Life Span Development in Cambodia
Crystal M Rowe
Harper College
March 5th 2012

Cambodia is an amazing country that has overcome much recent adversity. It is a ideal recent example to study human development in a redeveloping country. In fact as far as my research has taken me there is no published research on human development or transition to adult hood in Cambodia. The country of Cambodia or officially known as the Kingdom of Cambodia located in the southern portion of the Indochina Peninsula in Southeast Asia. Its total landmass is 181,035 square kilometers (69,898 sq mi), bordered by Thailand to the northwest, Laos to the northeast, Vietnam to the east and the Gulf of Thailand to the southwest [ (Wikipedia) ]. Cambodia has a population size of approximately 14.8 million with the official religion is Theravada Buddhism which is practiced by about 95% of the total countries population. Cambodia is one of poorest and least developed country in the region. In 2003 Cambodia is ranked 130th out of 175 countries worldwide and the human development index was 0.556. Cambodia largest city is Phnom Penh was originally colonization by the French and has grown to become the nation's center of economic ,industrial, political and rich in cultural heritage. It was once know more commonly known as the "Pearl of Asia". Little attention has been given to life span development in Cambodia. In this paper we will go though and discuss all phases of human development from prenatal to death and dying in a redeveloping country such as Cambodia. What makes this an even more interesting and challenging paper is big differences between the size of age groups and health due to the recent genocide of the Khmer Rouge regime (KRR). The death toll of KRR reached 1.7 million about a fourth of the total population at end of the KRR. The first quantitative evidence to date that attests to a one-third decline of fertility during this regime, followed by a substantial "baby boom" after the fall of the KR (Bunnak Poch). You have large disparity of data because of the KRR has caused some developmental stages to be much large than others. Post KRR census in 1998 showed 52.9% of the total population in Cambodia to be under the age of 19. The disparity of the age group disrupted the country, even the education system shows disparity because disruption of generations. Poor health is major cause of impoverishment and other forms of social development, such as lack of education and employment opportunities. The poor always tends to have the worse health and is less likely to know good health habits. Hygiene and sanitaion is another thing that most people in Cambodia don`t know about or have no access to. Common diseases faced by the majority of the poor include malaria, tuberculosis, dengue fever and HIV/AIDs. Aids was withheld in till between 1991 to 1993 when the United Nations had transitional authority of the country. Understanding the disparity of age group sizes we will start reviewing with prenatal care. Nearly all hospitals have been destroyed in the KKR and currently hospitals are all being rebuilt or operating as non for profit. Prenatal care is something new to the country. In Cambodia as recently as 2005, only 69 percent received any type of prenatal care and women had a 1 in 200 chance of dying in childbirth (Ratana, 2012). That has been improving to a 89 percent of pregnant mothers receiving prenatal care by a skilled provider. Companies like wild vision helped build clinics, educating families about the importance of breastfeeding, nutrition, hygiene, and sanitation (Ratana, 2012). The basic Cambodian food staples are rice, fish, vegetables, and fruit generally. Beef, pork, poultry, and eggs are foods eaten only on special occasions, unless the family can afford to have them more often (Harmon). Even with geographical location of this Asian country the probability of dying at less than five years old in Cambodia is the highest in the World Health Organization’s (WHO) Western Pacific Region, at approximately 143 deaths for every 1,000 live births (Harmon). Every year, an estimated 1,700 women die during pregnancy, delivery and after birth, according to Cambodia’s 2008 Census. That translates into 461 deaths per 100,000 live births, leaving Cambodia tarnished with one of the highest maternal mortality rates ("Maternal and newborn," ). While infant mortality has decreased, the number of newborns who die each year remains unacceptably high, as an estimated 10,000 babies die during or shortly after delivery each year. Women are dying because they lack basic emergency obstetric care while availability of trained birth attendants is limited. As you have leaned Cambodia is as such poverty, so bad that many women can`t afford prenatal care, yet alone hospital bills when giving birth in a hospital. The charge to give birth in a hospital is 35$ and 5$ per day. The average income for a home is less than 70$ per month. Only 58 per cent of women in Cambodia had access to a skilled birth attendant in 2009 and less than a third of births take place in a health facility—a situation that increases a pregnant woman’s risks while decreasing her chances of accessing life-saving interventions during childbirth. However, even when mothers can access health care, overall quality of care is deficient, magnifying the challenges women face in overcoming potential health problems at and after birth("Maternal and newborn," ). Cambodia is trying to take a nonprofit path to healthcare. Because of the KKR the redeveloping country is strapped fanatically and trying to redevelop it cannot put the appropriate funds towards healthcare or prenatal care. One of the biggest concurs in Cambodia is HIV with the birth of infants. A low cost strategy to assess HIV-RNA viral load, was implemented in 2005 and applied to the early diagnosis in infants. In, Cambodia, national programs have been funded to prevent mother-to-child transmission (MTCT) of HIV, scaled up since 2001, were hampered by lack of access to HIV early diagnosis in Infancy. The objectives that many doctors have intended were to generate information on the early diagnosis of HIV infection in Cambodia and to estimate the in uterus and prenatal MTCT rates of HIV-1 among mothers delivering in Cambodia hospitals, one inpaticuler Calmette Hospital, Phnom Penh. The next biggest issues with infants is nutrition, as most mothers cannot afford food or proper nutrition needs, they are forced to eat trash just to help supply breast milk to their infants. Children younger than 18 make up almost half of Cambodia population and 40% of the population lives on less than 63 us cents per day. Recent continuous conflict in Cambodia has not helped the situation for the young. I found an interesting article in the (PRB) Population Reference Bureau on Cambodia Short Falls of Early Childhood Nutrition published by the staff of the department of planning and health information, ministry of health, the reproductive health association of Cambodia and the PRB. This article clearly explains current problems that an Asian country is currently experiencing. 