number of
men
Age
15-24 1.1 1,760 (46.2) 19 2.1 524
15-19 0.2 926 * 2 1.4 69
20-24 2.1 835 (43.4) 18 2.2 455
25-29 2.9 815 * 24 3.0 715
30-39 3.2 1,463 (28.9) 47 3.6 1,438
40-49 4.3 1,152 (18.8) 50 4.4 1,144
Marital status
Never married 1.5 1,663 (84.2) 25 4.7 302
Married/living together 3.1 3,405 14.9 107 3.4 3,400
Divorced/separated/
widowed 6.2 122 * 8 2.8 120
Residence
Urban 7.1 869 47.7 61 8.0 605
Rural 1.8 4,321 16.3 78 2.7 3,216
Province
Banteay Meanchey 1.9 192 * 4 4.1 143
Kampong Cham 2.0 663 * 13 5.4 548
Kampong Chhnang 3.6 182 * 7 4.0 130
Kampong Speu 1.5 323 * 5 1.6 241
Kampong Thom 0.0 232 * 0 1.2 155
Kandal 1.0 413 * 4 1.4 317
Kratie 10.5 143 (24.7) 15 2.0 107
Phnom Penh 10.0 550 (47.5) 55 9.9 376
Prey Veng 4.2 342 * 14 2.6 263
Pursat 0.7 184 * 1 3.2 121
Siem Reap 1.4 337 * 5 1.1 243
Svay Rieng 1.6 183 * 3 3.0 143
Takeo 1.3 334 * 4 2.3 244
Otdar Meanchey 0.0 99 * 0 1.4 69
Battambang/Pailin 0.2 405 * 1 2.9 275
Kampot/Kep 1.7 241 * 4 2.2 187
Preah Sihanouk/
Koh Kong 4.5 120 * 5 6.9 90
Preah Vihear/
Stung Treng 0.0 112 * 0 1.2 78
Mondul Kiri/
Ratanak Kiri 0.0 134 * 0 1.9 91
Education
No education 2.7 324 * 9 1.4 284
Primary 1.9 2,167 (14.4) 41 2.5 1,747
Secondary and higher 3.3 2,699 36.1 90 4.8 1,790
Wealth quintile
Lowest 1.6 901 * 14 1.9 663
Second 0.9 954 * 9 2.3 716
Middle 2.0 1,040 * 20 2.7 778
Fourth 2.4 1,124 * 26 3.1 827
Highest 6.0 1,171 41.5 70 7.0 837
Total 2.7 5,190 30.1 140 3.5 3,821
Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on
fewer than 25 unweighted cases and has been suppressed.
1 Means are calculated excluding respondents who gave non-numeric responses.
Male respondents in the 2014 CDHS who had had sex in the past 12 months were asked whether
they had paid anyone in exchange for sex in the past 12 months or ever in their lifetime and whether any of
their last three partners in the past 12 months was a commercial sex worker.
The results in Table 18.8 show that 10 percent of men have ever paid for sexual intercourse and
that 3 percent had done so in the 12 months before the survey. Men age 25-29 (15 percent); men who are
divorced, separated, or widowed (18 percent); men living in urban areas (14 percent); and men living in
Preah Sihanouk/Koh Kong and Svay Rieng (36 percent and 22 percent, respectively) are most likely to
have ever paid for sexual intercourse.
222 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
Table 18.8 Payment for sexual intercourse and condom use at last paid sexual intercourse
Percentage of men age 15-49 who ever paid for sexual intercourse and percentage reporting payment for
sexual intercourse in the past 12 months, and among them, the percentage reporting that a condom was
used the last time they paid for sexual intercourse, by background characteristics, Cambodia 2014
Among all men:
Among men who paid for sex
in the past 12 months:
Background
characteristic
Percentage who
ever paid for
sexual
intercourse
Percentage who
paid for sexual
intercourse in the
past 12 months
Number of
men
Percentage
reporting
condom use at
last paid sexual
intercourse
Number of
men
Age
15-24 4.3 2.0 1,760 91.1 36
15-19 1.7 1.0 926 * 9
20-24 7.1 3.2 835 (93.6) 27
25-29 14.9 3.4 815 (67.8) 28
30-39 11.8 3.2 1,463 90.1 46
40-49 12.9 4.3 1,152 75.2 50
Marital status
Never married 6.4 2.9 1,663 93.4 49
Married/living together 11.4 2.8 3,405 75.5 94
Divorced/separated/
widowed 18.1 12.9 122 (83.4) 16
Residence
Urban 14.3 6.6 869 84.5 57
Rural 9.1 2.4 4,321 80.3 102
Province
Banteay Meanchey 18.6 2.1 192 * 4
Kampong Cham 19.8 2.5 663 * 16
Kampong Chhnang 4.3 4.2 182 * 8
Kampong Speu 1.5 1.2 323 * 4
Kampong Thom 0.6 0.0 232 * 0
Kandal 1.8 1.3 413 * 5
Kratie 15.4 15.3 143 84.6 22
Phnom Penh 9.7 7.6 550 (88.2) 42
Prey Veng 10.3 3.6 342 * 12
Pursat 17.5 2.2 184 * 4
Siem Reap 4.5 3.8 337 * 13
Svay Rieng 21.6 1.8 183 * 3
Takeo 17.2 2.9 334 * 10
Otdar Meanchey 2.4 0.0 99 * 0
Battambang/Pailin 2.3 0.4 405 * 2
Kampot/Kep 2.4 2.4 241 * 6
Preah Sihanouk/
Koh Kong 35.7 4.3 120 * 5
Preah Vihear/
Stung Treng 1.8 1.8 112 * 2
Mondul Kiri/
Ratanak Kiri 9.2 0.7 134 * 1
Education
No education 4.4 1.9 324 * 6
Primary 8.8 2.6 2,167 76.6 57
Secondary and higher 11.6 3.6 2,699 83.8 96
Wealth quintile
Lowest 4.3 2.1 901 * 19
Second 7.2 1.8 954 * 17
Middle 9.9 2.6 1,040 * 27
Fourth 12.7 3.0 1,124 (93.4) 34
Highest 14.1 5.3 1,171 79.0 62
Total 15-54 10.0 3.1 5,190 81.8 159
Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is
based on fewer than 25 unweighted cases and has been suppressed.
Men in Kratie (15 percent) are most likely to report having engaged in paid sex in the past 12
months. Men who are divorced, separated, or widowed are more likely than those in other marital status
categories to report having recently paid money for sex, with 13 percent having engaged in such a
transaction in the past year. Urban men (7 percent), men with a secondary education or higher (4 percent),
and the wealthiest men (5 percent) are more likely than their counterparts to report having paid for sex in
the past year. Eighty-two percent of men who paid for sex in the past year reported using a condom during
their most recent paid sex; due to the small number of cases, differentials between subgroups should be
interpreted with caution.
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 223
18.5 TESTING FOR HIV
Knowledge of HIV status helps HIV-negative individuals make specific decisions to reduce risk
and increase safer sex practices so they can remain disease free. For those who are HIV infected,
knowledge of their status allows them to take action to protect their sexual partners, to access treatment,
and to plan for the future. Testing of pregnant women is especially important so that action can be taken to
prevent mother-to-child transmission.
To obtain information on the prevalence of HIV testing, all respondents were asked whether they
had ever been tested for HIV. If they said that they had, they were asked whether they had received the
results of their last test. Women giving birth in the two-year period before the survey were asked additional
questions regarding testing that may have occurred as part of any antenatal care they received prior to the
birth.
Tables 18.9.1 and 18.9.2 show that, among the adult population age 15-49, 42 percent of women
and 36 percent of men have been tested for HIV at some time. These figures are substantially higher than
those reported in 2010, when only 25 percent of both women and men had ever been tested. Forty-one
percent of women and 35 percent of men were tested indicated that they had received the results of their
test. Ten percent of women and 9 percent of men said that they been tested and received results during the
12 months prior to the survey.
The proportions of both women and men ever tested were higher among those age 20 and older
than among those younger than age 20. Testing levels were highest among currently married women (54
percent), whereas levels were approximately the same among never-married men who had ever had sex (47
percent), currently married men (46 percent), and widowed, divorced, and separated men (48 percent).
Unmarried women and men who had never had sex were least likely to have ever been tested for HIV (11
percent and 9 percent, respectively). Urban residents, those with a secondary education or higher, and
those in the highest wealth quintile had higher testing levels than their counterparts. Women and men
residing in Preah Vihear/Stung Treng and Mondul Kiri/Ratanak Kiri are least likely to have ever been
tested for HIV.
224 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
Table 18.9.1 Coverage of prior HIV testing: Women
Percentage of women age 15-49 who know where to get an HIV test, percent distribution of women age 15-49 by testing status and by whether they
received the results of the last test, the percentage of women ever tested, and the percentage of women age 15-49 who were tested in the past 12
months and received the results of the last test, according to background characteristics, Cambodia 2014
Percentage who
know where to
get an HIV test
Percent distribution of women by testing
status and by whether they received the
results of the last test
Total
Percentage
ever tested
Percentage who
have been
tested for HIV in
the past 12
months and
received the
results of the last
test
Number of
women
Background
characteristic
Ever tested
and
received
results
Ever tested,
did not
receive
results
Never
tested1
Age
15-24 76.4 32.4 1.9 65.7 100.0 34.3 12.1 5,910
15-19 67.2 13.6 1.0 85.3 100.0 14.7 6.7 2,893
20-24 85.2 50.5 2.7 46.8 100.0 53.2 17.3 3,017
25-29 87.7 63.2 1.9 34.9 100.0 65.1 14.8 2,836
30-39 81.0 50.3 2.0 47.6 100.0 52.4 8.2 4,886
40-49 70.0 24.0 0.6 75.4 100.0 24.6 3.2 3,947
Marital status
Never married 70.2 10.8 0.8 88.4 100.0 11.6 3.8 4,428
Ever had sex 81.8 41.8 0.0 58.2 100.0 41.8 24.6 56
Never had sex 70.0 10.4 0.8 88.8 100.0 11.2 3.6 4,372
Married/living together 81.5 51.6 2.0 46.4 100.0 53.6 11.9 11,898
Divorced/separated/
widowed 73.7 39.7 1.0 59.3 100.0 40.7 6.6 1,252
Residence
Urban 90.3 51.4 1.2 47.4 100.0 52.6 12.8 3,251
Rural 75.3 38.0 1.7 60.3 100.0 39.7 8.7 14,327
Province
Banteay Meanchey 80.0 44.9 1.0 54.1 100.0 45.9 12.1 689
Kampong Cham 75.5 37.1 1.2 61.7 100.0 38.3 8.7 2,021
Kampong Chhnang 99.6 42.6 1.9 55.5 100.0 44.5 13.5 662
Kampong Speu 71.1 39.7 3.3 56.9 100.0 43.1 8.3 1,196
Kampong Thom 78.3 42.3 0.3 57.4 100.0 42.6 8.9 851
Kandal 74.8 34.7 2.4 62.9 100.0 37.1 7.7 1,330
Kratie 61.5 24.1 1.8 74.0 100.0 26.0 3.5 488
Phnom Penh 92.3 51.7 1.1 47.1 100.0 52.9 13.6 1,994
Prey Veng 80.4 34.6 0.2 65.2 100.0 34.8 4.4 1,188
Pursat 75.3 43.0 1.2 55.8 100.0 44.2 9.4 631
Siem Reap 77.4 46.4 3.2 50.4 100.0 49.6 10.6 1,137
Svay Rieng 87.6 40.0 4.5 55.4 100.0 44.6 11.3 654
Takeo 72.3 41.3 1.6 57.1 100.0 42.9 9.2 1,082
Otdar Meanchey 60.5 31.3 1.2 67.5 100.0 32.5 9.1 294
Battambang/Pailin 89.7 54.0 0.8 45.2 100.0 54.8 12.0 1,333
Kampot/Kep 72.4 33.5 1.7 64.8 100.0 35.2 6.6 770
Preah Sihanouk/
Koh Kong 88.8 50.2 1.9 47.9 100.0 52.1 16.3 422
Preah Vihear/
Stung Treng 48.2 16.6 1.4 82.0 100.0 18.0 4.9 462
Mondul Kiri/
Ratanak Kiri 37.3 14.1 0.4 85.6 100.0 14.4 4.1 372
Education
No education 59.1 29.8 1.6 68.6 100.0 31.4 6.3 2,250
Primary 76.8 40.6 1.8 57.5 100.0 42.5 8.5 8,281
Secondary and higher 85.6 43.7 1.4 54.8 100.0 45.2 11.6 7,047
Wealth quintile
Lowest 65.0 32.9 1.5 65.5 100.0 34.5 7.0 3,143
Second 72.0 34.5 2.0 63.5 100.0 36.5 9.0 3,314
Middle 77.3 38.1 1.9 60.0 100.0 40.0 8.2 3,381
Fourth 80.8 40.6 1.8 57.6 100.0 42.4 9.5 3,612
