Improvement of health standards in Cambodia still remains to be the main objective of the government of the nation. According to a report by UNICEF, child mortality in Cambodia still remains to be high even after previous actions of dealing with the problem. Many factors have been attributed to the high child mortality rate. Different organizations including the Cambodia Demographic and Health Survey (CDHS) have continued to study the population for several years to know the nature of the country’s population, health, and nutrition (UNICEF Cambodia, 2011). CDHS has made some conclusions that the state of health in the country is gradually improving. However, research conducted by CDHS states that much needs to be done in regards to family planning and child health. Poor access to pediatric health services remains to be a factor that contributes to health problems in Cambodia. Over the past several decades, the Cambodian economy has been boosted by international help and cooperation, which is having a significant effect on Cambodian culture and the way Khmer people utilize pediatric health services. The proposed study would be an important addition to the knowledge regarding Cambodia’s trajectory when it comes to helping one of the most vulnerable population groups in society who are the children (World Food Program, 2014).
Problem Statement and Purpose of the Study
The purpose of the study is to analyze the causes of poor child health in Cambodia and how health can be improved. The objective of the proposed study is to find whether family planning is a risk factor for low utilization of pediatric health services. The research question guiding the proposed study is given below:
Are the socio-ecological factors of family planning attitude, belief, and family planning behavior predictors of pediatric health service utilization?
Null Hypothesis 1 (H₀1): There is no relationship between family-planning practice and utilization of pediatric health services (Acuin et al., 2011).
Alternative Hypothesis 1 (Hₐ1): There is a relationship between family-planning behavior and the utilization of pediatric health services.
The study is also aimed at discovering the various methods of family planning present. Through the study of family planning, it will be easy to know how contraceptives can be used to reduce maternal mortality in Cambodia. The study of family planning techniques will also help in knowing how to prevent early pregnancies that have forced many women in Cambodia to have abortions (Andersen, 1995). The study will offer help of how, when, and how often to have children. Through that, the study will be able to determine various ways of protecting the health of women by reducing high-risk pregnancies, protecting the health of the young ones by allowing sufficient time from one pregnancy to another, fighting HIV/AIDS by providing guidance and counseling to couples and parents, stabilizing the population growth in Cambodia thus improving the economy, and lastly supporting women in the society by giving them opportunities like employment and education (Acuin et al., 2011) The study will show the social and economic benefits that are related with proper family planning and improved child healthcare. The economy of the country cannot sustain all the people including children in the country. The government of Cambodia does not have the capabilities to support all its population due to the high growth of population (World Food Program, 2014).
Significance of the Study
The proposed study could make an original contribution to public health because it could identify socio-ecological factors relating to a mother’s beliefs, attitudes and practices of family planning and abortion, which might have a significant impact on pediatric health service utilization in Cambodia (Ahn, Ham, Kim & Park, 2012). The results could help put pediatric health service utilization in temporal and cultural context. This could assist the policymakers in tailoring better guidelines on how to better target potential problem areas that slow the country down in reaching its child-related Millennium Development Goal 4 (Millennium Project, 2006), as well as help plan beyond the deadline of 2015 for further improvement of pediatric health and reduction of child mortality.
It is important to identify the association between mother’s attitudes towards family planning and abortion and pediatric health service utilization. The identification will bring positive social change by highlighting potential influential demographic group, which could reduce child diseases and mortality.
Nature of the Study
The proposed study will adopt a cross-sectional design to determine socio-ecological factors that determine utilization of pediatric health services among women with children in Cambodia (Platt, 2010).
Accessed Library, Databases, and Search Engines
The main source of data for the proposed study will be Cambodia Demographic and Health Survey (CDHS) for 2000, 2005, and 2010. The researcher will access CDHS surveys and GPS dataset (Mao, Saint & Nit, 2013). They will use responses from the Household, Individual, and Children’s surveys. The researcher intends to use data from GPS datasets because they contain the variables of interest for the proposed study. Maternal, Neonatal, child Health and family planning in Cambodia has had some challenges in the past (Andersen, 1995). Some of these challenges have not been eliminated until now.
The researcher searched MEDLINE and PUBMED databases through Walden University Library. The researcher restricted peer-reviewed literature date range for most articles to be from 2010 until 2015 (National Institute of Statistics, Directorate General for Health & ICF Macro, 2011). The reason for using the databases is to ensure the right information about the topic was gotten. The information in the databases has been approved and it is reliable for use. The search terms used were “child health services,” “developing countries,” “family planning,” “Cambodia,” and “Child Healthcare. All these words are the key in the formation in gathering vital information regarding the process of family planning and child healthcare in Cambodia. The criteria for article inclusion will be based on the question addressed in the work. The researcher will base the comparisons on the question with the real situation in Cambodia (Ahn et al., 2012). The question was based on the family planning and child health care in Cambodia (Mao et al., 2013). Google was the search engine used to gather information relating to this study. Google is a reliable search engine as it contains vast information.