45% of children under 5 are malnourished, not only is it from insufficient quantities of food but poor feeding practices or inadequate breastfeeding. From this article it is heart breaking to learn 11% of newborns are breastfed in the hour, even more heart breaking is only 1 in 4 during the first day of life. From this clearly explains what UNICEF is battling in that country. Those who do survive, frequent illness locks them into a cycle of recurring sickness, faltering growth, and diminished learning ability. Infants, under-five and maternal mortality rates are high in Cambodia. Infant mortality and under-five mortality is about 95 per 1,000 live births. The infant mortality rate among the poor is 95 per 1,000 live births compared with 47 per 1,000 live births among the well off (DHS 2000). There are few articles referencing young adult hood in Cambodia. Few people are educated about the recent genocide that just ended in that country in the last few years which is known as (KKR). Because it was so recent and so traumatic you rarely see or speak with anyone over the age of 40. Cambodia children are forced to learn to survive at a very young age. Of every 1,000 Cambodian children who enter the first grade, only 20 finish high school. Many do not even get into school. In Cambodia 15 years of age, is the legal age to work but most children are working under age to help support households. Most children are out of school at a very young age due to having to work. Most children have to go out to collect trash so their families and themselves can eat. Many children suffer from physical abuse. Children often get punished if they don’t make enough money during the day. Most of the people or shell I say young children working are teenagers. Some children as young as six or seven years old work with their parents or by themselves at the dump. There are people of all ages. They work from sunrise to sunset and sometimes until ten o’clock at night, It’s most dangerous at night when they can’t see what they’re grabbing or where they are stepping. Needles are common. The kids collect the plastic containers from the needles that have been discarded. The plastic is worth one penny each. Many children do cut themselves on needles and glass, and due to not having proper footwear or no footwear at all they cut themselves mostly on their feet. Some have flip flops but most others go barefoot. If the kids don’t make money, the parents get very angry at them, and that is where abuse comes in to play. Some families/parents are so poor that they are resorted to selling their kids. As Anett Haugom stated in her article that nearly half of Cambodia's prostitutes are under the age of 18. Children of all ages are forced out of school and into labor to help their families make ends meet. Most children are denied the opportunity to acquire the knowledge and skills needed for gainful future employment, thereby perpetuating the cycle of poverty. About 16 percent of children are already economically active at age six years, and over half of all children are economically active by the age of 10 years. By the age of 15, the share of children working in economic activity surpasses that of children attending school. As you can see that for early, middle and late childhood, most children don`t experience and are pushed in to the adulthood. If children are not working they are forced in to prostitution. The proportion of children studying exclusively, unhindered by the exigencies of work, peaks at the age of nine, at 49 percent. There are about 17,000 children under the age of 18 who are being sent out to prostitute. Cambodian children are sold at young ages inside the borders of Cambodia. The price of child is determined by appearance, age and virginity. The average value is approximately $150/child. It is such a high amount to people in Cambodia that children's own family`s are selling them to make money for the household. In Cambodia , in a day the amount someone can make is lower than ever. About 34% of the population is estimated to be living on less than $1 a day per person, and another 33.6% is living on $1 and $2 a day per person. Extremely low. Now think about this, on average women having about 5 children. So let's say education is costing around $30 to $60 ; food is maybe $20 and clothing is low like $10. Now add all that up which is about $120 for the week. Most cannot afford this. That is why more women and men are on a high dropout rate from school. So As I have learned and read about Cambodia is that by the time you are 22 to 24-years of age you are ether trying to help support your family. or doing poorly yourself. That is why most children at young ages are not in school, they are out working and digging for trash. Poverty is especially pervasive in rural areas. Same data has shown in the current study indicated that less than 9 percent of older adults in rural areas live in a household with a telephone, less than 2 percent in a household with a car, and less than 1 percent in a household with a refrigerator (Knodel et al. 2006). It has also showed only 20 percent of older Cambodians in rural areas believe they have enough money each month to meet their expenses. The health status of older Cambodians is generally poor, even in comparison to older adults in other countries in the region. Health care resources throughout rural Cambodia are underdeveloped and underfunded as we have stated earlier in the paper. According to Journal of Community Psychology; Fourteen percent of caregivers met criteria for posttraumatic stress disorder (PTSD). During the genocide of the Khmer Rouge the war of our time killing 25% of the total Cambodian population decimated generations. An Article from J. Am. Acad. concludes that high levels of emotional distress caused by lack of food, water, and shelter affected the entire population. Adolescents are eating trash or trying to survive off the tourist. The adults that did survive the Khmer Rouge are often disabled not having all their limbs. Cannot provide for adolescents. The men are most often attempting to work in the rice fields, in the tourism industry, or involved in crime. That is if they are healthy enough to survive that long.