Highest 91.2 52.9 1.1 46.0 100.0 54.0 12.7 4,128
Total 78.1 40.5 1.6 57.9 100.0 42.1 9.5 17,578
1 Includes “don’t know/missing”
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 225
Table 18.9.2 Coverage of prior HIV testing: Men
Percentage of men age 15-49 who know where to get an HIV test, percent distribution of men age 15-49 by testing status and by whether they
received the results of the last test, the percentage of men ever tested, and the percentage of men age 15-49 who were tested in the past 12 months
and received the results of the last test, according to background characteristics, Cambodia 2014
Percentage who
know where to
get an HIV test
Percent distribution of men by testing
status and by whether they received the
results of the last test
Total
Percentage ever
tested
Percentage who
have been tested
for HIV in the
past 12 months
and received the
results of the last
test
Number of
men
Background
characteristic
Ever tested
and
received
results
Ever tested,
did not
receive
results
Never
tested1
Age
15-24 70.8 18.1 0.8 81.1 100.0 18.9 6.6 1,760
15-19 62.4 6.7 0.8 92.5 100.0 7.5 2.9 926
20-24 80.0 30.8 0.8 68.5 100.0 31.5 10.7 835
25-29 86.7 56.9 0.4 42.6 100.0 57.4 17.3 815
30-39 80.5 48.5 1.6 49.9 100.0 50.1 8.2 1,463
40-49 73.1 29.9 1.0 69.1 100.0 30.9 6.4 1,152
Marital status
Never married 70.4 15.0 1.0 84.0 100.0 16.0 5.4 1,663
Ever had sex 88.2 45.0 2.2 52.8 100.0 47.2 17.7 303
Never had sex 66.4 8.4 0.7 90.9 100.0 9.1 2.6 1,360
Married/living together 79.3 44.9 1.1 54.0 100.0 46.0 10.2 3,405
Divorced/separated/
widowed 82.3 47.8 0.0 52.2 100.0 47.8 12.4 122
Residence
Urban 90.8 52.7 1.0 46.3 100.0 53.7 12.4 869
Rural 73.7 31.9 1.0 67.1 100.0 32.9 7.9 4,321
Province
Banteay Meanchey 78.6 39.4 0.0 60.6 100.0 39.4 5.2 192
Kampong Cham 57.9 31.8 2.1 66.1 100.0 33.9 13.0 663
Kampong Chhnang 97.5 41.6 1.7 56.8 100.0 43.2 12.1 182
Kampong Speu 59.5 33.3 1.5 65.2 100.0 34.8 6.8 323
Kampong Thom 70.8 36.9 0.0 63.1 100.0 36.9 1.8 232
Kandal 89.8 36.5 0.3 63.2 100.0 36.8 12.3 413
Kratie 67.4 28.7 0.4 70.8 100.0 29.2 6.4 143
Phnom Penh 92.4 55.6 0.9 43.5 100.0 56.5 11.7 550
Prey Veng 80.2 28.8 0.9 70.3 100.0 29.7 9.0 342
Pursat 75.5 33.7 0.9 65.4 100.0 34.6 5.6 184
Siem Reap 85.2 27.4 1.0 71.6 100.0 28.4 5.1 337
Svay Rieng 73.3 38.3 0.0 61.7 100.0 38.3 9.7 183
Takeo 79.6 34.0 2.2 63.8 100.0 36.2 10.5 334
Otdar Meanchey 58.0 32.0 0.6 67.4 100.0 32.6 5.3 99
Battambang/Pailin 88.9 40.0 1.2 58.8 100.0 41.2 8.8 405
Kampot/Kep 64.0 22.3 0.0 77.7 100.0 22.3 3.3 241
Preah Sihanouk/
Koh Kong 84.8 40.7 2.9 56.4 100.0 43.6 13.9 120
Preah Vihear/
Stung Treng 71.2 18.8 0.3 80.9 100.0 19.1 1.5 112
Mondul Kiri/
Ratanak Kiri 55.3 22.0 0.0 78.0 100.0 22.0 2.5 134
Education
No education 53.0 17.1 0.2 82.7 100.0 17.3 3.1 324
Primary 68.4 29.9 1.1 68.9 100.0 31.1 6.9 2,167
Secondary and higher 85.9 42.0 1.0 57.0 100.0 43.0 10.8 2,699
Wealth quintile
Lowest 59.8 22.4 1.1 76.5 100.0 23.5 5.4 901
Second 68.6 26.4 1.0 72.6 100.0 27.4 4.9 954
Middle 73.2 29.2 0.6 70.2 100.0 29.8 7.2 1,040
Fourth 83.7 39.8 1.2 59.0 100.0 41.0 10.3 1,124
Highest 92.0 54.0 1.2 44.9 100.0 55.1 14.1 1,171
Total 76.5 35.4 1.0 63.6 100.0 36.4 8.7 5,190
1 Includes “don’t know/missing”
More than three-quarters of women and men in Cambodia know where to get an HIV test.
Knowledge about where to get an HIV test is more common among women and men in urban areas than
rural areas. It is also higher among educated women and men and among those living in richer households.
Table 18.10 presents data on HIV/AIDS information and counseling during antenatal care. Among
women who had given birth in the two years before the survey, 57 percent received information and
counseling about HIV/AIDS during antenatal care for their most recent birth. Sixty-two percent of women
who had given birth in the past two years reported that they were tested for HIV during antenatal care and
226 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
received the test results and post-test counseling; 8 percent were tested and received the test results but not
post-test counseling; and 3 percent were tested but received neither the results nor post-test counseling.
Taking these elements into account, the 2014 CDHS results indicate that 51 percent of women giving birth
during the two-year period prior to the survey were counseled about HIV, were tested for HIV, and
received the test results.
Table 18.10 Pregnant women counseled and tested for HIV
Among all women age 15-49 who gave birth in the two years preceding the survey, the percentage who received HIV pretest counseling, the percentage
who received an HIV test during antenatal care for their most recent birth by whether they received their results and post-test counseling, and the
percentage who received an HIV test during ANC or labor for their most recent birth by whether they received their test results, according to background
characteristics, Cambodia 2014
Percentage
who received
counseling on
HIV during
antenatal
care1
Percentage who were tested for HIV during
antenatal care and who:
Percentage
who received
counseling on
HIV and an
HIV test during
ANC, and the
results
Percentage who had an HIV
test during ANC or labor and
who:2
Number of
women who
gave birth in
the past two
years3
Background
characteristic
Received
results and
received posttest counseling
Received
results and did
not receive
post-test
counseling
Did not receive
results
Received
results
Did not receive
results
Age
15-24 54.1 60.7 9.7 3.3 47.7 72.0 3.9 1,099
15-19 53.4 50.1 9.4 4.2 43.0 61.8 4.2 180
20-24 54.3 62.7 9.7 3.1 48.6 74.0 3.8 919
25-29 63.8 67.5 6.3 2.5 57.1 75.9 2.8 885
30-39 54.8 60.7 7.6 3.3 48.4 70.9 3.4 879
40-49 48.5 50.7 4.3 1.2 41.6 56.3 1.7 82
Marital status
Married/living together 56.7 62.4 8.0 3.1 50.1 72.4 3.4 2,831
Divorced/separated/
widowed 67.0 63.6 5.1 0.8 61.1 71.1 2.5 114
Residence
Urban 61.4 70.7 8.8 1.5 56.3 83.0 3.3 414
Rural 56.4 61.1 7.7 3.2 49.6 70.7 3.3 2,531
Province
Banteay Meanchey 62.7 62.1 20.7 4.1 56.5 82.8 4.1 120
Kampong Cham 45.6 53.6 7.7 3.1 40.8 64.5 3.1 418
Kampong Chhnang 90.8 93.0 0.0 0.8 87.3 93.0 2.0 111
Kampong Speu 49.2 54.2 15.4 5.6 43.7 73.0 5.8 182
Kampong Thom 89.2 87.4 0.4 0.0 85.4 89.4 0.0 141
Kandal 56.3 54.8 3.8 3.7 43.5 60.7 3.7 193
Kratie 37.6 35.2 2.2 3.7 28.8 38.7 4.4 107
Phnom Penh 58.3 66.2 7.0 1.4 51.6 79.4 3.6 257
Prey Veng 74.6 67.0 0.0 0.9 59.5 69.1 0.9 194
Pursat 82.8 79.4 1.3 3.3 73.7 82.1 3.3 122
Siem Reap 57.6 76.6 9.9 8.2 52.5 86.6 8.2 182
Svay Rieng 67.3 70.7 5.5 8.9 58.5 77.1 8.9 108
Takeo 72.8 74.9 2.5 2.6 68.4 78.5 2.6 164
Otdar Meanchey 61.7 63.7 1.1 3.0 53.5 66.2 3.0 54
Battambang/Pailin 34.9 58.3 28.0 1.2 33.4 88.9 1.2 247
Kampot/Kep 43.4 64.8 9.0 0.8 38.9 74.7 2.5 116
Preah Sihanouk/
Koh Kong 70.0 75.7 6.5 3.7 65.6 83.3 4.2 61
Preah Vihear/
Stung Treng 27.6 27.9 2.3 1.2 23.6 30.1 1.2 92
Mondul Kiri/
Ratanak Kiri 25.3 13.3 3.5 0.8 14.4 17.1 1.5 75
Education
No education 42.6 47.6 7.2 3.2 37.2 55.7 3.2 366
Primary 56.5 60.2 7.2 3.2 48.8 69.1 3.5 1,491
Secondary and higher 62.8 70.5 9.1 2.6 57.5 82.5 3.2 1,088
Wealth quintile
Lowest 52.7 55.8 6.1 3.5 46.0 62.8 3.6 694
Second 60.0 61.9 6.6 4.0 51.6 69.9 4.5 589
Middle 59.2 64.0 8.4 2.9 53.5 74.5 3.0 565
Fourth 56.9 63.8 10.9 2.6 51.6 76.2 3.1 536
Highest 57.5 68.3 7.9 1.7 51.0 81.1 2.5 560
Total 57.1 62.4 7.9 3.0 50.5 72.4 3.3 2,944
1 In this context, “pretest counseling” means that someone talked with the respondent about all three of the following topics: (1) babies getting the AIDS
virus from their mother, (2) preventing the virus, and (3) getting tested for the virus.
2 Women were asked whether they received an HIV test during labor only if they were not tested for HIV during ANC.
3 The denominator for percentages includes women who did not receive antenatal care for their last birth in the past two years.
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 227
Women living in urban areas were more likely than those living in rural areas to have received
counseling, testing, and results during antenatal care. According to province, pregnant women living in
Mondul Kiri/Ratanak Kiri (14 percent) and Preah Vihear/Stung Treng (24 percent) were least likely to
have received HIV/AIDS counseling and testing services. Women with a secondary education or higher
are more likely than those with no education to receive full counseling and testing services during antenatal
care.
Some women are tested for HIV after labor starts. Including such women, 72 percent were tested
for HIV and received results at some time during pregnancy.
18.6 REPORTS OF RECENT SEXUALLY TRANSMITTED INFECTIONS
Information about the incidence of sexually transmitted infections is useful not only as a marker of
unprotected sexual intercourse but also as a cofactor for HIV transmission. The 2014 CDHS asked
respondents who had ever had sex whether they had had an STI in the past 12 months. They were also
asked whether, in the past year, they had experienced a genital sore or ulcer and whether they had any
genital discharge. These symptoms have been shown useful in identifying STIs in men. They are less
easily interpreted in women because women are likely to experience more non-STI conditions of the
reproductive tract that produce a discharge.
Table 18.11 shows the self-reported prevalence of STIs and STI symptoms among women and
men age 15-49 who have ever had sexual intercourse. Six percent of women and less than 1 percent of men
who have ever had sex reported having had an STI in the 12 months before the survey. A higher proportion
of women (10 percent) than men (1 percent) reported having had an abnormal genital discharge.
Furthermore, 4 percent of women and 1 percent of men reported having had a genital sore or ulcer in the
past 12 months. Overall, 12 percent of women and 2 percent of men had either an STI or symptoms of an
STI in the 12 months preceding the survey.
The results presented in Table 18.11 indicate that the proportion of respondents who reported
having had an STI or an STI symptom varied considerably across provinces. Among women, the selfreported prevalence of STIs and STI symptoms ranged from a low of 5 percent in Kampong Thom and
Otdar Meanchey to a high of 22 percent in Preah Vihear/Stung Treng and 20 percent in Battambang/Pailin
and Preah Sihanouk/Koh Kong. Among men, the prevalence of reported STIs or symptoms of STIs is
highest in Svay Rieng (4 percent) and Kandal (5 percent). Differences in the prevalence of STIs or their
symptoms by other background characteristics are not large.
