ECONOMIC AND SOCIAL COMMISSION FOR ASIS AND THE PACIFIC and UNITED NATIONS POPULATION FUND
Fifth Asian and Pacific Population Conference
Bangkok
11-17 December 2002
Population and Poverty in Asia and the Pacific
Country Report: Cambodia 1
1 This report has been prepared by H. E. Ou Orhat, Secretary of State, Ministry of Planning and Mr. Chea
Chantum, Deputy Director, General Planning Department, General Directorate of Planning, Ministry of
Planning based on the outline suggested by ESCAP. They were assisted by Dr. Gouranga Dasvarma, Senior
Adviser, Ministry of Planning.

Executive Summary
Population and Poverty in Asia and the Pacific
Country Report: Cambodia
Cambodia’s population was counted as 11.4 million at the 1998 census, with a sex-ratio of 93 males for every 100 females The population was growing at the rate of 2.5% per annum.
About 85% of the population lived in rural areas. It is a young population with nearly 43% below age 15. More than 25% of the households in the country are headed by females. The adult literacy rate is 79.5% among males and 57% among females, and functional literacy is
47.6% among males and 29.1 % among females. The dependency ratio is 86.1. Thirty six percent of the population lives below the poverty line and 90% of Cambodia’s poor lives in rural areas. The estimated GDP per capita is US$257 as of 1999. There are large gender disparities in education and employment. The Human Development Index for Cambodia in
1999 was 0.541 giving it a rank of 121 out of 162 countries in that year.
The singulate mean age at marriage in 1998 was 22.5 years for females and 24.2 years for males. The total fertility rate was 4.0, infant mortality rate 95 per 1,000 live births, under-five mortality rate 124 per 1,000 live births and maternal mortality ratio is 437 per 100,000 live births. The HIV prevalence in the adult population is 2.8% in 2000. Life expectancy at birth is estimated as 53.1 years for males, 59.2 years for females and 56.1 years for both sexes combined.
The population is projected to grow to 14.8 million in 2006, 16.6 million in 2011 and 18.5 million in 2016 (NIS 2000:24).
Fertility and mortality have fluctuated since the 1970s, but fertility has started declining from the early 1990s. Likewise, infant and child mortality are also declining.
According to the 1998 census, 3.6 million persons or 31.5% of the population in Cambodia were migrants. The migration stream has been mostly from rural to rural areas, which accounts for more than two-thirds (64.2%) of all migrants based on place of previous residence at all times. Family movement accounted for the largest proportion of migration.
The proportion of the elderly (aged 60 years and above) was 5.2% (4.6% among males and
5.9% among females). These proportions are projected to grow to 5.8%, 5.6%, and 6.9 % respectively. There will be progressively fewer adults to care for their longer surviving parents because of declining fertility and increasing longevity and the out-migration of adults from rural areas in search of jobs. Many of the older persons will have the responsibility of looking after young grand children orphaned by the death of their parents from HIV/AIDS.
There will be increasing number of older, single (widowed) women rendered vulnerable without economic, family and social support.
The reproductive health situation in Cambodia needs improvement. Of the births occurring in the last five years only 9.9% were delivered in a health facility (6.3% in rural and 33.9% in urban areas), and 32% were assisted by trained health personnel (28% in rural and 57% in urban areas). Less than a third (30%) of the women giving birth in the last five years had received two doses of tetanus toxoid injection (28% in rural and 45% in urban areas). Only
43% of the women giving birth in the last five years had received antenatal care and one half

ii of them were pregnant for nearly 6 months when they had their first antenatal visit.
Contraceptive prevalence for any modern method among currently married women was
18.5% (17.6% in rural and 23.2% in urban areas). Unmet need for family planning was high at 33% (34% in rural and 27% in urban areas). About a quarter of the births occurring in the last five years were not wanted and a further 9% were mistimed (i.e., wanted later). Women who gave birth in the last five years wanted, on average, one child less than they actually had.
There is no stated government policy on adolescent reproductive health in Cambodia, although a few NGOs have been known to be active in this field. It is needed to expand the current reproductive health (RH) services, advice and counselling to cover the adolescents and to include RH education in the high school curricula.
Cambodia has one of the highest prevalence of HIV/AIDS in Asia and the south-east Asian region. The highest prevalence rates are in urban areas, in the southeast and central provinces and along the Thai border. The epidemic is already generalised throughout the population, beyond the so-called “risk groups”, but from 1997 onwards there has been a steady decline in
HIV prevalence from 3.9 percent to 2.8 percent. However, many tens of thousands of the adult population are infected with HIV and that many more people including children will develop AIDS within the next 5-10 years. Other concerns include the link of HIV/AIDS with the widely prevalent poverty, social inequality and gender inequality, all of which exacerbate the epidemic. The age and sex structure of the population is of key importance in relation to
HIV/AIDS. The costs of the epidemic is very high. An estimate shows that the total cost for
1999 was of the order of US$24.7 million, consisting of US$1.6 million in direct costs and
US$23.1 million in indirect costs.
Notwithstanding the above, there have been important achievements in the country’s fight against the epidemic and it is hoped that Cambodia will join the small number of countries that have started a sustained decline in sero-prevalence rates.
Women in Cambodia have traditionally enjoyed a higher social status than women in other
Asian countries, but there is a difference between traditional norms and social and economic realities. Cambodian women have less access to education, paid employment, land ownership and other property rights and are more disadvantaged than men by the lack of adequate health services (because of the health risks associated with pregnancy and maternity). Adult literacy rate and educational levels for males is much higher than that for females. Women also suffer from poor or no availability of reproductive health services.
The lower status of women in Cambodia vis-à-vis men can be seen as constraining development in a number of ways and improving their status would address equity issues, strengthen development efforts and reduce poverty.
Advocacy and information dissemination for policymakers, planners and parliamentarians are carried out through the Population and Development Policy Unit (PDPU) at the Council of
Ministers. Advocacy and BCC workshops on gender mainstreaming are conducted through the Ministry of Women’s and Veteran’s Affairs. A specific recommendation for advocacy is to promote a small family norm to help reduce fertility and population growth rate and improve levels of human resources development. Appropriate BCC and advocacy strategies are also needed for users and providers of family planning services to address the high level of unmet need for family planning.