Due to unsanitary living conditions, diseases that were contracted because of drinking dirty water, diseases contracted easily such as Malaria, and also because 21% of the population was killed in a genocide known as the Kmher Rouge in 1945, and that 21% would now be the 70-80 year olds in Cambodia, but instead the average life expectancy is just 62. In Cambodia, death is viewed in a very different way. May Cambodians are Buddhists and who do not view death as the end of one`s life but rather as the end of one`s life cycle. In Buddhism, the belief is that all life evolves in a successive cycle of birth, sickness, old age, death and rebirth/reincarnation. In Cambodia, when a person dies, the care of the body is undertaken by family. The body would be brought home, washed, dressed, and placed into a coffin. The body is not to be dissected and organs are not to be removed because it is believed that would affect one's rebirth. If you were fortunate to live past birth, early adulthood, young adulthood and middle adulthood, you are left old and brittle. Most elderly people malnutrition is very poor.

Although differences in life expectancy across wealth quartiles likely play a role in determining prevalence rates of health problems, it is not clear why survival would have an impact on associations with disability but not on associations with other health outcomes. It is likely that the measure of disability differs in some way from the measure of other health problems. References
Wikipedia: The free encyclopedia. (2004, July 22). FL: Wikimedia Foundation, Inc. Retrieved August 10, 2004, from http://www.wikipedia.org
Bunnak Poch, P. H. (n.d.). The phoenix population: demographic crisis and rebound in cambodia. Retrieved from http://www.biomedexperts.com/Abstract.bme/17583312/The_Phoenix_population_demographic_crisis_and_rebound_in_Cambodia

Ratana, L. (2012, February 02). In cambodia, more moms survive childbirth. Retrieved from http://www.worldvision.org/news/cambodia-more-moms-survive-childbirth

Harmon, K. (n.d.). A step toward reducing maternal and infant. Retrieved from www.defiance.edu/.../Cambodia09_15_Maternal_Infant_Mortality_R...

(n.d.). Maternal and newborn health. Retrieved from http://www.unicef.org/cambodia/12963_13115.html

MOLLICA, R., SON, L., & POOLE, C. (1997). Next »journal of the American academy of child & adolescent psychiatry. Retrieved from http://www.sciencedirect.com/science/article/pii/S0890856709626186

Mony, K. (2004). Death in cambodian buddhist culture .

Mulsow, M., Cleveland, H., & Hart, S. (2009). Journal of community psychology. (6 ed., Vol. 27, pp. p754-768).
Ngin, S., Kruy, S. L., Segeral, O., Horm, V. S., Ek, L. M., Sethikar, I., ... & Nerrienet, E. (2008).
Early diagnosis of HIV-1 infection in Cambodian infants. Retrovirology, 5(Suppl 1), P22.

Poverty, W. I. (2006). woRKING.

Zimmer, Z. (2008). Poverty, wealth inequality and health among older adults in rural Cambodia. Social Science & Medicine, 66(1), 57-71.