The Used in the Study
The theory used is the social-ecological model. The model helps in the formation of a clear thesis of a research. The Social-ecological model (SEM) makes it easy to understand the concept (Babitsch, Gohl & Lengerke, 2012). CDC is one of the entities that use this model. It utilizes a four-tier SEM to analyze situations and the environment within which they are set. The social-ecological model helps in understanding a certain society, the community, and the relationship created between the society and an individual or the community with an individual. Cambodia is the society in this case. Different communities in Cambodia have different beliefs about family planning and child health care. Some of their behaviors of the people in Cambodia towards family planning and child healthcare are influenced by the environment and the relationship with other factors (National Institute of Statistics et al., 2011). Arranged in ascending order, the individual is the first level, followed by relationship, community and lastly the society. The four levels will help in understanding the purpose of the study. History has to be included to make concrete conclusions and substantial facts about healthcare in Cambodia.
Origin of the Theory
The source of the theory dates back to the period after First World War. It is believed that the model originated from sociologists associated with Chicago School (Centers for Disease Control and Prevention, 2014). The present version of the model is the one used in this study. It is associated with Urie Bronfenbrenner. He revised the earlier framework in the early 1970s (Babitsch et al., 2012). From then on, the model has continued to be used in the study of human behavior in the form he proposed. The model was formalized in the 1980s.
Major Theoretical Propositions
The major theoretical propositions, including delineation of any assumptions appropriate to the social-ecological theory, are grouped into five categories. The first preposition is the hypothesis-oriented framework. It is followed by assessment-oriented framework, action-oriented framework, problem-oriented framework, and theory-oriented framework. The frameworks help in better understanding of the theories and the problems in the modern society. The hypothesis oriented frameworks are quite specific (Centers for Disease Control and Prevention, 2014). Women will accept to use the contraceptives depending on what they know about them (Chau, 2010). Assessment-oriented framework helps individuals to think in a structured way about something or an occurrence. Poor child healthcare is Cambodia will be attributed to poor medical conditions in Cambodia (Malhotra & Upadhyay, 2013).
Action-oriented frameworks recommend that a particular course of action established, there must be a response to the action. The framework recommends that for every problem, there must be a solution that can be achieved without creating another problem. The problem of child and maternal mortality is a problem is Cambodia (Kavanaugh & Anderson, 2013). The problem can be solved using different ways. However, the best to be implemented should not result into another problem. In this case, the action involves the improvement of the health care should be the best solution to the problem (Malhotra & Upadhyay, 2013). The problem-oriented frameworks tend to deal with the problem itself. They difference comes in as the problem-oriented frameworks do not start by defining the solution right away (Hoerster et al., 2011). For example in Cambodia, there is the problem related to healthcare. It is a clear study that measures the impacts of the proposed solutions to the environment or the stakeholders involved before taking a quick action.
The last preposition is the theory-oriented framework. As the name suggests, the theory does not aim at providing solutions but it tends to gather information within a certain environment that help in the coming up materials for a specific research. The theory-oriented framework also searches for information from other sources. The framework seeks to compare different findings from different theoretical works and with the current findings in order to come up with a justifiable answer that can be proved after the research if the need arises (Chau, 2010). A study about Cambodia’s family planning and child healthcare techniques can have a theory-oriented framework around the community beliefs and their behaviors. Researches that have been conducted previously regarding the country can also act as materials for the research. The goals of the frameworks are to provide the best solution to a problem or a research and in the simplest way possible.
Use of the Theory in Previous Studies
The ecological approach has been used in several secondary data analysis studies to gain an in-depth understanding of factors affecting utilization of healthcare services. Secondary data refers to the information collected by someone else rather than the user. USAID is a good example of an institution that has used the ecological approach to deal with international problems related to family planning and child healthcare (Mosha, Ruben & Kakoko, 2013). At the individual level, female gender and favorable prior health care utilization experience were positively associated with health care utilization. Community-level factors affecting utilization of preventive health care services has been witnessed in Uganda. Uganda is a perfect example of a developing nation in Africa. The government of Uganda provided different new health facilities but the people in the region were not ready to utilize the resources to the maximum (Hoerster et al., 2011). It was for the good of the people but the people were not ready to utilize all the resources because of different reasons.
The approach helped in identifying that most of the people were illiterate. The people had not been exposed to any health education. They had different myths regarding medicine and the modern methods of treatment. The solution applied was to educate them on the benefits of the new and modern methods healthcare (Sajid & Malik, 2011). After the education, they realized the benefits of the process and adopted the new ways (Mosha et al., 2013). The case of Uganda is a perfect example of how the theory has previously been used to come up with a solution regarding healthcare of persons.
Rationale for the use of the Theory
SEM would provide a comprehensive evaluation of multi-level biological and environmental influences on pediatric health service utilization. It allows for a break-down of potential influencing factors into four core groups: individual, relationship, community and societal. In doing so, SEM acknowledges that health behavior is an outcome of complex interactions of factors at different levels. The theory puts it clearly of how the factors contribute to one thing. The influence on each other is evident even in the arrangement (Platt, 2010). By using SEM, it is possible to know the behavior of an individual. The model also highlights factors behind the behavior. It is important to find out such information regarding the people and the community when carrying out a research or a study because it helps in making conclusive facts or answers towards a problem.