228 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
Table 18.11 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms
Among women and men age 15-49 who ever had sexual intercourse, the percentage reporting having an STI and/or symptoms of an STI in the past 12 months,
by background characteristics, Cambodia 2014
Percentage of women who reported having in the past 12 months: Percentage of men who reported having in the past 12 months:
Background
characteristic STI
Bad
smelling/
abnormal
genital
discharge
Genital
sore/ulcer
STI/genital
discharge/
sore or ulcer
Number of
women who
ever had
sexual
intercourse STI
Bad
smelling/
abnormal
discharge
from penis
Genital
sore/ulcer
STI/
abnormal
discharge
from penis/
sore or ulcer
Number of
men who
ever had
sexual
intercourse
Age
15-24 4.4 10.3 2.8 11.8 2,452 0.6 2.1 1.3 2.7 525
15-19 2.2 8.7 2.4 10.1 496 0.0 2.6 2.6 2.6 69
20-24 5.0 10.7 2.9 12.2 1,956 0.6 2.0 1.1 2.7 455
25-29 6.6 11.3 4.5 13.6 2,417 0.6 1.1 0.5 1.2 716
30-39 6.4 10.1 3.5 12.0 4,566 0.4 0.5 0.8 1.1 1,440
40-49 4.8 8.1 3.7 9.8 3,768 0.7 0.5 1.3 1.8 1,147
Marital status
Never married 5.0 5.0 10.0 10.6 56 0.5 1.8 1.2 1.8 303
Married/living together 5.6 9.8 3.6 11.7 11,897 0.5 0.7 1.0 1.5 3,405
Divorced/separated/
widowed 5.6 9.6 3.3 10.7 1,250 1.8 0.0 0.0 1.8 120
Residence
Urban 4.5 8.6 4.4 10.8 2,098 1.4 0.9 1.1 1.9 606
Rural 5.8 10.0 3.5 11.8 11,105 0.4 0.8 0.9 1.5 3,221
Province
Banteay Meanchey 4.0 6.5 1.9 8.7 542 1.5 0.6 1.2 1.8 143
Kampong Cham 8.7 15.8 1.1 17.9 1,624 0.7 1.2 1.2 1.8 548
Kampong Chhnang 3.5 7.8 3.4 8.1 453 0.0 0.2 1.0 1.0 131
Kampong Speu 13.0 10.8 1.7 15.5 936 0.6 0.2 0.6 0.7 241
Kampong Thom 3.7 3.6 0.9 4.5 639 0.0 0.0 0.0 0.0 155
Kandal 2.5 5.5 3.4 6.6 991 0.8 2.9 2.5 4.5 317
Kratie 0.6 8.5 1.4 8.7 383 0.9 0.0 0.5 0.9 108
Phnom Penh 3.5 8.7 4.5 11.0 1,249 1.8 0.8 1.4 2.4 376
Prey Veng 6.4 7.8 2.5 8.2 995 0.0 0.0 0.0 0.0 265
Pursat 2.4 6.7 2.1 6.8 455 0.5 0.0 0.5 0.5 122
Siem Reap 4.4 9.5 3.9 10.0 861 0.0 0.0 0.0 0.0 243
Svay Rieng 3.7 12.6 6.4 13.0 525 0.8 2.1 2.3 4.3 143
Takeo 5.5 7.1 3.8 8.9 786 0.0 1.3 2.5 3.0 244
Otdar Meanchey 1.2 4.8 2.6 4.9 230 0.2 0.0 0.0 0.2 69
Battambang/Pailin 8.9 17.5 8.3 20.4 960 0.3 0.9 0.3 0.9 275
Kampot/Kep 3.9 1.5 1.1 5.7 618 0.5 0.5 0.0 0.5 187
Preah Sihanouk/
Koh Kong 8.5 17.6 13.1 19.9 296 0.4 0.7 1.5 1.9 90
Preah Vihear/
Stung Treng 1.2 17.3 14.5 22.0 354 0.0 0.0 0.0 0.0 78
Mondul Kiri/
Ratanak Kiri 9.3 10.5 0.5 11.4 307 0.0 0.0 0.0 0.0 91
Education
No education 6.9 11.7 4.3 13.6 2,038 0.0 0.2 0.2 0.2 286
Primary 5.9 10.1 3.8 11.8 7,042 0.7 1.2 1.4 2.3 1,750
Secondary and higher 4.5 8.3 3.0 10.3 4,124 0.5 0.5 0.7 1.1 1,791
Wealth quintile
Lowest 5.9 11.8 3.9 13.4 2,555 0.0 0.6 1.6 1.8 663
Second 6.2 11.1 4.1 12.7 2,625 0.8 1.4 0.3 1.6 718
Middle 5.4 9.2 2.7 11.2 2,605 0.4 0.6 0.6 0.8 778
Fourth 5.8 8.6 3.7 10.7 2,654 0.4 0.9 0.9 1.7 830
Highest 4.9 8.5 3.6 10.2 2,764 1.1 0.6 1.3 1.8 839
Total 5.6 9.8 3.6 11.6 13,204 0.6 0.8 1.0 1.6 3,828
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 229
18.7 INJECTIONS
Injection overuse in a health care setting can contribute to the transmission of blood-borne
pathogens to the extent that it encourages unsafe practices such as reuse of injection equipment. The
proportion of injections given with reused injection equipment is an important prevention indicator in
initiatives designed to control the spread of HIV/AIDS.
Table 18.12 presents data on the prevalence of injections among respondents. Respondents were
asked whether they had had any injections given by a health worker in the 12 months preceding the survey
and, if so, the number of injections they had received and whether their last injection was given with a
syringe from a new, unopened package. It should be noted that medical injections can be self-administered
(e.g., insulin for diabetes). These injections were not included in the calculations.
Women were more likely than men to report having received at least one injection from a health
provider in the previous 12 months (37 percent and 27 percent, respectively). On average, women had
received two injections, and men had received one injection.
The largest variations in injection prevalence were across provinces. Among women, for example,
the percentage reporting that they had received at least one injection from a health worker during the 12
months prior to the survey varied from a low of 15 percent in Mondul Kiri/Ratanak Kiri to a high of 45
percent in Phnom Penh. Among men, the likelihood of having received an injection was also lowest in
Mondul Kiri/Ratanak Kiri (15 percent), and it was highest in Kampong Chhnang (43 percent). There is
practically no difference between urban and rural residents in terms of receiving at least one injection from
a health provider. The associations between receiving at least one injection from a health provider and
other background characteristics such as education and wealth were not consistent.
The majority of recent injections (99 percent among both women and men) were administered
with a needle and syringe taken from a newly opened package.
230 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
Table 18.12 Prevalence of medical injections
Percentage of women and men age 15-49 who received at least one medical injection in the last 12 months, the average number of medical injections per
person in the last 12 months, and among those who received a medical injection, the percentage of last medical injections for which the syringe and needle
were taken from a new, unopened package, by background characteristics, Cambodia 2014
Women Men
Background
characteristic
Percentage
who
received a
medical
injection in
the last 12
months
Average
number of
medical
injections
per person
in the last
12 months
Number of
respondents
For last
injection,
syringe and
needle
taken from
a new,
unopened
package
Number of
respondents
receiving
medical
injections in
the last 12
months
Percentage
who
received a
medical
injection in
the last 12
months
Average
number of
medical
injections
per person
in the last
12 months
Number of
respondents
For last
injection,
syringe and
needle
taken from
a new,
unopened
package
Number of
respondents
receiving
medical
injections in
the last 12
months
Age
15-24 38.0 1.7 5,910 98.2 2,245 27.9 0.8 1,760 99.3 491
15-19 32.6 1.2 2,893 98.2 943 28.7 0.8 926 100.0 266
20-24 43.2 2.2 3,017 98.2 1,302 26.9 0.9 835 98.5 225
25-29 41.5 2.6 2,836 98.6 1,176 28.0 1.2 815 99.3 228
30-39 37.2 2.4 4,886 99.2 1,817 25.6 1.1 1,463 99.5 374
40-49 33.6 2.0 3,947 98.1 1,325 27.6 1.6 1,152 98.3 318
Marital status
Never married 31.0 1.2 4,428 98.3 1,374 28.1 0.9 1,663 99.6 468
Ever had sex 25.4 0.6 56 * 14 33.0 1.1 303 98.0 100
Never had sex 31.1 1.2 4,372 98.4 1,360 27.1 0.8 1,360 100.0 368
Married/living together 40.3 2.4 11,898 98.6 4,798 26.7 1.2 3,405 99.2 909
Divorced/separated/
widowed 31.2 2.1 1,252 98.8 391 27.0 0.9 122 (91.2) 33
Residence
Urban 37.1 2.1 3,251 97.7 1,206 26.1 1.0 869 99.1 227
Rural 37.4 2.1 14,327 98.7 5,357 27.4 1.1 4,321 99.1 1,183
Province
Banteay Meanchey 39.7 2.0 689 97.2 273 17.3 0.4 192 (100.0) 33
Kampong Cham 39.3 2.0 2,021 99.5 794 29.3 1.0 663 99.6 194
Kampong Chhnang 41.1 3.8 662 99.5 272 43.0 2.4 182 100.0 79
Kampong Speu 43.9 2.2 1,196 96.8 525 29.3 1.2 323 97.0 95
Kampong Thom 23.5 1.5 851 98.5 200 19.7 0.6 232 100.0 46
Kandal 41.6 2.2 1,330 99.6 553 32.3 1.4 413 98.8 134
Kratie 39.3 2.0 488 97.5 192 42.1 1.3 143 100.0 60
Phnom Penh 44.8 2.7 1,994 98.3 893 29.7 1.1 550 99.5 163
Prey Veng 37.5 3.2 1,188 100.0 445 17.5 1.6 342 (100.0) 60
Pursat 32.5 1.7 631 97.4 205 21.7 0.6 184 100.0 40
Siem Reap 38.4 1.2 1,137 100.0 436 16.2 0.5 337 97.5 55
Svay Rieng 43.5 2.0 654 99.2 285 40.3 1.2 183 98.5 74
Takeo 29.5 2.3 1,082 99.6 320 33.2 1.0 334 96.9 111
Otdar Meanchey 24.3 1.5 294 99.6 72 26.2 1.2 99 98.8 26
Battambang/Pailin 30.2 1.6 1,333 99.1 403 29.1 1.7 405 100.0 118
Kampot/Kep 38.2 2.0 770 93.0 294 20.6 0.7 241 100.0 50
Preah Sihanouk/
Koh Kong 34.8 1.6 422 95.6 147 23.9 1.8 120 100.0 29
Preah Vihear/
Stung Treng 43.1 1.7 462 99.7 199 22.9 0.5 112 100.0 26
Mondul Kiri/
Ratanak Kiri 14.6 0.6 372 98.8 54 15.2 0.3 134 100.0 20
Education
No education 32.5 1.9 2,250 98.8 731 21.2 0.8 324 100.0 69
Primary 38.6 2.2 8,281 98.5 3,197 25.8 1.1 2,167 99.2 560
Secondary and higher 37.4 2.1 7,047 98.5 2,636 29.0 1.2 2,699 99.0 782
Wealth quintile
Lowest 36.7 1.9 3,143 98.7 1,155 22.9 0.8 901 99.3 206
Second 35.8 1.8 3,314 98.7 1,185 27.2 1.2 954 99.4 259
Middle 38.1 2.4 3,381 98.3 1,289 30.5 1.3 1,040 99.5 317
Fourth 38.9 2.2 3,612 98.5 1,404 26.1 1.0 1,124 97.6 294
Highest 37.1 2.1 4,128 98.6 1,531 28.5 1.2 1,171 99.8 333
Total 37.3 2.1 17,578 98.5 6,563 27.2 1.1 5,190 99.1 1,410
Note: Medical injections are those given by a doctor, nurse, pharmacist, dentist, or other health worker. Figures in parentheses are based on 25-49 unweighted
cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.
18.8 HIV/AIDS-RELATED KNOWLEDGE AND BEHAVIOR AMONG YOUTH
Knowledge of HIV/AIDS issues and related sexual behavior among youth age 15-24 is of
particular interest because the period between sexual initiation and marriage is, for many young people, a
time of sexual experimentation that may involve high-risk behaviors. This section considers a number of
issues that relate to both transmission and prevention of HIV/AIDS among youth, including the extent to
which youth have comprehensive knowledge of HIV/AIDS transmission and prevention modes and
knowledge of a source where they can obtain condoms. Issues such as abstinence, age at sexual debut, and
condom use are also covered in this section.