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The use of information and communication technology in Cambodia has taken a forward step with the publication of the 1998 population census results. Besides conventional means of data dissemination, the results of the census have been disseminated through electronic media such as CD-ROM and National Institute of Statistics (NIS) web site. The census results have also been put on population maps down to the village level. Poverty and vulnerability maps have been prepared which, when superimposed on population maps would be immensely useful for monitoring population characteristics, health, education, and poverty.
Attempts to trace Cambodia’s demographic history are hampered by lack of data, but the data situation has considerably improved with a number of surveys and a census taking place during the 1990s and 2000. Forthcoming data collection includes another household socioeconomic survey in 2002-2003 to collect data on poverty and an inter-censal demographic and reproductive health survey is due to be conducted in 2004. The NIS is the main government agency charged with collecting or coordinating the collection of population and other data in Cambodia.
The situation with research and training in population has remained underdeveloped for a long time, but efforts are underway to improve the situation through international assistance and collaboration with academic and government institutions.
The government has identified ten priority issues on population, development and poverty reduction on which separate analytical reports will be prepared. In the area of populationdevelopment and population-poverty reduction, the government is working in partnership with a number of international organizations. These projects also include collaboration with several academic and research organizations, both in Cambodia and overseas. Collaboration with the UNFPA has already resulted in an analysis of the population situation in Cambodia and the identification of nine major population issues that have implications for socioeconomic development and poverty reduction and the incorporation of these issues in the country’s second Socio-Economic Development Plan (SEDP II) and the Poverty Reduction
Strategy Paper.
More than 90% of Cambodia’s population is ethnic Khmer and 95% of the population speaks
Khmer. The state religion of Cambodia is Theravada Buddhism which is followed by 96% of the population.
The low social status of Cambodian women is partly responsible for their low education, which in turn may be responsible for the undesirable outcomes in fertility, mortality and nutrition for women and children. Women’s health, development and human rights are adversely affected by their experience of domestic violence. A very high percentage of
Cambodian women have knowledge of contraceptives and a similarly high percentage were aware of HIV/AIDS. Seen against the fairly high exposure of Cambodian women to mass media, their preference for fewer children and their widespread rejection of domestic violence, the unsatisfactory state of affairs in the reproductive health and family planning area needs to improved by improving the reach and effectiveness of these services.
Low levels of human resources development, particularly among women limit economic productivity and make it difficult to design and implement effective programs for poverty reduction and socio-economic development.

Population and Poverty in Asia and the Pacific
Country Report: Cambodia
Section 1: Overview of the population and development situation and prospects, with special attention to poverty
At the 1998 Census, the population of Cambodia was counted as 11.4 million, which consisted of 5.5 million males and 5.9 million females. The population growth rate was 2.5% per annum. Nearly 85% of the population lived in rural areas. The population is very young with nearly 43% below age 15 in 1998. The overall sex composition of 93 males for every
100 females reflects an abnormal shortage of males due to the losses suffered at ages 20 and above during the Khmer Rouge period of 1975-1979. More than a quarter of the households in the country are headed by females. Adult literacy rate is 79.5% among males and only
57% among females (NIS 2000a). Functional literacy, in the sense of having “acquired the essential knowledge and skills in reading, writing, arithmetic and problem-solving to function effectively in all areas of their lives and contribute to their communities” (So and Supote
2000: 2) is 47.6% among males and 29.1 % among females. Cambodia has made considerable progress in terms of its human development index (HDI) from 0.422 in 1995
(OUP 1998: 130) to 0.541 in 1999 (OUP 2001: 147). Its HDI rank was 140 out of 174 countries in 1995 which became 121 out of 162 countries in 1999.
The singulate mean age at marriage in 1998 was 22.5 years for females and 24.2 years for males (NIS 1999 xvi). The dependency ratio was 86.1. Estimates based on data from the
Cambodia Socio-Economic Surveys of 1997 and 1999 show that 36% of the population lived below the poverty line with 90% of Cambodia’s poor living in rural areas. The estimated
GDP per capita was US$257 in 1999. There is a large gender disparity in education and employment. Women suffer from poor reproductive health services. According to the
Cambodia Demographic and Health Survey of 2000 (NIS et al. 2001), Cambodia has a total fertility rate of 4.0, contraceptive prevalence rate (any modern method) among all women of
18.5%, unmet need for family planning of 32.6% (17.4% for spacing and 15.2% for limiting), infant mortality rate of 95 per 1,000 live births, under-five mortality rate of 124 per 1,000 live births and a maternal mortality ratio of 437 per 100,000 live births (NIS et al, 2001). The
HIV prevalence in the adult population is estimated to be 2.8% in 2000 (Ministry of Planning
2002: 22). The estimated life expectancy at birth is 53.1 years for males and 59.2 years for females (PDPST 2002b), which correspond to a life expectancy of 56.1 years for both sexes combined.
Official population projections carried out by the National Institute of Statistics (NIS) show that Cambodia’s population will grow to 14.8 million in 2006, 16.6 million in 2011 and 18.5 million in 2016 (NIS 2000a: 24). The population projections are currently being reviewed at the National Institute of Statistics with respect to the base and projected levels of fertility and mortality.
Future challenges arising from the population situation of Cambodia centre on nine major population issues, ten if HIV/AIDS is considered a separate issue by itself. These issues are: high population growth, high fertility, high mortality, politically induced migration, imbalances in age-sex structure, high level of poverty, low levels of human resources development, gender inequalities and population pressure on natural resources in certain

2 areas (Hayes 2000) and a high HIV prevalence in the adult population . While most of these issues require population influencing policy responses, some of them, such as politically induced migration and imbalances in age-sex structure require population accommodative policy responses.
Addressing the population issues is a logical way of achieving socio-economic development and poverty reduction in a resource poor country like Cambodia. These issues have been incorporated in Cambodia’s Second Socio-Economic Development Plan 2001-2005 (SEDP
II) and in Cambodia’s draft Poverty Reduction Strategy Paper (PRSP). SEDP II is the first plan document that shows evidence of the integration of population variables into development planning in Cambodia. Poverty reduction strategy in Cambodia is based on an approach of consultation and participation between different government sectors, with support from NGOs, civil society and the international donor community. There is a strong emphasis on inter-sectoral collaboration in addressing the crosscutting issues such as population and gender. Specific targets and indicators for Cambodia corresponding to the
Millennium Development Goals (MDGs) are under preparation.
Cambodian policymakers, planners and other stakeholders including NGOs and civil society are being sensitised to the population issue and their implications for development and poverty reduction through a number of seminars, workshops and dissemination of data at national and provincial levels. Policy briefing kits, discussion briefs and fact sheets in Khmer are under preparation through collaborative efforts between the Royal Government of
Cambodia and the UNFPA.
The priority population issues mentioned above are among the issues on which recommendations were made at major international conferences, such as the Fourth Asian-
Pacific Population Conference, Bali 1992 and the International Conference on Population and
Development, Cairo 1994. By addressing these priority issues, the relevant recommendations of these conferences are also being followed. For example, efforts aimed at improving the reproductive health situation including birth spacing and family planning are aimed at addressing the issues of high fertility, high mortality and high growth rate (part of Bali recommendation); efforts aimed at improving the level of human resources are in accordance with the Bali recommendations; efforts aimed at reducing gender disparities in education, employment and health care and programs and strategies aimed at poverty reduction follow the recommendations of both Bali and Cairo. Similarly, and integrating population variables in development planning follow both the Bali and Cairo recommendations. The Royal
Government of Cambodia is not only integrating population variables in development planning, but is going one step further by attempting to use its population and development strategies for poverty reduction.
Under the UNFPA-funded population and development strategies project 2001-2005, the government has formulated specific plans to prepare a number of analytical reports on the key population issues mentioned above, and to bring out population policy directions and population and development strategies.
Section 2: Fertility levels and trends, and their implications for reproductive health, including family planning programmes
Fertility in Cambodia was high in the early 1960s with a crude birth rate over 40 per 1,000 and a total fertility rate (TFR) of around 7. The Khmer Rouge period of 1975-1979 saw a