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 231
18.8.1 Knowledge about HIV/AIDS and Source for Condoms
Knowledge of how HIV is transmitted is crucial in enabling young people to avoid AIDS. Young
people are often at greater risk because they may have shorter relationships with more partners or engage
in other risky behaviors. As discussed earlier, comprehensive knowledge is defined as knowing that people
can reduce their chances of getting the AIDS virus by having sex with only one uninfected faithful partner
and by using condoms consistently, that a healthy-looking person can have the AIDS virus, and that HIV
cannot be transmitted by mosquito bites or by sharing food with a person who has AIDS.
Table 18.13 shows that only 38 percent of young women and 46 percent of young men age 15-24
know all of these facts about HIV/AIDS. The level of comprehensive knowledge about HIV/AIDS slightly
increases with age in the youth population. Young women and men who have never been married but have
had sex (49 percent and 54 percent, respectively) are more likely than never-married (39 percent and 46
percent, respectively) and ever-married (36 percent and 44 percent, respectively) young adults to have
comprehensive knowledge about HIV/AIDS.
As expected, comprehensive HIV/AIDS knowledge is much more common among urban than
rural youth. Young adults with a secondary education or higher are about three times as likely as those
with no schooling to have comprehensive knowledge of HIV/AIDS.
Because condoms play an important role in combating the transmission of HIV, young women
were asked whether they knew where condoms could be obtained. Only “formal” sources of condoms were
counted; friends and family and other similar sources were not included.
As shown in Table 18.13, 65 percent of young women know where to obtain a condom.
Knowledge of a condom source tends to increase with age. Ever-married young women are more likely to
know about a source for condoms than those who have never been married. Women in urban areas are
more likely than those in rural areas to know of a condom source. Knowledge of a condom source among
women is lowest in Kampong Speu (38 percent) and Kratie (42 percent) and highest in Kampong Chhnang
(100 percent). Consistent with the patterns observed for other indicators, young women who are better
educated and live in wealthier households are more likely than their counterparts to know a source of
condoms.
232 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
Table 18.13 Comprehensive knowledge about AIDS and of a source of condoms among youth
Percentage of young women and young men age 15-24 with comprehensive knowledge about AIDS and
percentage of young women with knowledge of a source of condoms, by background characteristics, Cambodia
2014
Women Men
Background
characteristic
Percentage with
comprehensive
knowledge of
AIDS1
Percentage who
know a condom
source2
Number of
respondents
Percentage with
comprehensive
knowledge of
AIDS1
Number of
respondents
Age
15-19 32.7 56.7 2,893 42.4 926
15-17 31.7 53.2 1,774 42.0 581
18-19 34.2 62.3 1,119 43.0 345
20-24 42.4 73.7 3,017 49.9 835
20-22 38.6 71.6 1,811 50.3 545
23-24 48.0 76.8 1,206 49.2 289
Marital status
Never married 38.5 59.5 3,495 46.4 1,392
Ever had sex (48.5) (86.0) 37 53.5 158
Never had sex 38.4 59.2 3,458 45.5 1,234
Ever married 36.4 73.9 2,415 44.2 368
Residence
Urban 55.0 79.8 1,171 63.9 324
Rural 33.3 61.9 4,739 41.9 1,436
Province
Banteay Meanchey 10.1 56.4 233 39.7 64
Kampong Cham 26.7 61.5 628 47.3 193
Kampong Chhnang 43.1 100.0 238 49.2 66
Kampong Speu 23.6 37.9 413 39.2 114
Kampong Thom 59.2 79.0 271 75.4 86
Kandal 34.9 68.1 426 0.2 120
Kratie 38.3 41.6 175 22.8 53
Phnom Penh 65.4 85.3 744 75.3 217
Prey Veng 26.4 75.0 310 67.3 85
Pursat 28.0 58.1 227 59.3 71
Siem Reap 27.9 70.7 391 27.9 120
Svay Rieng 15.9 49.0 176 40.2 61
Takeo 49.3 52.8 367 45.4 109
Otdar Meanchey 29.0 53.0 99 0.3 37
Battambang/Pailin 49.7 63.9 486 58.6 149
Kampot/Kep 38.6 66.5 236 46.9 78
Preah Sihanouk/
Koh Kong 36.4 71.5 161 50.9 36
Preah Vihear/
Stung Treng 20.2 52.9 183 18.9 47
Mondul Kiri/
Ratanak Kiri 33.9 60.1 145 30.6 55
Education
No education 16.3 46.1 243 17.8 57
Primary 24.7 58.2 1,955 28.8 572
Secondary and higher 45.8 70.5 3,712 56.0 1,131
Wealth quintile
Lowest 26.6 56.8 956 28.2 323
Second 27.7 59.0 1,057 40.0 304
Middle 28.5 61.4 1,139 44.1 354
Fourth 42.1 61.1 1,262 50.0 384
Highest 54.9 82.1 1,496 62.7 396
Total 37.6 65.4 5,910 45.9 1,760
Note: Figures in parentheses are based on 25-49 unweighted cases.
1 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and
having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing that a
healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions
about AIDS transmission or prevention of the AIDS virus. The components of comprehensive knowledge are
presented in Tables 18.2, 18.3.1, and 18.3.2.
2 For this table, the following responses are not considered a source for condoms: friends, family members, and
home.
18.8.2 Age at First Sex and Condom Use at First Sexual Intercourse
Information from the 2014 CDHS can be used to look at several important issues related to the
initiation of sexual activity among youth, such as age at first sex and condom use at first sexual
intercourse.
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 233
Table 18.14 shows the proportion of women and men in the 15-24 age cohort who had sex before
age 15 and before age 18. Approximately 2 percent of young women and less than 1 percent of young men
had sex by age 15, whereas 18 percent of young women and 5 percent of young men had sex by age 18.
Table 18.14 Age at first sexual intercourse among young people
Percentage of young women and young men age 15-24 who had sexual intercourse before age 15 and percentage of young women and young men age 18-24
who had sexual intercourse before age 18, by background characteristics, Cambodia 2014
Women Men
Background
characteristic
Percentage who
had sexual
intercourse
before age 15
Number of
respondents
(15-24)
Percentage who
had sexual
intercourse
before age 18
Number of
respondents
(18-24)
Percentage who
had sexual
intercourse
before age 15
Number of
respondents
(15-24)
Percentage who
had sexual
intercourse
before age 18
Number of
respondents
(18-24)
Age
15-19 1.4 2,893 na na 0.3 926 na na
15-17 0.7 1,774 na na 0.5 581 na na
18-19 2.4 1,119 20.6 1,119 0.0 345 4.9 345
20-24 1.6 3,017 17.4 3,017 0.4 835 4.4 835
20-22 1.6 1,811 17.6 1,811 0.6 545 5.2 545
23-24 1.7 1,206 17.0 1,206 0.0 289 3.1 289
Marital status
Never married 0.0 3,495 0.5 1,837 0.4 1,392 2.4 819
Ever married 3.7 2,415 32.4 2,299 0.0 368 9.4 361
Knows condom
source1
Yes 1.5 3,865 19.0 2,921 na na na na
No 1.6 2,045 16.5 1,215 na na na na
Residence
Urban 0.9 1,171 8.5 873 0.0 324 3.0 237
Rural 1.6 4,739 20.8 3,263 0.4 1,436 5.0 942
Province
Banteay Meanchey 0.4 233 13.6 168 0.0 64 (10.0) 43
Kampong Cham 2.0 628 29.2 423 3.1 193 12.2 132
Kampong Chhnang 0.4 238 13.3 155 0.0 66 4.0 44
Kampong Speu 1.6 413 18.5 292 0.0 114 0.0 77
Kampong Thom 0.0 271 20.5 155 0.0 86 0.0 44
Kandal 3.0 426 16.8 285 0.0 120 0.9 81
Kratie 3.1 175 29.4 128 0.0 53 5.4 36
Phnom Penh 0.9 744 6.2 577 0.0 217 1.5 163
Prey Veng 0.5 310 26.1 207 0.0 85 (0.0) 48
Pursat 1.2 227 11.8 168 0.0 71 3.9 48
Siem Reap 0.1 391 24.3 285 0.0 120 8.3 84
Svay Rieng 0.7 176 15.6 130 0.0 61 (2.2) 37
Takeo 1.3 367 12.1 239 0.0 109 3.6 77
Otdar Meanchey 1.7 99 20.7 69 0.0 37 2.4 23
Battambang/Pailin 0.6 486 14.8 349 0.0 149 5.9 94
Kampot/Kep 2.9 236 22.9 161 0.0 78 5.1 52
Preah Sihanouk/
Koh Kong 1.1 161 14.2 117 0.0 36 4.9 24
Preah Vihear/
Stung Treng 3.8 183 25.9 123 0.0 47 5.5 30
Mondul Kiri/
Ratanak Kiri 8.7 145 35.2 104 0.0 55 6.5 43
Education
No education 5.2 243 38.0 201 0.0 57 9.0 50
Primary 2.3 1,955 26.4 1,468 0.5 572 6.3 372
Secondary and higher 0.9 3,712 11.8 2,467 0.3 1,131 3.4 758
Wealth quintile
Lowest 2.1 956 29.3 662 0.0 323 7.3 210
Second 1.9 1,057 21.9 717 1.0 304 6.3 200
Middle 1.7 1,139 17.8 769 0.8 354 5.8 228
Fourth 1.2 1,262 15.7 891 0.0 384 2.5 250
Highest 1.0 1,496 11.5 1,098 0.0 396 2.2 292
Total 1.5 5,910 18.2 4,136 0.3 1,760 4.6 1,180
Note: Figures in parentheses are based on 25-49 unweighted cases.
na = Not applicable
1 For this table, the following responses are not considered a source for condoms: friends, family members, and home.
234 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
In Cambodia, it is rare for women to have sex prior to marriage; therefore, given that the median
age at first marriage among Cambodian women is 21 years, very few women report that they have had sex
before age 15. Young women who live in Mondul Kiri/Ratanak Kiri, perhaps by virtue of having a
comparatively younger median age at first marriage of 19 years, are most likely to report having had sexual
intercourse before age 15 (9 percent).
Among young women in the 18-24 age group, those in urban areas were less likely to have had
sex by age 18 than those in rural areas (9 percent versus 21 percent). The proportion of women age 18-24
who reported having had sex before age 18 ranged from 6 percent in Phnom Penh to 35 percent in Mondul
Kiri/Ratanak Kiri. Education and wealth showed a negative association with early initiation of sexual
activity: as education and wealth increased, the proportion of women reporting sex before age 18
decreased.
Differentials in these indicators among young men tend to be more muted than those among
young women. This is in part because the proportions of men initiating sexual activity before age 18 were
not large in most subgroups. As was the case with young women, education and wealth were related to
initiation of sexual activity before age 18 among young men. For example, young men with no education
were more likely to have had sex by age 18 than young men with a secondary education or higher (9
percent versus 3 percent).
18.8.3 Recent Sexual Activity
The period between first sex and marriage is often a time of sexual experimentation.
Unfortunately, in the era of HIV/AIDS, it can also be a risky time. Table 18.15 presents data on the
percentage of never-married young women and men age 15-24 who have never had sexual intercourse, the
percentage who had sex in the 12 months preceding the survey, and, among men who have had sexual
intercourse, the percentage who used a condom during their most recent sexual intercourse.
The majority of never-married young women (99 percent) and men (89 percent) reported that they
had never had sex, and as a result the proportions reporting recent sexual activity (i.e., within the 12-month
period before the survey) are low (less than 1 percent among young women and 7 percent among young
men).
Given the comparatively small proportion of never-married young women reporting premarital
sexual intercourse, differentials in this indicator are for the most part minimal. Among never-married
young men, the proportion reporting premarital sexual activity generally increases with age and wealth and
is higher among urban than rural residents. Phnom Penh and Kampong Cham (16 percent each) have the
highest proportion of never-married young men reporting premarital sex in the past 12 months. Among
men reporting premarital sex, only two-thirds (66 percent) used a condom during their last sexual
intercourse.
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 235
Table 18.15 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth
Among never-married women and men age 15-24, the percentage who have never had sexual intercourse, the percentage who had sexual intercourse in the past
12 months, and, among men who had premarital sexual intercourse in the past 12 months, the percentage who used a condom at the last sexual intercourse, by
background characteristics, Cambodia 2014
Women Men
Background
characteristic
Percentage who
have never had
sexual
intercourse
Percentage who
had sexual
intercourse in the
past 12 months
Number of
never-married
respondents
Percentage who
have never had
sexual
intercourse
Percentage who
had sexual
intercourse in the
past 12 months
Number of
never-married
respondents
Percentage who
used a condom
at last sexual
intercourse
Number of
respondents
Age
15-19 99.3 0.3 2,414 95.6 3.5 896 (50.6) 31
15-17 99.8 0.1 1,658 97.7 1.7 574 * 10
18-19 98.2 0.6 756 91.7 6.6 323 * 21
20-24 98.1 1.6 1,081 76.2 14.0 496 72.8 69
20-22 98.0 1.9 762 79.4 11.9 378 64.4 45
23-24 98.5 1.0 319 65.9 20.6 118 (88.3) 24
Knows condom
source1
Yes 98.5 1.1 2,081 na na na na na
No 99.6 0.1 1,414 na na na na na
Residence
Urban 97.4 2.4 870 79.2 13.8 294 85.3 41
Rural 99.4 0.1 2,625 91.2 5.4 1,099 (52.8) 60
Province
Banteay Meanchey 100.0 0.0 122 91.4 4.6 50 * 2
Kampong Cham 99.3 0.0 322 74.4 15.6 141 * 22
Kampong Chhnang 100.0 0.0 158 89.0 5.0 49 * 2
Kampong Speu 99.4 0.0 230 94.7 5.3 81 * 4
Kampong Thom 100.0 0.0 172 98.1 0.9 73 * 1
Kandal 97.0 0.6 258 87.8 7.3 102 * 7
Kratie 100.0 0.0 84 85.4 10.2 38 * 4
Phnom Penh 97.2 2.7 550 78.1 15.9 200 (78.3) 32
Prey Veng 100.0 0.0 153 94.8 0.0 69 * 0
Pursat 100.0 0.0 136 91.6 7.2 59 * 4
Siem Reap 96.6 2.9 225 95.1 2.4 93 * 2
Svay Rieng 100.0 0.0 94 88.1 7.1 46 * 3
Takeo 99.4 0.0 242 85.6 6.4 92 * 6
Otdar Meanchey 99.1 0.9 56 98.8 1.2 28 * 0
Battambang/Pailin 100.0 0.0 308 98.3 1.0 114 * 1
Kampot/Kep 100.0 0.0 125 90.9 7.4 55 * 4
Preah Sihanouk/
Koh Kong 99.4 0.3 107 87.7 10.1 30 * 3
Preah Vihear/
Stung Treng 99.6 0.4 95 100.0 0.0 32 * 0
Mondul Kiri/
Ratanak Kiri 99.8 0.2 58 94.9 3.5 42 * 1
Education
No education 99.4 0.6 77 (89.4) (10.6) 35 * 4
Primary 99.1 0.5 886 89.4 6.5 415 (68.2) 27
Secondary and higher 98.9 0.7 2,532 88.3 7.4 943 68.6 70
Wealth quintile
Lowest 100.0 0.0 470 93.7 5.3 234 * 12
Second 99.8 0.0 574 91.7 3.5 234 * 8
Middle 99.4 0.2 631 87.7 6.8 274 * 19
Fourth 98.4 0.6 776 88.7 8.3 298 * 25
Highest 98.2 1.7 1,044 84.0 10.3 353 80.9 36
Total 98.9 0.7 3,495 88.7 7.2 1,392 66.0 100
Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been
suppressed.
na = Not applicable
1 For this table, the following responses are not considered a source for condoms: friends, family members, and home.
18.8.4 Multiple Sexual Partnerships
The most common mode of HIV transmission in Cambodia is through unprotected sex with an
infected person. To prevent HIV/AIDS transmission, it is important for young people to be faithful to one
uninfected partner. Table 18.16 shows the percentage of all young women and men age 15-24 who had
sexual intercourse with more than one partner in the 12 months before the survey, by background
characteristics.
236 • HIV/AIDS-related Knowledge, Attitudes, and Behavior
Table 18.16 Multiple sexual partners in the past 12 months among youth
Among all young women and men age 15-24, the percentage who had sexual intercourse
with more than one sexual partner in the past 12 months, and among those having more than
one partner in the past 12 months, the percentage reporting that a condom was used at last
intercourse, by background characteristics, Cambodia 2014
Women age 15-24 Men age 15-24
Background
characteristic
Percentage who
had 2+ partners
in the past 12
months
Number of
women
Percentage who
had 2+ partners
in the past 12
months
Number of
men
Age
15-19 0.0 2,893 0.2 926
15-17 0.0 1,774 0.0 581
18-19 0.0 1,119 0.5 345
20-24 0.3 3,017 2.1 835
20-22 0.3 1,811 2.1 545
23-24 0.2 1,206 2.2 289
Marital status
Never married 0.0 3,495 0.7 1,392
Ever married 0.3 2,415 2.4 368
Knows condom
source1
No 0.2 3,865 na na
Yes 0.0 2,045 na na
Residence
Urban 0.3 1,171 3.5 324
Rural 0.1 4,739 0.6 1,436
Education
No education 0.6 243 0.0 57
Primary 0.3 1,955 0.9 572
Secondary and higher 0.0 3,712 1.3 1,131
Total 0.1 5,910 1.1 1,760
na = Not available
1 For this table, the following responses are not considered a source for condoms: friends,
family members, and home.
Overall, less than 1 percent of young women and 1 percent of young men reported having had two
or more sexual partners in the past 12 months. Given the comparatively small proportions of young women
and men having had multiple sexual partners in the past 12 months, differentials in this indicator are
generally not significant.
18.8.5 HIV Testing
Young people may believe there are barriers to accessing and using many health services and
facilities, and this is particularly true for sensitive concerns relating to sexual health, such as HIV/AIDS
and other STIs. Table 18.17 presents data on the percentage of sexually active youth who had been tested
and received their results within the past year. Young women who had had sexual intercourse in the 12
months before the survey were more likely than young men to have been tested for HIV (25 percent and 18
percent, respectively). In the case of young women, testing levels were higher among those living in urban
areas, those with a secondary education or higher, those in the highest wealth quintile, and those living in
Kampong Chhnang. Among young men, testing rates were higher among those with a secondary education
or higher. There was no clear association among young men between HIV testing and other background
characteristics.
HIV/AIDS-related Knowledge, Attitudes, and Behavior • 237
Table 18.17 Recent HIV tests among youth
Among young women and young men age 15-24 who have had sexual intercourse in the past 12
months, the percentage who were tested for HIV in the past 12 months and received the results of
the last test, by background characteristics, Cambodia 2014
Women age 15-24 who have had
sexual intercourse in the past 12
months:
Men age 15-24 who have had
sexual intercourse in the past 12
months:
Background
characteristic
Percentage who
have been tested
for HIV in the past
12 months and
received the results
of the last test
Number of
women
Percentage who
have been tested
for HIV in the past
12 months and
received the results
of the last test
Number of
men
Age
15-19 29.0 468 19.7 60
15-17 36.2 116 * 17
18-19 26.7 353 (27.3) 44
20-24 24.1 1,859 17.6 388
20-22 27.5 1,016 19.0 202
23-24 20.1 843 16.1 186
Marital status
Never married (39.3) 24 16.2 100
Ever married 25.0 2,303 18.4 348
Knows condom
source1
Yes 27.1 1,726 na na
No 19.6 601 na na
Residence
Urban 36.8 305 17.6 70
Rural 23.4 2,022 18.0 378
Province
Banteay Meanchey 35.7 102 * 17
Kampong Cham 22.7 293 (22.8) 74
Kampong Chhnang 45.0 72 * 18
Kampong Speu 22.7 181 (20.4) 35
Kampong Thom 29.5 98 * 14
Kandal 23.6 159 * 26
Kratie 4.3 87 (7.0) 18
Phnom Penh 35.6 199 (16.8) 48
Prey Veng 11.1 150 * 12
Pursat 26.5 88 * 16
Siem Reap 28.6 168 * 30
Svay Rieng 34.5 78 * 17
Takeo 27.8 115 * 22
Otdar Meanchey 21.6 42 (20.8) 9
Battambang/Pailin 34.6 172 * 29
Kampot/Kep 20.0 106 (5.8) 26
Preah Sihanouk/
Koh Kong 37.0 52 * 8
Preah Vihear/
Stung Treng 8.4 83 (0.0) 15
Mondul Kiri/
Ratanak Kiri 5.2 82 (0.0) 15
Education
No education 21.0 154 (0.0) 25
Primary 21.7 1,022 13.4 179
Secondary and higher 28.7 1,151 23.0 245
Wealth quintile
Lowest 18.6 466 8.3 99
Second 25.1 469 19.2 75
Middle 22.8 479 22.5 98
Fourth 26.7 471 20.2 100
Highest 32.9 442 20.3 77
Total 25.1 2,327 17.9 448
Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a
figure is based on fewer than 25 unweighted cases and has been suppressed.
na = Not available
1 For this table, the following responses are not considered a source for condoms: friends, family
members, and home.
Women’s Empowerment and Demographic and Health Outcomes • 239
WOMEN’S EMPOWERMENT AND DEMOGRAPHIC
AND HEALTH OUTCOMES 19
Key Findings
• Seventy-four percent of currently married employed women who earn
cash make independent decisions about how to spend their earnings.
• About 4 in 10 women own a house and/or land, mostly jointly with their
husband.
• A large majority of currently married women (86 percent) participate in
three specified decisions pertaining to their own health care, major
household purchases, and visits to their family or relatives.
• Fifty percent of women believe that wife beating is justified for at least one
of six specified reasons.
he 2014 CDHS collected information on the general background characteristics of respondents
(age, education, wealth quintile, and employment status) but also information specific to women’s
empowerment, such as receipt of cash earnings, the magnitude of a woman’s earnings relative to
those of her husband, and control over the use of her own earnings and those of her spouse.1
In addition, the 2014 CDHS collected information on women’s participation in household decision
making and their attitude, as well as that of their husband, towards wife beating. This report uses the two
DHS-developed indices of women’s empowerment to measure women’s and men’s responses to the
questions. The first index is based on the number of household decisions in which the woman participates,
and the second is based on the respondent’s opinion regarding the number of reasons that justify wife
beating. The ranking of women on these two indices is then related to selected demographic and health
outcomes, including use of contraception, ideal family size, and the use of reproductive health care
services during pregnancy, childbirth, and the postnatal period.
19.1 EMPLOYMENT AND FORMS OF EARNINGS
Employment can be a source of empowerment for both women and men. It is particularly so for
women if it puts them in control of the household income. In the 2014 CDHS, respondents were asked
whether they were employed at the time of the survey and, if not, whether they were employed in the
12 months preceding the survey.
Table 19.1 shows that 81 percent of currently married women age 15-49 were employed at the
time of the survey or within the 12 months preceding the survey, as compared with practically all men.
Younger married women (age 15-24) were less likely to be employed than older respondents.
Among currently married respondents who had been employed in the past 12 months, 92 percent
of women and 95 percent of men received earnings in cash or cash and in-kind. About 3 percent of women
and 2 percent of men employed in the past 12 months were not paid. The proportion not paid was highest
among young respondents.
1 The questions were phrased in terms of “husband/partner” (for women) and “wife/partner” (for men), referring to
marital partners; however, in this report, the word “partner” has been dropped to simplify the text and tables.
T
240 • Women’s Empowerment and Demographic and Health Outcomes
Table 19.1 Employment and cash earnings of currently married women and men
Percentage of currently married women and men age 15-49 who were employed at any time in the past 12 months and the percent distribution of currently
married women and men employed in the past 12 months by type of earnings, according to age, Cambodia 2014
Among currently married
respondents:
Percent distribution of currently married respondents employed in the past 12
months, by type of earnings
Total
Number of
women Age
Percentage
employed in
past 12
months
Number of
respondents Cash only
Cash and
in-kind In-kind only Not paid
Missing/don’t
know
WOMEN
15-19 70.6 450 86.6 3.8 3.1 6.5 0.0 100.0 318
20-24 73.8 1,833 84.5 7.7 2.3 5.4 0.0 100.0 1,352
25-29 77.8 2,249 85.5 7.5 4.0 3.0 0.0 100.0 1,750
30-34 82.5 2,625 87.1 7.7 3.2 2.0 0.0 100.0 2,166
35-39 85.9 1,573 82.5 8.7 5.8 3.0 0.0 100.0 1,351
40-44 87.8 1,673 79.9 10.2 6.8 3.1 0.0 100.0 1,469
45-49 85.2 1,495 78.3 11.4 7.1 3.3 0.0 100.0 1,273
Total 81.3 11,898 83.6 8.5 4.6 3.3 0.0 100.0 9,679
MEN
15-19 * 27 * * * * * * 25
20-24 100.0 308 81.5 13.5 0.2 4.9 0.0 100.0 308
25-29 99.3 591 88.7 7.3 2.1 1.8 0.0 100.0 587
30-34 99.9 832 88.4 8.5 1.7 1.5 0.0 100.0 831
35-39 100.0 529 80.2 12.8 5.7 1.4 0.0 100.0 529
40-44 99.4 572 84.0 12.0 1.5 2.5 0.0 100.0 569
45-49 99.4 545 77.3 18.7 2.5 1.5 0.0 100.0 542
Total 99.6 3,405 83.9 11.5 2.4 2.1 0.0 100.0 3,391
Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.