3 drastic decline in fertility, with the crude birth rate dropping down to between 20 and 25 in
1976-1979. Return towards normalcy in life and in living conditions after the end of Khmer
Rouge rule brought about a dramatic increase in fertility, with the estimated crude birth rate going up to 44 in the mid-1980s, thereafter slowly declining to around 40 in 1988 and 38 in
1990. The estimated total fertility rate for 1990 was around 6. Thus, fertility increased between the late 1950s and early 1970s, fell considerably between the mid to the end of
1970s, and recovered with a “ baby boom
” in the 1980s before starting to decline again
(Desbarats 1995).
The most striking feature of Cambodian population dynamics in the 1980s and early 1990s is the fast recovery which the survivors of the 1970s have shown with respect to their reproductive behaviour. The sharp decline in fertility induced by the unusual political and economic conditions of the second half of the 1970s was quickly reversed with the return to more normal conditions in the early 1980s. The fertility dynamics have several implications.
Women born in the early 1980s are now entering their prime childbearing years, and they will soon be followed in turn by the relatively large birth cohorts of the late 1980s and early
1990s. Consequently, even if the average number of birth per woman declines steadily over the next one or two decades the total number of children born each year will increase over the next few years and remain high because of the large number of women still remaining in their reproductive ages (Hayes 2000).
Notwithstanding the recent declining trends mentioned above, fertility in Cambodia remains high, and it is significantly higher than any other ASEAN nation except Laos. There are two recent estimates of fertility in Cambodia, one based on the 1998 Census data, derived by using the Arriaga variant of Brass P/F ratio method, which produced a TFR of 5.3 during the five years prior to 1998 (rural TFR of 5.5 and an urban TFR of 4.4). The other estimate is based on birth history of women of reproductive ages, collected at the Cambodian
Demographic and Health Survey 2000 (CDHS 2000), which produced a TFR of 4.0 during the five years prior to the survey (rural TFR 4.2 and urban TFR 3.1) (NIS et al. 2001: 60).
The decline in fertility between the periods corresponding to the 1998 Census and the 2000
CDHS is really not as large as implied by these two estimates because the estimate based on
CDHS 2000 data is considered to be more accurate while that based on 1998 Census data is considered an over estimate. Work in progress at the Ministry of Planning, which uses other techniques of estimating fertility such as the “Own Children” and the “Rele” methods indicates that fertility in Cambodia has started declining since the early 1990s, and the TFR was around 4.1 during 1994-1998 (Ministry of Planning: forthcoming).
The Royal Government of Cambodia, through the Ministry of Health, has adopted the birth spacing program as a major policy to protect the health of mothers and newborn children.
This would also help reduce rapid population growth. The Second Socio-Economic
Development Plan (SEDPII, 2001-2005) recognises the detrimental effects high fertility on the health and nutrition of mothers and their infants and the contribution of high fertility to high population growth (Ministry of Planning, 2001). High fertility, besides being recognised as a key population issue affecting socio-economic development, has been identified as a major obstacle to poverty reduction in Cambodia. The priority action in this regard is to improve birth spacing and reduce fertility among the poor through providing and promoting improved family planning and reproductive health services. This will have a relatively direct impact on alleviating and reducing poverty by reducing maternal and infant mortality, by improving the health of mothers and children, and thereby contributing to the welfare of poor families. It is also seen to have a more indirect impact on poverty reduction by reducing

4 family size, by reducing the population growth rate and by lessening the young dependency ratio (Royal Government of Cambodia 2002)
Section 3: Mortality and morbidity trends and poverty
Variations in mortality in Cambodia have been just as dramatic as those in fertility (Hayes
2000). Like in other developing countries, mortality began to decline in Cambodia towards the end of the colonial period and life expectancy at birth rose from about 35 years in 1945 to about 45 years in the early 1960s (Desbarats 1995). It is very difficult to estimate mortality in Cambodia for the 1970s due to lack of reliable data. An estimated 600,000 war casualties during the Lon Nol period served to counterbalance any further long-term decline. According to UN estimates, the average crude death rate (CDR) was 22.5 per 1,000 during 1970-75. The excess mortality in this period is now thought to be around one million persons. It is even more difficult to estimate mortality during the Democratic Kampuchea period (1979-1991).
By the end of the 1970s the infant mortality rate (IMR) is thought to have reached 263 per
1,000 live births, the highest in the world at the time. Life expectancy dropped to around 31 years. The UN estimates the CDR averaged around 40 during 1970-80. A further 500,000 people died in 1979-80 at the beginning of People’s Republic of Kampuchea period because of the famine resulting from disrupted harvest. However, mortality has started to decline since the early 1980s. The UN estimates a CDR of 20 per 1,000 for 1980-85 and an IMR of about 160 per 1,000 live births. Mortality declines during the 1980s and early 1990s are largely due to better control of infant mortality. (Desbarats 1995, cited in Hayes 2000).
Notwithstanding the decline mentioned above, current mortality is high in Cambodia.
According to the Cambodian Demographic and Health Survey 2000, the infant mortality rate
(IMR) during the five years preceding the survey was 95 per 1,000 live births (NIS et al.
2001: 121), which corresponds to an IMR of 105.3 for males and 84.2 for females. Estimate of under-five mortality for the five years preceding the survey is 124.4 per 1,000 live births,
(135.8 for males and 112.6 for females). The maternal mortality ratio is 437 per 100,000 live births (NIS et al., 2001:117). New estimates of mortality for the period 1996-2000 show a life expectancy at birth of 53.1 for males and 59.2 for females (PDPST 2002b: Table 7) and 56.1 years for both sexes combined.
Current high mortality in Cambodia has several implications as follows (Hayes 2000):
The overall high mortality for the population as a whole is associated with especially high mortality for certain groups, such as infants, children and mothers. These particularly high rates for certain groups, coupled with differentials by class, level of education, and urban-rural differentials, compromises the Royal Government of Cambodia’s efforts to achieve a fair, just and peaceful society and to raise the living standards of all Cambodians.
High mortality represents a loss of human capital and undermines the effectiveness of efforts to improve productivity.
High mortality is associated with high morbidity, which is a further constraint on quality of life and labour productivity .

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Therefore, producing further reductions in mortality, particularly for groups with especially high mortality rates, such as mothers and children among the poor, is fundamental to the success of efforts aimed at socio-economic development and poverty reduction in Cambodia.
The Royal Government of Cambodia, through the Ministry of Health, has adopted several strategies for mortality reduction. The more specific strategies for poverty reduction hinge on the following priority programmes:

Provision of basic health services to the people of Cambodia with the full involvement of the community.

Priority emphasis on prevention and control of communicable and noncommunicable diseases.

Priority emphasis on provision of good quality care to mother and child.

Active promotion of appropriate health and health-seeking behaviours among the population.

Promotion of equitable access to priority services, especially by the poor.
Section 4: Migration, urbanisation and poverty
Urbanisation in Cambodia is a relatively recent post-colonial phenomenon (Desbarats 1995:
143). In the 1960s about 11% of the population lived in cities and large towns, but Cambodia had the lowest rate of urbanisation in Southeast Asia. By 1968 this proportion had increased to 12.5%. Within a week after the entry of the Khmer Rouge in Phnom Penh, the percentage of the country’s population living in cities “had dropped to virtually zero”, but the process of re-urbanisation accelerated after the demise of the Khmer Rouge and by 1985 the proportion of urban population was estimated at 7 % (Desbarats 2000). According to the 1998 population census, the proportion of urban population in 1998 was 15.7% (NIS 2000B: 4).
The 1996 Demographic Survey of Cambodia had estimated the urban population to be 14.4%
(NIS 1996:8), implying an increase of more than one percentage point in the proportion of urban population in the last two years of the census. There are no mega cities in Cambodia.
The capital, Phnom Penh, with a population of 999,804 in 1998, is 57% urban. However, the concepts and definitions of urban and rural areas are based on administrative criteria (NIS
2002). In a policy discussion paper, the National Institute of Statistics proposes to apply a consistent set of criteria based on the density of population, proportion of male employment in agriculture and population size to define urban and rural areas. If this definition were adopted, then the proportion of urban population in Cambodia would be 17%. Further, there would be several urban agglomerations among which the capital Phnom Penh and parts of municipalities in contiguous provinces would form an agglomeration of one million plus persons (NIS 2002). These have implications for urban planning and management including solid waste disposal, sewerage, transportation, water supply and sanitation.
Migration occupies a special position in Cambodia’s demographic history because of the forced movement of large populations during the Khmer Rouge period of 1975-1979 and the return migration following the restoration of normalcy thereafter. The Cambodian population has experienced much internal and international migration since 1970, most of which has been the result of war, violent confrontation and political instability. Generally, such migration has not been associated with better opportunities for the migrants and their families nor has it been associated with economic development. Rather, this politically and violently induced migration has produced loss of human and social capital at the local level, as well as with psychological trauma, disruption and despair. It has occurred on such a massive scale

6 that traditional community institutions of mutual help in many villages have not been able to cope with it (Hayes 2000: 7-8).
International migration has had a significant impact on Cambodia’s population size, growth rate and composition. Some 200,000 Vietnamese were repatriated during the Lon Nol years and large numbers of people, including many Sino-Cambodians and Chams fled to Thailand and Vietnam during the Khmer Rouge period. It is not possible to quantify this movement accurately because most of it was clandestine, but according to Desbarats (1995: 100, based on Ea 1987): “Overall, it is not impossible that a total of up to 650,000 persons left Cambodia between 1970 and 1978, which would represent almost 10 percent of the 1970 population.”
There were further waves of refugees during the People’s Republic period (and also some return movement from Vietnam and Thailand). The cumulative total of displaced persons in border camps increased by over 100,000 during 1982-91. After the Paris peace accord of
1991 return migration took place on a large scale. The UNHCR sponsored the repatriation of over 360,000 border refugees in time to register for the 1993 elections. Presumably the numbers involved in internal migration during this period would be of similar magnitude, or even larger. The forced relocation of the urban population to the countryside during the Pol
Pot years could have involved 700,000 persons or more (although many fled the country and so are included in the international migration totals mentioned above) (Hayes 2000).
The implications of all this politically- and violently-induced population movement in the recent past for Cambodia’s current development efforts needs to be studied. We know that not all return migrants have returned to the place they previously left but reliable statistics are not yet available.
The migration questions in the census do not provide enough details to probe the complex movements. In general, the 1998 Population Census defined migrants as those whose previous place of residence was other than the village of enumeration (NIS 2000B: 10).
Based on this concept, 3.6 million persons in Cambodia were migrants. This volume of migration is equivalent to 31.5% of the total population of Cambodia. The percentage of migrants among males was 32.5% and among females 30.5%. The migration stream has been mostly from rural to rural areas, which accounts for more than two-thirds (64.2%) of all migrants based on place of previous residence at all times. The next biggest migration stream is from rural to urban areas (17.3%), followed by urban to urban (12.3%) and urban to rural
(6.2%). In terms of recent migrants, i.e., migrants based on place of residence five years ago, the migration stream consists of a smaller proportion of rural to rural migrants (58.2%), but higher proportions of rural to urban (19.2%), urban to urban (14.5%) and urban to rural
(8.1%) migrants. With respect to reasons for migration for persons of both sexes, 35.6% migrated because their “family moved”, 14.0% moved “in search of employment”, 13.4% were “repatriated or returned after displacement” and 12.7% moved because of marriage.
About 5.8% moved because of “natural calamities/ insecurity” (NIS 2000B).
From the point of view of development politically- and violently-induced migration
(including return migration) in Cambodia during 1970-93 has had the following consequences (Hayes 2000):

Politically- and violently-induced migration represents not only a loss of human capital for many villages, but also a loss or disruption of local social institutions and social capital of the sort that normally needs to be mobilized to advance development goals.

7

At the individual level this migration is often associated with extreme psychological trauma, which can affect motivation, ability to trust others, and overall emotional well being.