19.2 CONTROL OVER WOMEN’S AND MEN’S EARNINGS
Currently married women who were employed and received cash for their work were asked to
identify the main decision maker in the family regarding use of their earnings. They were also asked the
relative magnitude of their earnings in comparison with those of their husband. Women whose husbands
were employed for cash were asked who usually decides how his earnings are used. Men were also asked
who mainly decides how their earnings are used. These pieces of information provide insight into women’s
level of empowerment in the family and the extent of their control over decision making regarding the use
of household income. It is expected that employment and cash earnings are more likely to empower
women if they control their own earnings and perceive their earnings as important relative to those of their
husband and important to the welfare of the household.
Table 19.2.1 shows the results on women’s control over their cash earnings and the relative
magnitude of their earnings relative to those of their husband for currently married women who had cash
earnings in the 12 months preceding the survey. Seventy-four percent of married women who are
employed say that they mainly control their cash earnings; 25 percent say that decisions regarding how
their earnings are used are made jointly with their husband, and only 2 percent say that their husband
mainly controls their cash earnings.
Women’s control over their cash earnings is highest among those in Kampot/Kep (92 percent),
Kampong Thom (90 percent), and Svay Rieng (90 percent) and lowest among those in Mondul
Kiri/Ratanak Kiri (24 percent) and Banteay Meanchey (36 percent). Younger women and women with no
education are less likely than other women to control their cash earnings. There is little variation in control
of cash income by other background characteristics.
Nearly one in two (48 percent) currently married, employed women in Cambodia say they earn
less than their husband; 35 percent say they earn about the same amount, and 17 percent say either that
they earn more than their husband or that their husband has no earnings. Thus, half of currently married,
employed women earn at least as much as their husband. Employed women in urban areas are more likely
than employed women in rural areas to earn more than their husbands, as are better educated women and
those in higher wealth quintiles.
Women’s Empowerment and Demographic and Health Outcomes • 241
Table 19.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings
Percent distribution of currently married women age 15-49 who received cash earnings for employment in the 12 months preceding the survey by person who decides how
wife’s cash earnings are used and by whether she earned more or less than her husband, according to background characteristics, Cambodia 2014
Person who decides how the wife’s cash earnings are
used:
Total
Wife’s cash earnings compared with husband’s cash
earnings:
Total
Number
of women
Background
characteristic
Mainly
wife
Wife and
husband
jointly
Mainly
husband Other Missing More Less
About the
same
Husband
has no
earnings
Don’t
know/
missing
Age
15-19 63.7 33.6 2.1 0.7 0.0 100.0 9.8 64.0 26.2 0.0 0.0 100.0 287
20-24 71.1 27.0 1.0 0.9 0.0 100.0 14.6 55.2 29.8 0.4 0.0 100.0 1,247
25-29 71.0 27.5 1.4 0.1 0.0 100.0 15.9 49.0 34.4 0.6 0.2 100.0 1,628
30-34 74.2 23.7 1.9 0.2 0.0 100.0 16.2 49.9 33.2 0.5 0.2 100.0 2,054
35-39 75.1 23.5 1.3 0.0 0.0 100.0 18.9 45.4 35.0 0.7 0.0 100.0 1,232
40-44 77.1 20.9 1.8 0.0 0.2 100.0 17.4 42.7 38.8 0.7 0.4 100.0 1,324
45-49 75.4 23.4 1.2 0.0 0.0 100.0 13.7 41.2 42.6 2.2 0.3 100.0 1,141
Number of living
children
0 71.0 26.5 1.6 0.9 0.0 100.0 18.1 50.8 30.6 0.5 0.0 100.0 849
1-2 73.1 25.4 1.2 0.2 0.1 100.0 16.5 49.2 33.5 0.6 0.2 100.0 4,403
3-4 74.8 23.2 1.9 0.1 0.0 100.0 15.5 45.7 37.8 0.8 0.2 100.0 2,716
5+ 74.1 24.1 1.7 0.0 0.0 100.0 12.6 48.0 37.8 1.5 0.1 100.0 945
Residence
Urban 71.7 27.1 1.1 0.2 0.0 100.0 20.2 41.7 36.8 1.2 0.1 100.0 1,414
Rural 73.9 24.3 1.6 0.2 0.1 100.0 15.1 49.3 34.7 0.7 0.2 100.0 7,499
Province
Banteay Meanchey 35.8 62.7 1.0 0.0 0.5 100.0 6.8 67.5 25.1 0.0 0.6 100.0 412
Kampong Cham 87.6 10.8 1.6 0.0 0.0 100.0 11.0 46.1 42.4 0.6 0.0 100.0 1,065
Kampong Chhnang 43.5 54.6 1.9 0.0 0.0 100.0 13.8 48.4 37.8 0.0 0.0 100.0 381
Kampong Speu 77.5 20.7 0.9 0.9 0.0 100.0 22.4 37.4 39.0 0.6 0.6 100.0 765
Kampong Thom 90.3 9.2 0.2 0.2 0.0 100.0 11.5 47.4 40.4 0.6 0.0 100.0 477
Kandal 77.6 22.1 0.2 0.0 0.0 100.0 27.1 46.7 26.1 0.1 0.0 100.0 708
Kratie 80.6 16.8 2.0 0.0 0.6 100.0 9.7 68.1 20.3 1.2 0.7 100.0 200
Phnom Penh 70.7 28.0 0.8 0.4 0.0 100.0 20.0 45.4 33.2 1.5 0.0 100.0 862
Prey Veng 78.9 20.7 0.3 0.0 0.0 100.0 12.2 53.3 33.7 0.8 0.0 100.0 732
Pursat 80.4 18.7 0.8 0.0 0.0 100.0 12.9 58.8 28.0 0.3 0.0 100.0 300
Siem Reap 66.5 31.5 1.7 0.3 0.0 100.0 24.8 39.7 35.0 0.6 0.0 100.0 460
Svay Rieng 89.7 7.7 1.4 1.2 0.0 100.0 12.6 41.0 44.6 1.8 0.0 100.0 421
Takeo 70.8 18.4 10.4 0.4 0.0 100.0 27.0 47.2 24.7 1.1 0.0 100.0 395
Otdar Meanchey 66.7 31.5 1.6 0.0 0.2 100.0 6.5 44.1 48.4 0.9 0.2 100.0 175
Battambang/Pailin 79.4 18.8 1.8 0.0 0.0 100.0 15.8 43.0 39.7 0.4 1.0 100.0 490
Kampot/Kep 91.5 7.8 0.7 0.0 0.0 100.0 12.7 64.0 20.6 2.4 0.3 100.0 451
Preah Sihanouk/
Koh Kong 53.1 46.3 0.5 0.0 0.0 100.0 16.7 44.2 38.5 0.6 0.0 100.0 187
Preah Vihear/
Stung Treng 55.8 44.0 0.0 0.0 0.1 100.0 11.3 57.4 30.4 0.0 0.9 100.0 193
Mondul Kiri/
Ratanak Kiri 24.0 72.3 3.6 0.0 0.1 100.0 5.4 36.6 57.9 0.0 0.2 100.0 239
Education
No education 69.7 27.8 2.5 0.0 0.0 100.0 12.2 45.6 40.3 1.6 0.3 100.0 1,261
Primary 75.2 23.2 1.3 0.2 0.1 100.0 15.6 48.8 34.7 0.7 0.3 100.0 4,763
Secondary and higher 72.5 25.9 1.3 0.3 0.0 100.0 18.1 48.2 33.1 0.5 0.0 100.0 2,889
Wealth quintile
Lowest 73.0 25.2 1.6 0.3 0.0 100.0 11.0 53.1 34.4 1.2 0.3 100.0 1,653
Second 75.7 22.9 1.2 0.1 0.1 100.0 13.8 51.5 33.9 0.7 0.2 100.0 1,777
Middle 75.5 23.2 0.9 0.3 0.1 100.0 15.3 51.1 32.8 0.6 0.2 100.0 1,681
Fourth 72.6 24.4 2.7 0.3 0.0 100.0 18.7 44.5 36.2 0.4 0.1 100.0 1,872
Highest 71.2 27.6 1.1 0.1 0.0 100.0 20.0 41.7 37.2 0.9 0.2 100.0 1,930
Total 73.5 24.7 1.5 0.2 0.0 100.0 15.9 48.1 35.0 0.7 0.2 100.0 8,913
Currently married men age 15-49 who receive cash earnings and currently married women age 1549 whose husbands receive cash earnings were asked who decides how the husband’s cash earnings are
spent. Table 19.2.2 shows that 50 percent of men and 61 percent of women say that the wife mainly
decides how the husband’s earnings are used. Forty-one percent of men and 35 percent of women say the
husband and wife decide jointly how the man’s cash earnings are used.
242 • Women’s Empowerment and Demographic and Health Outcomes
Table 19.2.2 Control over men’s cash earnings
Percent distributions of currently married men age 15-49 who receive cash earnings and of currently married women age 15-49 whose husbands receive cash
earnings, by person who decides how husband’s cash earnings are used, according to background characteristics, Cambodia 2014
Men Women
Background
characteristic
Mainly
wife
Husband
and wife
jointly
Mainly
husband Other Missing Total Number
Mainly
wife
Husband
and wife
jointly
Mainly
husband Other Missing Total Number
Age
15-19 * * * * * 100.0 20 54.5 39.6 5.3 0.5 0.1 100.0 449
20-24 49.4 44.1 6.0 0.4 0.1 100.0 292 59.2 37.8 2.7 0.3 0.0 100.0 1,828
25-29 48.5 41.6 9.7 0.2 0.0 100.0 564 61.7 35.5 2.8 0.1 0.0 100.0 2,240
30-34 50.3 42.1 7.6 0.1 0.0 100.0 805 60.8 34.8 4.4 0.0 0.0 100.0 2,614
35-39 46.9 42.6 10.4 0.0 0.1 100.0 492 60.7 35.6 3.7 0.0 0.0 100.0 1,563
40-44 53.2 38.0 8.8 0.0 0.0 100.0 546 63.9 31.7 4.3 0.1 0.0 100.0 1,660
45-49 50.9 40.6 8.4 0.0 0.1 100.0 520 63.2 32.6 4.2 0.0 0.0 100.0 1,463
Number of living
children
0 46.1 45.3 8.1 0.5 0.0 100.0 307 56.3 40.1 3.1 0.4 0.0 100.0 1,122
1-2 50.8 41.0 8.1 0.1 0.1 100.0 1,593 61.5 34.6 3.8 0.1 0.0 100.0 5,911
3-4 50.0 40.4 9.6 0.0 0.0 100.0 1,004 62.1 34.1 3.7 0.0 0.0 100.0 3,546
5+ 49.4 42.9 7.6 0.0 0.1 100.0 334 61.5 34.4 4.1 0.1 0.0 100.0 1,239
Residence
Urban 39.4 50.5 10.0 0.0 0.1 100.0 462 53.5 39.8 6.6 0.1 0.0 100.0 1,799
Rural 51.7 39.9 8.3 0.1 0.0 100.0 2,776 62.6 34.1 3.2 0.1 0.0 100.0 10,019
Province
Banteay Meanchey 93.7 4.5 1.8 0.0 0.0 100.0 127 23.9 74.9 1.1 0.0 0.0 100.0 503
Kampong Cham 43.2 42.9 13.9 0.0 0.0 100.0 437 60.2 36.2 3.6 0.0 0.0 100.0 1,484
Kampong Chhnang 13.5 73.6 12.4 0.0 0.4 100.0 115 27.4 68.8 3.7 0.0 0.0 100.0 396
Kampong Speu 41.7 50.9 7.4 0.0 0.0 100.0 221 53.2 43.7 2.7 0.5 0.0 100.0 837
Kampong Thom 91.2 6.9 1.9 0.0 0.0 100.0 145 84.7 14.2 1.1 0.0 0.0 100.0 569
Kandal 72.7 8.6 18.6 0.0 0.0 100.0 288 76.0 21.8 2.1 0.0 0.0 100.0 869
Kratie 35.3 45.0 18.2 0.6 1.0 100.0 86 71.4 27.5 0.7 0.2 0.2 100.0 356
Phnom Penh 30.8 60.4 8.8 0.0 0.0 100.0 278 49.8 41.3 8.8 0.1 0.0 100.0 1,070
Prey Veng 66.4 25.2 7.9 0.4 0.0 100.0 246 73.6 25.9 0.5 0.0 0.0 100.0 883
Pursat 53.8 36.7 9.4 0.0 0.0 100.0 102 71.2 26.7 1.9 0.2 0.0 100.0 424
Siem Reap 1.4 98.6 0.0 0.0 0.0 100.0 188 53.7 41.8 4.3 0.2 0.0 100.0 754
Svay Rieng 9.0 86.1 4.0 0.9 0.0 100.0 124 80.0 17.4 2.6 0.0 0.0 100.0 474
Takeo 62.0 23.9 14.1 0.0 0.0 100.0 180 62.3 21.9 15.5 0.3 0.0 100.0 673
Otdar Meanchey 0.0 100.0 0.0 0.0 0.0 100.0 58 53.9 45.9 0.2 0.0 0.0 100.0 216
Battambang/Pailin 81.5 17.4 1.1 0.0 0.0 100.0 242 77.0 19.5 3.3 0.2 0.0 100.0 886
Kampot/Kep 64.0 30.5 5.5 0.0 0.0 100.0 173 90.4 7.6 2.0 0.0 0.0 100.0 563
Preah Sihanouk/
Koh Kong 66.7 21.8 11.5 0.0 0.0 100.0 74 43.0 56.1 0.9 0.0 0.0 100.0 264
Preah Vihear/
Stung Treng 44.7 51.5 3.8 0.0 0.0 100.0 72 30.9 67.8 1.3 0.0 0.0 100.0 314
Mondul Kiri/
Ratanak Kiri 13.0 84.0 3.0 0.0 0.0 100.0 82 22.1 73.4 4.3 0.0 0.2 100.0 281
Education
No education 50.0 45.3 4.7 0.0 0.0 100.0 240 58.0 36.5 5.5 0.0 0.0 100.0 1,746
Primary 53.1 38.1 8.7 0.0 0.1 100.0 1,528 62.9 33.7 3.3 0.2 0.0 100.0 6,363
Secondary and
higher 46.6 44.3 8.9 0.2 0.0 100.0 1,470 59.8 36.5 3.7 0.0 0.0 100.0 3,709
Wealth quintile
Lowest 53.4 39.3 7.1 0.0 0.1 100.0 572 60.7 36.0 3.1 0.1 0.0 100.0 2,270
Second 49.4 41.6 8.9 0.2 0.0 100.0 615 64.7 32.8 2.4 0.1 0.0 100.0 2,390
Middle 52.9 37.1 9.7 0.2 0.1 100.0 664 62.7 33.8 3.3 0.1 0.0 100.0 2,352
Fourth 51.1 41.5 7.5 0.0 0.0 100.0 720 61.2 34.1 4.6 0.1 0.0 100.0 2,381
Highest 43.3 47.4 9.3 0.0 0.0 100.0 667 56.8 38.1 5.1 0.1 0.0 100.0 2,424
Total 49.9 41.4 8.5 0.1 0.0 100.0 3,238 61.2 35.0 3.7 0.1 0.0 100.0 11,818
Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed.