Migrants, and communities with high proportions of migrants, are likely therefore to have special needs if they are to participate fully in the development process, and they may comprise specific vulnerable groups.
Section 5: Population ageing
According to the 1998 Population Census, persons aged 65 years and above comprise 3.5% of the total population of both sexes in Cambodia. The corresponding proportions among males and females are respectively 3.0% and 3.9% (Huguet et al. 2000: 6). However, conventionally 65 years is the internationally used cut-off age for defining the elderly population. In Cambodia, where life expectancy is estimated to be 53.1 years for males, 59.2 years for females and 56.1 years for both sexes combined (PDPST 2000), and the official retirement age for government employees is 55 or 60 years, the elderly population may be more appropriately defined as that aged 55 or 60 years and above. The percentage of population aged 60 years is 4.6% among males, 5.9% among females and 5.2% among the population of both sexes combined (Huguet et al. 2000:6). Population projections prepared by the National Institute of Statistics (NIS 2000A: 24) show that in the year 2016, the proportion of persons aged 60 years and above will be 5.6% among males,6.9 % among females and 5.8% among the population of both sexes combined. This falls far short of 10%, which is the conventional cut-off proportion of the elderly for a population to be considered aged (Shryock et al. 1984:132). Thus, there appears to be no immediate cause for concern with respect to the ageing of Cambodia’s population. However, even the percentages mentioned above, that translate to a total population of 600,422 aged 60 years and above in
1998 (with a sex-ratio of 72 males per 100 females), and is projected to increase to
1,073,423. in 2016 (with a sex-ratio of 66 males per 100 females), there is a need to formulate policies and programmes to address the following questions about the elderly: (i) there will be progressively fewer adults to care for their longer surviving parents because of declining fertility and increasing longevity and particularly in rural areas, because of the outmigration of adults in search of jobs, mainly to urban areas; (ii) many of the older persons will be burdened with the responsibility of looking after young grand children orphaned by the death of their parents from HIV/AIDS, and (iii) there will be more and more older, single
(widowed) women rendered vulnerable without economic, family and social support..
A survey of 600 persons aged 55 years and above, carried out around 1997 by the Ministry of
Social Affairs, Labour and Veterans Affairs (MSALVA) and HelpAge International (HAI) in five villages shows that the situation of the elderly in Cambodia is characterised by (i) lack of access to affordable health care, (ii) rural poverty, (iii) suffering from the consequences of unequal geographic development (their adult children leaving them to migrate to other places in search of jobs, thus forcing the elderly to look after young grand children) and consequences of AIDs (their adult children dying of the epidemic thus leaving the elderly to look after their orphaned grand children), (iv) lack of economic opportunities and (v) inadequate living arrangements (MSALVA and HAI 1998: 43-44).
The Royal Government of Cambodia does not yet have any policy or programmes for the elderly, although the Ministry of Social Affairs, Labour, Vocational Training and Youth
Rehabilitation (MoSALVY) is in the process of formulating such policies and programmes that would address the questions of health, economic conditions, participation in the society

8 and general welfare of the elderly. The Ministry has formed Old People’s Associations
(OPA) to encourage the participation of the elderly in the formulation of policies and programmes.
Section 6: Reproductive health
The reproductive health situation in Cambodia needs improvement. The Cambodian
Demographic and Health Survey 2000 reports that only 9.9% of the births occurring in the last five years were delivered in a health facility (6.3% in rural and 33.9% in urban areas).
Trained health personnel attended only 32% of these births (28% in rural and 57% in urban areas). Only 30% of women giving birth in the last five years had received two doses of tetanus toxoid injection (28% in rural and 45% in urban areas). Only 43% of the women giving birth in the last five years had received antenatal care and one half of them were pregnant for nearly 6 months at the time of their first antenatal visit. Contraceptive prevalence for any modern method among currently married women was 18.5% (17.6% in rural and 23.2% in urban areas). Unmet need for family planning was high at 32.6% (34% in rural and 27% in urban areas). Twenty four per cent of the births occurring in the last five years were not wanted and a further 9% were mistimed (i.e., wanted later). Women who gave birth in the last five years wanted, on average, one child less than they actually had (total wanted fertility rate of 3.1 against the observed total fertility rate of 4.0) (NIS et al., 2001:
82-141).
The above findings, together with the observed high fertility and high maternal mortality, poor reproductive health (RH) services utilisation point to the importance of providing good quality RH and family planning programs in Cambodia.
The Ministry of Health has formulated two important policies in respect of safe motherhood and reproductive health. The National Birth Spacing Policy was developed in 1994. In the same year, the National Reproductive Health Programme was developed. Since then birth spacing services have been made available to women and men, with their own service choice and decision in having children. The National Safe Motherhood Policy was developed in
1997. Nearly 900 health centres throughout the country are providing birth spacing services.
Notable efforts have been made to fight against HIV/AIDS, which is apparent from the reduction of HIV prevalence noted above.
The main focus of the Safe Motherhood Policy of Cambodia is to strengthen and expand preventive and curative care services at all levels of care starting from the family, the community, health centres and referral hospitals.
Cambodia has made notable progress in reproductive health matters. For example,
Cambodian women’s knowledge of birth spacing methods has increased from 35.9% in 1995 to 95.5% in 2000, and use of “birth spacing” services (the contraceptive prevalence rate or
CPR of modern contraception) has increased from 7% in 1994 to nearly 19% in 2000. The maternal mortality ratio has decreased from 473/100,000 live births in 1995 to 437/100,000 live births in 2000. The prevalence of HIV among adults aged 15-49 has declined from 3.9% in 1997 to 2.8% in 2000. However, t he current Cambodian reproductive health programs and policies do not adequately cover all the components of comprehensive reproductive health services as recommended by the ICPD 1994. Particularly missing from the Cambodian RH policies and programs are issues related to adolescent reproductive health and infertility. The

9 policies and programs also do not explicitly cover the reproductive health needs of unmarried women of reproductive ages and those of post-reproductive age women (PDPST 2002a).
The future strategy of the Ministry of Health includes the development and expansion of necessary clinical protocols for the implementation of safe motherhood activities, development of human resources, especially midwives, strengthen skills of staff at health centres in ANC and PNC, basic emergency obstetric care, birth spacing including IUD insertion and treatment of STDs; Strengthen skills of staff at referral hospitals in essential obstetric care and surgical contraception; provide safe abortion services; educate TBAs to avoid harmful practices and to link with midwives; provide community based distribution contraceptives; implement outreach activities from health centres according to the protocols; strengthen IEC activities on RH for people and adolescents; strengthen referral system; participate in the control of human trafficking; strengthen coordination between different institutions and with different ministries in the implementation of the safe motherhood policy
Participate in the implementation of the poverty alleviation policy of the royal government
Develop other Reproductive Health policies as necessary (Chhun Long 2002).
Section 7: Adolescent reproductive health
There is no stated government policy, objectives and goals for adolescent reproductive health in Cambodia, although a few NGOs have been known to be active in this field (Laddaporn
Ampornsuwanna et al. 2000:11).
Two studies conducted on school going and out of school adolescents in Phnom Penh by the
Reproductive Health Association of Cambodia (RHAC) revealed low communication between adolescents about sexuality and reproductive health, low knowledge about reproductive health, moderate levels of sexual experience among out of school adolescents
(but low among school going adolescents), moderate to high level of awareness of STDs and
HIV/AIDS, low to moderate knowledge about family planning and low to moderate use of family planning (RHAC, 1997, 1999).
A national advocacy seminar on reproductive health, held in February 2002 noted the absence of adolescent reproductive health services from the Cambodian reproductive health agenda and recommended that there should be an emphasis on providing attention to such needs of adolescents by expanding the current reproductive health (RH) services, advice and counselling to include the adolescents. It further recommended that RH education should be included in the high school curricula. The question of expanding RH services to include the adolescents is also justified because they are related with STDs, RTIs and HIV/AIDS and could be linked with drug trafficking etc (PDPST 2002a).
Section 8: Demographic, economic and social impact of HIV/AIDS
Cambodia has one of the highest prevalence of HIV/AIDS in Asia and the south-east Asian region. HIV was first detected in Cambodia in 1991 during serological screening of donated blood and the first cases of AIDS were diagnosed in late 1993 and early 1994. HIV infection has been detected in all regions of the country, although the highest prevalence rates are in urban areas, and in the southeast, central provinces, and along the Thai border. (Hayes 2000).
The epidemic is already generalised throughout the population, beyond the so-called “risk groups”, but powerful efforts may be expected to keep it under control and to decrease its

10 impact, provided that the 2001 surveillance results confirms the downward trend. From 1997 onwards, the series of national prevalence rates among adults aged 15-49, as estimated through HIV surveillance surveys, shows a steady decline in HIV prevalence from 3.9 percent to 2.8 percent. Comparable recent prevalence figures for counties of the region are:
Thailand (2.15%), Laos (0.05%), Vietnam (.024%), Malaysia (0.42%) and Indonesia (0.05%)
(UNAIDS and WHO 2000). The decrease in prevalence for Cambodia represents an important success in slowing down the worst AIDS epidemic in south-east Asia. However, it is also estimated that many tens of thousands of the adult population are infected with HIV; and that possibly two hundred thousand people including children will develop AIDS within the next 5-10 years. There are other reasons for concern, such as the links of the epidemic with poverty and with social inequality, both of which are widely prevalent in Cambodia.
Poverty and gender inequality in Cambodia and exacerbate the HIV/AIDS epidemic.
(Ministry of Planning 2002: 22).
In order to design and implement a relevant response to the threat of the epidemic, and to scale up achievements already made in the fight against the epidemic, it is necessary to understand how it affects society. This understanding is necessary because setbacks in human development achievements worsen the social context and provide opportunities for the epidemic to resist and develop new roots in the population (Ministry of Planning 2002: 22).
It is also essential to consider the dynamics of population structure in assessing the potential social and economic consequences of the HIV/AIDS epidemic. The age and sex structure of the population is one such issue of key importance. The population structure in Cambodia has been heavily affected by several decades of war and conflict. The survivors of the significantly small number of children born during a period of low fertility in the Khmer
Rouge regime (1975-1978) now form a cohort that is proportionately small in number compared to other age cohorts because of its initial small size further reduced by the high mortality it experienced. Faced with the HIV/AIDS epidemic, this cohort is likely to be severely affected by AIDS deaths. Further, the 1998 census results show that the urban population of young to the mid-working ages (15 through early 30s) exhibits a predominance of males (sex-ratio of over 100) due to migration to urban areas for employment opportunities. This rural-urban sex-imbalance is more pronounced in some provinces than others. Therefore, the spatial imbalance of men and women in Cambodia is another significant factor to be taken into account when considering the national level projections for the potential spread of the HIV/AIDS epidemic. (Ministry of Planning 2002: 22; 49-50).
The calculation of the costs of illness and death resulting from HIV/AIDS are based on direct and indirect costs of the epidemic. Direct costs include the public and private costs of treatment and care, the costs of caring for children orphaned by AIDS, the cost of prevention and the costs of preparing the health system to cope with the growing epidemic. Indirect costs are computed as the loss of earning of adults dying from AIDS. One estimate, based on an estimated cumulative number of AIDS cases and the estimated number of AIDS related deaths in 1999 shows that the total cost of HIV/AIDS was of the order of US$24.7 million, consisting of direct costs amounting to US$1.6 million and indirect costs amounting to
US$23.1 million (Ministry of Planning 2002: 59).
Poverty, inequality, mortality and weak public sector services and infrastructure provide fertile ground for the epidemic. The situation in Cambodia in 2001 includes a range of obstacles to HIV/AIDS prevention, care and impact mitigation (widespread poverty, low human development achievement, and weakness in means of governance). On the other hand,

11 there have been important achievements in the response to the epidemic that it is hoped to enable Cambodia to join the very small number of countries that has decreased their seroprevalence rates.
In its cooperation with UN agencies, the Royal Government of Cambodia has created an
HIV/AIDS taskforce to respond quickly to the emerging HIV/AIDS epidemic in Cambodia.
The National AIDS Authority (NAA) plays a key coordinating role in the government response to the HIV/AIDS epidemic. Key tasks include making policy recommendation and action at national level and ensuring information exchange and communication. The National
Center for HIV/AIDS, Dermatology and STDs (NCHADS) of the Ministry of Health is in charge of the sentinel surveillance system it develops in line with the Strategic Plan for
HIV/AIDS and STI Prevention and Care for 2001-2005.
A conceptual national strategic framework for a comprehensive and multi-sectoral response to HIV/AIDS, 2001-2005 has been developed by the NAA. The vision of NAA has relied on the observation of two complementary approaches in supporting the decrease of vulnerability to HIV/AIDS at individual, community and sectoral level. The first approach concentrates on influencing individuals to understand that safe behaviour is a more attractive option, whereas, the second strategy focuses on changing aspects of the existing socio-economic context to support individuals to protect themselves from HIV infection and to cope with the consequence of HIV/AIDS. The NAA strategy calls for a change to the existing paradigm for
HIV/AIDS actions from a segmented, health centered, and top-down approach to a more holistic development approach that is gender sensitive and people-centered with a focus on empowering individuals, communities, and society.
Section 9: Gender, equality and development
Women’s position in a society is a vital indicator of its development and one can draw many conclusions from the way women are or are not involved in the political, economic, social life of a particular country. Women have equal rights in the public and cultural spheres, as well as equal opportunities of training, education, employment, health, and remuneration as men’s (UNDP 1997).
Because of the Khmer kinship structure, Cambodian women have traditionally enjoyed a higher social status than women in other countries in Asia. They are supposed to enjoy the protection and support of their kinsmen even after they are married. Daughters are seen to be of economic value to their parents and are not to be discriminated against. However, like in most cultures, there is a difference between traditional norms and social and economic realities in Cambodia. It would not be correct to say that there is no discrimination against women in Cambodia and it is argued that the social status of women has fallen with the
“surplus” of women in the country resulting from a sex imbalance due to abnormally higher male mortality during the three decades of civil strife and conflict. (Ministry of Planning
1998).
Women have less access to education, especially at the higher levels of educational attainment; less access to paid employment, again especially in the higher categories of the occupational scale; less access to land ownership and other property rights (because of inheritance customs); fewer opportunities to ensure their views are included in political processes; and arguably are more disadvantaged than men by the lack of adequate health