Men in Kandal and Kratie (19 percent and 18 percent, respectively) are more likely to make
decisions themselves on how to use their cash earnings than their counterparts in other provinces. More
women in Takeo (16 percent) whose husbands receive cash earnings report that their husbands usually
have sole authority over the use of their earnings than in other provinces. All of the married, working men
interviewed in Otdar Meanchey reported that decisions on how to use their earnings were made jointly
with their wives.
Table 19.3 shows the percent distribution of currently married women age 15-49 who received
cash earnings in the past 12 months by the person who decides how their cash earnings are used and the
percent distribution of currently married women age 15-49 whose husbands received cash earnings in the
Women’s Empowerment and Demographic and Health Outcomes • 243
past 12 months by the person who decides how the husband’s cash earnings are used, according to the
relative magnitude of the earnings of the woman and her husband.
Women who earn more than their husbands are more likely to decide how their cash earnings are
used (79 percent) than women whose cash earnings are the same as those of their husband (69 percent).
Women who say they earn about the same amount as their husband are more likely to make joint decisions
with their husband about how their cash earnings and those of their husbands are used (30 percent and 42
percent, respectively).
Table 19.3 Women’s control over their own earnings and over those of their husbands
Percent distribution of currently married women age 15-49 with cash earnings in the last 12 months by person who decides how the wife’s cash earnings are used and
percent distribution of currently married women age 15-49 whose husbands have cash earnings by person who decides how the husband’s cash earnings are used,
according to the relation between wife’s and husband’s cash earnings, Cambodia 2014
Person who decides how the wife’s cash
earnings are used:
Total Number
Person who decides how the husband’s cash
earnings are used:
Total
Number
of women
Women’s earnings
relative to husband’s
earnings
Mainly
wife
Wife and
husband
jointly
Mainly
husband Other Missing
Mainly
wife
Wife and
husband
jointly
Mainly
husband Other Missing
More than husband 78.7 19.4 1.8 0.1 0.0 100.0 1,422 67.9 27.2 4.9 0.0 0.0 100.0 1,422
Less than husband 75.1 23.1 1.6 0.2 0.0 100.0 4,290 60.4 36.0 3.5 0.0 0.0 100.0 4,290
Same as husband 68.8 29.7 1.3 0.3 0.0 100.0 3,119 55.6 42.1 2.1 0.2 0.0 100.0 3,119
Husband has no cash
earnings or did not
work 86.3 13.7 0.0 0.0 0.0 100.0 67 na na na na na na 0
Woman worked but has
no cash earnings na na na na na na 0 64.3 33.1 2.6 0.0 0.0 100.0 760
Woman did not work na na na na na na 0 65.6 28.6 5.6 0.2 0.0 100.0 2,211
Total 73.5 24.7 1.5 0.2 0.0 100.0 8,913 61.2 35.0 3.7 0.1 0.0 100.0 11,818
Note: Total includes 17 cases where a woman does not know whether she earned more or less than her husband.
na = Not applicable
19.3 PARTICIPATION IN HOUSEHOLD DECISION MAKING
The ability to make decisions about their own life is important to women’s empowerment. In
addition to information on women’s control over cash earnings, the 2014 CDHS collected information
from both women and men on other measures of women’s empowerment. Respondents were asked about
women’s role in household decision making and acceptance of wife beating. Such information provides
insight into women’s control over their environment and their attitudes towards gender roles, both of which
are relevant to understanding women’s ability to make independent decisions about their own health care
and that of their children.
To assess women’s decision-making autonomy, information was collected on their participation in
three types of household decisions: their own health care, making large household purchases, and visiting
their family or relatives. Having a final say in the decision-making process represents the highest degree of
autonomy. Women are considered to participate in a decision if they usually make that decision alone or
jointly with their husband. Table 19.4 shows the percent distribution of currently married women age 1549 by the person in the household who usually makes decisions concerning these matters.
Cambodian women are usually involved in all three specific decisions, although the extent of their
involvement depends on the issue being decided. Forty-six percent of women say they alone make
decisions about their own health care. However, decisions about major household purchases and visits to
the wife’s family or relatives are usually made jointly by the husband and wife.
Married men are somewhat less likely than women to mainly make decisions about their own
health care (29 percent versus 46 percent). However, 73 percent of men say they make decisions about
major household purchases jointly with their wives, about the same proportion as among women (76
percent).
244 • Women’s Empowerment and Demographic and Health Outcomes
Table 19.4 Participation in decision making
Percent distribution of currently married women and currently married men age 15-49 by person who usually makes decisions about various
issues, Cambodia 2014
Decision Mainly wife
Wife and
husband
jointly
Mainly
husband
Someone
else Other Missing Total Number
WOMEN
Own health care 46.4 45.1 8.0 0.5 0.1 0.0 100.0 11,898
Major household purchases 17.2 76.3 5.5 0.9 0.1 0.0 100.0 11,898
Visits to her family or relatives 22.8 73.6 3.4 0.2 0.0 0.0 100.0 11,898
MEN
Own health care 24.9 46.0 28.9 0.1 0.0 0.0 100.0 3,405
Major household purchases 17.6 73.2 8.9 0.3 0.0 0.0 100.0 3,405
Table 19.5.1 shows the percentage of married women who participate in the three decisions
specified for female respondents, according to background characteristics. As noted above, a woman is
considered to participate in a decision if she says she usually makes the decision alone or jointly with her
husband.
Ninety-two percent of currently married women age 15-49 say they make decisions about their
own health care either by themselves or jointly with their husbands, and 94 percent say they participate in
decisions about major household purchases. Ninety-six percent say they participate in decisions about
visits to their family or relatives. Overall, 86 percent of currently married women participate in all three
decisions, and less than 2 percent do not participate in any of the three decisions.
Younger women are less likely than older women to participate in all three kinds of decisions. In
addition, women employed for cash are more likely to participate in all three decisions (88 percent) than
women who are employed but not for cash (79 percent). Women with children are more likely to
participate in all three decisions (86-88 percent) than women with no children (80 percent).
Women in Phnom Penh and Kratie are less likely to participate in all three decisions. Almost one
in five women in Takeo say they do not participate in any of the three types of decisions. Women in rural
areas are more likely than those in urban areas to participate in all three decisions. Women’s participation
in decision making varies slightly by education and wealth quintile.
Women’s Empowerment and Demographic and Health Outcomes • 245
Table 19.5.1 Women’s participation in decision making by background characteristics
Percentage of currently married women age 15-49 who usually make specific decisions either by themselves or jointly
with their husband, by background characteristics, Cambodia 2014
Specific decisions
All three
decisions
None of the
three
decisions
Number of
women
Background
characteristic
Woman’s own
health care
Making major
household
purchases
Visits to her
family or
relatives
Age
15-19 89.2 86.7 95.3 77.3 1.3 450
20-24 90.7 92.0 95.7 82.9 1.2 1,833
25-29 92.1 94.2 97.4 87.8 1.0 2,249
30-34 90.4 93.6 96.0 86.0 1.9 2,625
35-39 92.5 94.7 96.8 87.5 1.0 1,573
40-44 92.0 93.5 95.6 87.4 1.7 1,673
45-49 92.3 94.9 97.3 89.1 1.6 1,495
Employment (last 12
months)
Not employed 88.8 90.0 92.7 81.5 3.3 2,218
Employed for cash 92.6 94.5 97.2 88.2 1.1 8,913
Employed not for cash 86.4 92.3 98.0 78.8 0.3 766
Number of living
children
0 88.7 90.4 95.9 80.3 1.0 1,128
1-2 91.3 93.5 96.4 86.0 1.5 5,942
3-4 92.5 94.5 96.5 88.2 1.4 3,572
5+ 91.8 93.6 96.9 88.1 1.7 1,257
Residence
Urban 84.5 92.8 96.4 79.4 1.0 1,818
Rural 92.7 93.6 96.4 87.6 1.5 10,080
Province
Banteay Meanchey 99.5 99.1 99.9 98.6 0.0 503
Kampong Cham 98.4 98.2 99.9 97.0 0.0 1,490
Kampong Chhnang 98.0 97.1 96.8 94.7 0.4 396
Kampong Speu 94.3 96.0 98.2 91.3 0.7 843
Kampong Thom 98.9 98.7 99.4 97.9 0.3 572
Kandal 98.9 95.3 97.1 92.9 0.3 870
Kratie 69.2 94.0 96.6 63.7 0.9 359
Phnom Penh 70.8 90.5 95.6 65.0 1.0 1,084
Prey Veng 99.5 98.7 99.8 98.1 0.0 889
Pursat 93.0 93.0 97.8 86.6 0.4 425
Siem Reap 89.3 90.6 94.6 77.8 0.0 765
Svay Rieng 89.8 90.4 97.7 80.6 0.2 483
Takeo 80.1 80.6 79.8 76.1 17.0 677
Otdar Meanchey 98.2 90.2 99.6 89.5 0.2 218
Battambang/Pailin 89.9 88.4 92.4 79.0 1.3 890
Kampot/Kep 95.8 89.1 97.8 85.9 0.6 574
Preah Sihanouk/
Koh Kong 99.4 99.3 99.6 98.8 0.0 266
Preah Vihear/
Stung Treng 81.0 89.8 96.0 75.1 1.6 314
Mondul Kiri/
Ratanak Kiri 95.7 95.0 95.3 91.5 1.7 281
Education
No education 91.5 92.2 94.8 86.1 2.7 1,774
Primary 92.3 94.2 96.6 87.2 1.1 6,399
Secondary and higher 90.0 92.9 96.9 85.0 1.4 3,726
Wealth quintile
Lowest 92.6 94.1 96.7 86.9 0.8 2,294
Second 92.3 93.7 96.6 87.3 1.4 2,404
Middle 93.8 93.4 95.9 88.7 1.8 2,365
Fourth 92.5 92.9 96.1 87.7 2.4 2,393
Highest 86.3 93.4 96.8 81.3 0.7 2,443
Total 91.5 93.5 96.4 86.3 1.4 11,898
Note: Total includes 1 missing case for employment.
Table 19.5.2 presents similar data on men’s participation in decisions about their own health care
and about major household purchases by background characteristics. Seventy-five percent of men
participate in decisions about their own health care, and 82 percent participate in decisions about major
household purchases; only 8 percent do not make decisions on either of the two issues.
Participation in both decisions does not have a clear association with age. Men who are employed
for cash are less likely than those who are not employed for cash to participate in both decisions. Men who
246 • Women’s Empowerment and Demographic and Health Outcomes
live in urban areas and have a secondary education or higher are more likely than other men to participate
in both decisions. There is no clear pattern in decision making by level of wealth. Only 16 percent of men
from Banteay Meanchey participate in making decisions on both issues, while more than 90 percent of
men from Kampong Chhnang, Kampong Thom, Pursat, Siem Reap, and Otdar Meanchey say they make
decisions on both issues.
Table 19.5.2 Men’s participation in decision making by background characteristics
Percentage of currently married men age 15-49 who usually make specific decisions either alone or
jointly with their wife, by background characteristics, Cambodia 2014
Specific decisions
Both decisions
Neither of the
two decisions
Number of
men
Background
characteristic
Man’s own
health
Making major
household
purchases
Age
15-19 * * * * 27
20-24 75.0 83.8 66.0 7.3 308
25-29 74.4 80.8 62.7 7.6 591
30-34 76.1 83.1 65.6 6.3 832
35-39 78.3 78.5 66.1 9.3 529
40-44 72.6 84.0 64.7 8.1 572
45-49 73.2 83.1 65.7 9.3 545
Employment (last 12
months)
Not employed * * * * 14
Employed for cash 74.3 81.9 64.2 8.1 3,238
Employed not for cash 88.4 84.6 76.6 3.6 153
Number of living
children
0 70.3 81.5 60.3 8.4 333
1-2 75.8 83.5 66.2 6.9 1,670
3-4 74.6 79.6 63.3 9.2 1,046
5+ 76.4 83.5 67.8 7.9 357
Residence
Urban 77.9 86.4 69.3 5.0 465
Rural 74.5 81.4 64.2 8.3 2,940
Province
Banteay Meanchey 15.6 94.0 15.6 6.0 131
Kampong Cham 86.5 75.8 70.8 8.5 474
Kampong Chhnang 98.9 96.9 96.0 0.2 115
Kampong Speu 89.0 70.8 63.0 3.2 221
Kampong Thom 97.1 99.0 97.0 0.8 146
Kandal 47.7 58.0 32.3 26.6 288
Kratie 70.1 94.8 68.6 3.7 95
Phnom Penh 83.0 87.5 73.0 2.5 279
Prey Veng 37.9 82.8 37.4 16.8 248
Pursat 98.2 94.7 93.6 0.7 109
Siem Reap 99.7 98.9 98.9 0.3 229
Svay Rieng 95.9 89.2 86.5 1.5 130
Takeo 66.4 69.0 48.1 12.6 214
Otdar Meanchey 99.5 93.6 93.1 0.0 67
Battambang/Pailin 46.8 79.4 42.3 16.0 247
Kampot/Kep 85.9 96.9 84.0 1.1 173
Preah Sihanouk/
Koh Kong 93.6 65.2 63.3 4.4 75
Preah Vihear/
Stung Treng 66.8 80.6 55.0 7.6 77
Mondul Kiri/
Ratanak Kiri 98.4 71.8 70.9 0.7 87
Education
No education 74.7 77.6 62.3 10.0 273
Primary 71.8 81.6 61.8 8.5 1,618
Secondary and higher 78.4 83.4 68.7 6.8 1,513
Wealth quintile
Lowest 77.6 81.0 67.4 8.8 618
Second 76.3 84.6 67.3 6.4 665
Middle 69.8 81.0 61.1 10.3 709
Fourth 72.7 77.9 59.1 8.5 735
Highest 79.1 86.3 70.5 5.1 677
Total 75.0 82.1 64.9 7.8 3,405
Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been
suppressed.
Women’s Empowerment and Demographic and Health Outcomes • 247
19.4 OWNERSHIP OF ASSETS
Ownership and control of assets by women and men influence their individual participation in
development processes at all levels. Lack of assets makes women vulnerable to various forms of violence
and lessens their decision-making power in the household. Tradition and low economic status limit
women’s ownership of productive assets such as land and housing. Ownership of assets confers additional
economic value, status, and bargaining power.
Table 19.6.1 shows the percent distribution of women age 15-49 by ownership of a house and
land, according to background characteristics. Owning a house is more common among women than
owning land. Overall, 62 percent of women own a house and 54 percent own land. The majority of women
who do own assets own them jointly; 43 percent of women own a house jointly, and 35 percent own land
jointly.
There are variations in ownership of a house and land by age, residence, region, education, and
wealth. Ownership of houses and land increases with age. Eighty percent of young women age 15-19 do
not own a house, and 82 percent do not own land. Ownership of a house or land is more common in rural
than in urban areas: 58 percent and 34 percent of urban and rural women, respectively, do not own a house,
and 65 percent and 41 percent, respectively, do not own land.
Fifteen percent of women in Kandal own a house alone and 15 percent own land alone, among the
highest percentages in the country. Women in Phnom Penh are most likely not to own a house (65
percent), and women in Preah Sihanouk/Koh Kong are most likely not to own land (80 percent). The
likelihood of owning either a house or land decreases with increasing education. The percentage of women
with a secondary education or higher who do not own a house (54 percent) is more than double that of
women with no education (21 percent). Fifty-three percent of women in the highest wealth quintile do not
own a house, as compared with 29 percent of women in the lowest quintile. In addition, 60 percent of
women in the highest quintile do not own land, compared with 39 percent in the lowest quintile.
The results indicate that tradition is likely to play a larger role in asset ownership than women’s
socioeconomic status. These findings might be explained by the fact that in general respondents who live
in urban areas are more educated and wealthier than their rural counterparts, and they are probably also
more likely to rent a place to live and to not own any land.
The pattern of ownership of land among men is similar to that among women with the exception
that slightly fewer men than women own a house and land (Table 19.6.2). Overall, 49 percent of men age
15-49 do not own a house (compared with 39 percent of women) and 49 percent do not own land
(compared with 46 percent of women). As is true for women, ownership of both housing and land
increases with age among men. A larger proportion of men in rural areas own a house and land than their
counterparts in urban areas. Men in Phnom Penh are most likely not to own a house (72 percent) or land
(64 percent). Men in Banteay Meanchey are least likely not to own a house (34 percent), and men in
Kampong Speu are least likely not to own land (32 percent). Similar to women, education and wealth are
negatively associated with land and house ownership among men.
248 • Women’s Empowerment and Demographic and Health Outcomes
Table 19.6.1 Ownership of assets: Women
Percent distribution of women age 15-49 by ownership of housing and land, according to background characteristics, Cambodia 2014
Percentage who own a house:
Total
Percentage who own land:
Total Number
Background
characteristic Alone Jointly
Alone and
jointly
Percentage who
do not
own a
house Missing Alone Jointly
Alone and
jointly
Percentage who
do not
own land Missing
Age
15-19 1.9 13.8 4.1 80.2 0.0 100.0 3.0 11.2 3.8 82.0 0.0 100.0 2,893
20-24 4.2 25.3 7.2 63.3 0.0 100.0 7.8 22.6 5.9 63.8 0.0 100.0 3,017
25-29 5.8 43.2 9.8 41.2 0.0 100.0 10.1 35.3 7.4 47.3 0.0 100.0 2,836
30-34 7.2 55.5 13.1 24.2 0.0 100.0 10.2 44.6 11.3 33.9 0.0 100.0 3,046
35-39 12.4 61.8 12.5 13.3 0.0 100.0 12.8 49.3 10.2 27.6 0.0 100.0 1,839
40-44 13.8 61.5 13.8 10.9 0.0 100.0 15.0 50.0 11.5 23.6 0.0 100.0 2,030
45-49 16.7 59.9 15.0 8.3 0.1 100.0 17.8 48.7 13.1 20.2 0.2 100.0 1,916
Residence
Urban 6.2 30.0 5.7 58.1 0.0 100.0 7.1 24.2 3.6 65.1 0.0 100.0 3,251
Rural 8.3 46.3 11.3 34.0 0.0 100.0 10.9 37.9 9.7 41.4 0.0 100.0 14,327
Province
Banteay Meanchey 7.1 52.7 7.9 32.3 0.0 100.0 8.4 48.1 7.9 35.6 0.0 100.0 689
Kampong Cham 8.8 43.9 3.4 43.8 0.0 100.0 9.2 36.5 3.1 51.0 0.1 100.0 2,021
Kampong Chhnang 5.3 43.5 19.7 31.6 0.0 100.0 3.9 28.8 18.9 48.4 0.0 100.0 662
Kampong Speu 8.7 70.9 7.2 13.1 0.0 100.0 16.3 62.1 6.0 15.5 0.0 100.0 1,196
Kampong Thom 7.1 53.9 3.7 35.3 0.0 100.0 6.4 48.2 1.7 43.8 0.0 100.0 851
Kandal 15.1 47.0 15.9 22.0 0.0 100.0 15.3 27.3 10.4 46.9 0.0 100.0 1,330
Kratie 3.4 41.7 22.2 32.8 0.0 100.0 6.1 37.8 21.3 34.9 0.0 100.0 488
Phnom Penh 6.5 25.7 3.0 64.8 0.0 100.0 7.8 22.5 1.5 68.3 0.0 100.0 1,994
Prey Veng 8.1 14.8 39.4 37.7 0.0 100.0 7.8 15.0 38.5 38.6 0.0 100.0 1,188
Pursat 8.4 36.4 12.7 42.5 0.0 100.0 16.8 28.1 10.6 44.5 0.0 100.0 631
Siem Reap 8.3 45.7 15.6 30.3 0.1 100.0 12.5 19.2 11.7 56.4 0.1 100.0 1,137
Svay Rieng 6.2 59.8 7.2 26.9 0.0 100.0 19.4 49.6 5.2 25.8 0.0 100.0 654
Takeo 7.7 47.2 7.1 38.1 0.0 100.0 9.0 45.5 6.4 39.1 0.0 100.0 1,082
Otdar Meanchey 6.8 54.1 12.5 26.6 0.0 100.0 5.9 45.9 10.7 37.5 0.0 100.0 294
Battambang/Pailin 7.6 42.1 1.2 49.1 0.0 100.0 11.8 36.0 0.9 51.2 0.0 100.0 1,333
Kampot/Kep 7.5 47.7 10.6 34.3 0.0 100.0 9.3 44.9 8.9 36.9 0.0 100.0 770
Preah Sihanouk/
Koh Kong 4.5 22.4 14.3 58.8 0.0 100.0 3.9 9.8 6.7 79.6 0.0 100.0 422
Preah Vihear/
Stung Treng 8.2 48.6 1.7 41.5 0.0 100.0 10.1 48.5 1.1 40.4 0.0 100.0 462
Mondul Kiri/
Ratanak Kiri 3.5 51.7 2.1 42.7 0.0 100.0 4.0 51.5 1.8 42.7 0.0 100.0 372
Education
No education 11.0 55.0 12.5 21.3 0.1 100.0 10.7 41.4 10.8 37.0 0.1 100.0 2,250
Primary 8.7 49.4 12.1 29.8 0.0 100.0 11.3 40.6 10.2 37.9 0.0 100.0 8,281
Secondary and
higher 6.0 32.3 7.5 54.2 0.0 100.0 8.8 27.3 6.1 57.8 0.0 100.0 7,047
Wealth quintile
Lowest 9.8 50.5 10.9 28.8 0.0 100.0 11.3 40.1 9.6 39.0 0.0 100.0 3,143
Second 8.5 47.5 11.8 32.2 0.0 100.0 10.5 39.1 10.0 40.4 0.1 100.0 3,314
Middle 7.3 44.7 11.6 36.3 0.0 100.0 11.1 36.6 10.5 41.8 0.0 100.0 3,381
Fourth 8.3 42.8 11.1 37.8 0.0 100.0 11.2 35.0 9.4 44.3 0.0 100.0 3,612
Highest 6.1 33.8 6.9 53.2 0.0 100.0 7.6 28.2 4.6 59.7 0.0 100.0 4,128
Total 7.9 43.3 10.3 38.5 0.0 100.0 10.2 35.4 8.6 45.8 0.0 100.0 17,578
Women’s Empowerment and Demographic and Health Outcomes • 249
Table 19.6.2 Ownership of assets: Men
Percent distribution of men age 15-49 by ownership of housing and land, according to background characteristics, Cambodia 2014
Percentage who own a house:
Total
Percentage wh