12 services (because of the health risks associated with pregnancy and maternity) (Hayes 2000:
15-17).
According to the 1998 census the adult literacy rate is 79.5 per cent for males and only 57.0 per cent for females (NIS 2000A: xiv-xv). Among literate persons 25 years and older proportionately more males have completed primary school eduction compared to females.
Similarly, among those aged 5-24 years who are attending the formal school system, proportionately more males are attending above the primary school level than females (NIS
1999c). Further, 47.6 per cent of males 15 years and older are functionally literate compared to only 29.1 per cent among females (So and Supote 2000: 2).
Women also suffer from poor or no availability of reproductive health services (Beaufils
2000). Anemia is a major but preventable cause of maternal mortality and morbidity in
Cambodia (Chhin, Chan and Sprechmann 1998). Educated women make better use of available services in family planning, reproductive health and maternal and child health than uneducated women.
In Cambodia the lower status of women vis-à-vis men can be seen as constraining development in a number of ways (Beaufils 2000). Improving their status would address equity issues as well as strengthen development efforts and reduce poverty. In this connection, it is worth mentioning the government’s commitments and strategies aimed at the following goals:
  nsuring that girls are enrolled in school and stay enrolled;
  ncouraging better birth spacing and providing more accessible reproductive health services.
Since 1995, the Royal Government has endeavoured to establish equality and equity between men and women through a series of legal and institutional measures to remove discrimination against women, to protect women’s rights and participation in political, economic, cultural and social spheres of Cambodian society, to deal with the crime of trafficking exploitation of women and children, and the establishment of the State Secretariat for Women’s Affairs in
1993, upgraded to the Ministry of Women’s and Veterans’ Affairs in 1998 (National Institute of Statistics, 2000). The Ministry of Women’s and Veterans’ Affairs plays an important role as a catalyst and facilitator in responding to gender concerns in prioritised sectors. It also provides a framework for further discussion and negotiation with the relevant ministries towards the formulation of the national plan for the advancement of the role and status of women in Cambodia, and responding to the needs and concerns of veterans and their families
(Ministry of Women’s and Veteran’s Affairs, 2002).
The Royal Government of Cambodia has adopted several policies and strategies for gender development during the second Five-Year Socio-Economic Development Plan 2001-2005
(SEDP II). These aimed at ensuring that (i) women, girls and veterans receive full rights in education and skills training at all level in order for them to become active human resources in promoting equality in society; (ii) women, girls and veterans receive full legal protection with equity according to governmental laws and the principle that women’s rights are human rights, (iii) equal rights of women and veterans to access to economic resources and opportunities and thereby to participate equitably in national development and poverty alleviation, and (iv) there is sustainability, transparency, efficiency and effectiveness in

13 institutional management; planning monitoring and evaluation; human resource management and financial management (Ministry of Women’s and Veteran’s Affairs, 2002).
On a positive note, things are improving, albeit slowly. Cambodian women today do have greater participation in social, economic, and political activities than before. For example, there are two women who hold high offices, one as Minister for Women’s and Veterans’
Affairs, and the other as Minister for Culture and Fine Arts. Several women hold positions of
Secretaries and Under Secretaries of State. There were only seven members of National
Parliament in the first national mandate of 1993; there are 14 in the second mandate of 1998.
There are eight women members of the Senate.
Section 10: Behavioural change communication and advocacy and information and communication technology as tools for population and development and poverty reduction
(a) BCC and advocacy. In the population and development and poverty reduction area, advocacy activities are carried out under the UNFPA-assisted Population and Development
Strategies project through the Population and Development Policy Unit (PDPU) at the
Council of Ministers. This is being done by organising seminars and workshops with senior policymakers and planners, and through the publication of discussion briefs and fact sheets.
Under the same project, the National Institute of Statistics (NIS) organises data dissemination workshops for officials of various ministries and for parliamentarians at the national assembly. Advocacy on gender mainstreaming is done under the UNFPA assisted Advocacy sub-program through the Ministry of Women’s and Veteran’s Affairs (MoWVA). Workshops on behaviour change communication have also been conducted through the MoWVA. Both advocacy and BCC have very important roles to play in promoting behaviour that is conducive to bringing about changes in population characteristics which would support socio-economic development and poverty reduction. One of the recommendations put forward for reducing high fertility, high population growth and low levels of human resources development is to promote a small family norm (Hayes 2000: 26-27). This recommendation is aimed at educating people about the benefits of smaller families in the context of development and is intended in the spirit of the principles of voluntarism and choice adopted at ICPD 1994.
Even though small families are inevitable consequences of socio-economic development in the long run
, it makes sense to actively promote the “small family norm” now to help the process along, so that the burden of high population growth on social and economic development and poverty reduction in Cambodia can be eased sooner rather than later (Hayes
2000: 26-27).
However, for this policy to succeed as a pro-poor policy the real and perceived needs of poor families must be fully understood. It would be unethical and counterproductive to promote a small family norm among the poor before infant and child mortality are reduced further so that couples become confident of their children surviving till the parents’ old age. Similarly understanding is needed to address the issue of child labour in farming families. It would be helpful to know more about the factors which determine ideal family size for young
Cambodian couples, and the characteristics of couples who may end up having more children than they say they want, as shown by the Cambodia Demographic and Health Survey 2000.
Advocacy campaigns could then target specific demographic groups. Promotion of a small family norm can take place through many media: population and sexuality education in

14 schools; sponsored television programmes and soap operas; popular music; poster campaigns and leaflets distributed through health posts and clinics; and workshops and seminars to reach opinion makers (Hayes 2000: 26-27). Appropriate BCC and advocacy strategies could also be used among users and providers of family planning services to address the high level of unmet need for family planning. All these issues are under consideration and will form parts of policy-oriented analytical reports of the Ministry of Planning.
( b) Information and communication technology. The use of information and communication technology has taken a forward step with the publication of the 1998 population census results. Besides conventional means of data dissemination, the results of the census have been disseminated through electronic media such as CD-ROM and NIS web site. With gradual improvements in IT in Cambodia and the building of national capacity in using IT, data and information can be disseminated more efficiently to all regions of the country. The census results have been put on population maps down to the village level. Recently, the World Food
Program has prepared maps of poverty, which when superimposed on population maps would be of immense value in monitoring population characteristics, health, education, and poverty.
Section 11: Data, research and training
Any attempt to trace Cambodia’s demographic history is hampered by lack of data. The earliest known population census in post-colonial times was conducted in 1962. It took 36 years for the next population census to be conducted in 1998. A Socio-Economic Survey was conducted in 1993-94 (Royal Government of Cambodia 1995) and a KAP Survey on Fertility and Contraception in Cambodia conducted in 1994-1995 (Chhun Long et al., 1995). This was followed by the Demographic Survey of Cambodia 1996 (NIS 1996). Two more Socio-
Economic Surveys were conducted in 1997 and 1999. A major survey of note is the
Cambodian Demographic and Health Survey, conducted in 2000 (CDHS 2000). Another household S-E Survey is due to be conducted in 2002-2003, mainly to collect data on poverty. An inter-censal demographic and reproductive health survey is due to be conducted in 2004. Thus the frequency and number of population surveys in Cambodia has increased since 1991 providing more information for assessing the demographic rends in the country.
The National Institute of Statistics (NIS), Ministry of Planning, is the main government agency charged with collecting or coordinating the collection of population and other data in
Cambodia. The NIS is receiving technical and financial assistance from UNFPA and other international agencies to improve its capability.
The situation with research and training in population has been underdeveloped, but efforts are underway to improve the situation through international assistance and collaboration.
UNFPA is providing technical and financial assistance to the Centre for Population Studies,
Royal University of Phnom Penh for research and training, to the Ministry of Planning for improving population analysis and policy proposal formulation, to the Council of Ministers and the Ministry of Women’s and Veteran’s Affairs for advocacy on population, poverty and gender issues, to the National Institute of Statistics for improving its capabilities in data collection as well as services for data utilisation and data dissemination and to the Ministry of
Health to improve its RH program. The project at the Royal University of Phnom Penh also includes south-south collaboration between the Centre for Population Studies and the
Demographic Institute of the University of Indonesia.

15
The reproductive health approach implies massive training needs to upgrade the skills and orientation of all health personnel in terms of attitudes, inter-personal skills, and service delivery (Jones, 1999) in all areas of family planning, maternal and child health. The strategy of the Ministry of Health for the next five years includes a strong component on human resource development of its staff. The Ministry is receiving similar assistance for improving, among other things, its reproductive health and birth spacing programs. Training in population and development issues is being provided through the UNFPA-funded Population and Development Strategies sub-program in the form of long and short-term classroom training overseas (namely the Australian National University and Flinders University) and in the form of on-the-job training through the analysis of priority issues on population and development.
In the area of poverty reduction, there is on-going collaboration between relevant ministries and international agencies that includes training. For example, the Ministry of Planning, the ministry responsible for producing the PRSP is collaborating with the UNDP and the World
Bank and national and international institutions. Included in the project is a component on training in poverty monitoring and analysis.
In the population and development strategies project supported by the UNFPA, ten priority issues have been identified on which separate analytical reports are to be prepared by government staff in collaboration with international experts.
Section 12: Partnerships and resources
In the area of population-development and population-poverty reduction strategies, the government is working in partnership with a number of international organisations. Notable among these are the collaboration with the UNFPA on population-development-poverty reduction strategies, with the World Bank on poverty reduction strategy paper (PRSP), with
UNDP on poverty monitoring and analysis. Financial and technical assistance on these projects from the international agencies mentioned above also includes collaboration with several academic and research organisations such as the Cambodian Development Resource
Institute, the Australia National University and the Canadian IDEA. Collaboration with the
UNFPA has already resulted in an analysis of the population situation in Cambodia and the identification of nine major population issues that have implications for socio-economic development and poverty reduction and in the incorporation of these issues in the country’s second Socio-Economic Development Plan (SEDP II) and the Poverty Reduction Strategy
Paper. Collaboration with UNFPA and the participation of the Ministry of Planning, Council of Ministers, Royal University of Phnom Penh, and the National Institute of Statistics is progressing towards the production of analytical reports on the key population issues, and the formulation of a population policy and population and development strategies.
Section 13: Other issues: Socio-cultural context of reproductive health, family planning and poverty alleviation strategies
Ethnically, the Cambodian population is composed of more than 90% Khmer. The minority groups consist of Cham, Chinese, Vietnamese, and tribal groups in the eastern and northeastern hill border areas. The Chams form the largest minority group. About 95% of the population speaks Khmer (Chhun Long et al. 1995). The state religion of Cambodia is
Theravada Buddhism, to which the majority of the population subscribes. Buddhists comprise

16
96% of the population and Muslims 2.5%, with Christians and others forming the remainder
(NIS et al. 2001:41).
There is no reported objection to using RH and family planning methods from a religious point of view in Cambodia. About 70% of the women surveyed during the Demographic and
Health Survey 2000 were exposed to one of the three types of mass media such as newspaper, radio and television. This proportion was much higher in urban areas (85%) compared to rural areas (66.5%). A very high percentage of Cambodian women have knowledge of contraceptives and a similarly high percentage of women were aware of HIV/AIDS (NIS et al. 2001a). However, there are other socio-economic and cultural factors that could create a hindrance to RH, family planning and poverty reduction in Cambodia.
As stated in Section 1, adult literacy is 79.5% among males and only 57% among females, and functional literacy is 47.6% among males and 29.1 % among females. The level of literacy tends be higher for the younger women compared to the older women. More than a quarter of the women were not currently employed and of those currently employed, nearly
67% were engaged in agricultural occupations (NIS et al., 2001: 46-49). The mean age at marriage is high at 24.2 years for males and 22.5 years for females. This implies that adolescents spend, on an average between 8 and 10 years as single persons for whom appropriate RH services need to be made available. Cambodian women desire fewer children than they have already had, yet there is a high level of unmet need for contraception.
Overall, the low social status of Cambodian women is partly responsible for their low education, which in turn may be responsible for the undesirable outcomes in fertility, mortality and nutrition for women and children. Further, women’s health, development and human rights are adversely affected by their experience of domestic violence. As reported earlier, use of other reproductive health services such as antenatal care and tetanus toxoid injections, or the percentage of women delivering in hospitals or with the assistance of trained health personnel is very low. Seen against the fairly high exposure of Cambodian women to mass media, their preference for fewer children and their widespread rejection of domestic violence, the unsatisfactory state of affairs in the reproductive health and family planning area needs to improved by improving the reach and effectiveness of these services and by improving advocacy and BCC among the women/ couples.
Low levels of human resources development, particularly that among women, limit economic productivity, and make it difficult to design and implement effective programs for poverty reduction and socio-economic development.
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17
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