The theory will be used to analyze the relationship between behaviors of individuals in Cambodia with regards to family planning and child healthcare utilization. The theory clearly explains how different factors relating to environment and biology influence health service utilization (Kavanaugh & Anderson, 2013). In Cambodia, environmental factors like education have led to the poor family planning mechanism and poor child healthcare utilization. Lack of proper education has also seen them fail to take care of themselves during and after pregnancy. Myths about contraceptives are the biological factors that have made some couple to avoid using contraceptives.
How and Why the Selected Theory Relates to the Present Study
The theory makes it easy to understand the relationships between an individual and the community in a logical way. The research question is related to the socio-ecological theory. The question tries to establish the process of family planning and child healthcare utilization in Cambodia. The theory will help the researcher to find answers by highlighting the factors that influence family planning and child healthcare.
Definition of the Concept
The concept in this study relates to family planning and child health in Cambodia. The two elements have been neglected in this country. The main reason behind the high number of infant and maternal mortality in the country is illiteracy and poor utilization of health services. Many couples do not know what is required of them with regards to population control and the use of contraceptives (World Food Program, 2014). The Government of Cambodia together with other international organizations has come up with ways of controlling the population of that nation. In 1991, the Government initiated programs that would see women educated to use the new methods of family planning. Controlling the population of the nation is very important. Cambodia is not an economically stable country. The measures of controlling the population as many researchers say have continued to be implemented till now. Child health care has also been prioritized to reduce the deaths of infants who die due to poor health methods (World Health Organization & Cambodian Ministry of Health, 2012).
Primary Writings by Key Theorists and Philosophers
Primary writings by key philosophers attribute the failure of the family planning and child healthcare to the government and underutilization of health centers. The government of Cambodia faces different challenges when implementing health programs. A survey conducted by seminar researchers in one village in Cambodia provided different results. The survey was carried out on married women only (Lakew, Reda, Tamene, Benedict & Deribe, 2013). Most of the women in the village were aware of at least one family planning method. 50 percent of the female respondents had information on places to access contraceptives. However, many were afraid to use them because of the myths they had about using contraceptives and how they affected the environment in different ways. A small scale program funded by International non-governmental organizations in 1991 was started. The program was aimed at educating communities on the needs of adopting family planning methods. It was the first family planning program initiative in the nation (Lakew et al., 2013). The program did not do very well because it was funded on a small scale. Cambodia was a developing nation. International organizations have made developing nations realize the importance of family planning.
According to researchers, the majority of the people in Cambodia had little or no knowledge (Dingle, Powell-Jackson & Goodman, 2013). Most of the households in Cambodia were headed by men who were illiterate. The men knew nothing about family planning. The access of information and health services by women in the rural area in Cambodia was very crucial but it never occurred to them. The society had unequal gender roles. The men were favored from women. Sexual violence was also present in the society. Early marriages led to early pregnancies. Some of the girls who were married off when they were young did not know how to take care of themselves during pregnancies (Medhanyie et al., 2012). The young girls ended up feeding bad diets that affected the unborn child as well. Research shows that some of these women did not have safe deliveries. Most of the children born were very weak. Some of them died during deliveries. Some young women miscarried due to domestic violence at home. Lack of proper medical facilities also affected the children. Some children got infected with HIV during birth. Some of these problems were inevitable during that time because the government of Cambodia was not also ready to face the challenges (Medhanyie et al., 2012).
Key Statements and Definitions Inherent in the Framework
The key statements written by philosophers about Cambodia say that most of the maternal and infant deaths are avoidable. The statements define poor family planning and poor child healthcare as the main reason for the increase in number of child and maternal mortality rate in Cambodia. Lack of antenatal care during pregnancies contributed to the death. Lack of better clinics and facilities forced some women to deliver at home. The Home was not the safest place. Lack of hygienic conditions at home and lack of qualified medical practitioners to help in the delivery process contributed the poor child health and poor deliveries. Lack of medics prevented mothers from receiving appropriate and timely postpartum care (Dingle et al., 2013). The high child mortality rate in Cambodia was attributed to poor check-up done on the baby after birth. Research shows that many children have never received the vaccinations they are supposed to get in different stages of their early childhood. Lack of the vaccination has caused the deaths of many young ones. Research also shows that most women who have never received postnatal services have had different problems with the health of their children. Children below the age of 5 years do not have a strong immune system. Such children require regular check-ups to ensure that their bodies are safe from diseases. In the early 1980s, Cambodia did not have such services (Ikeda, Irie & Shibuya, 2013). About thirty percent of the children below the age of five years during this period suffered from different acute respiratory problems.
Some of the problems associated with children in Cambodia are caused by poor nutrition. Many parents in the region lacked the knowledge to treat and serve their children in the right way. The effects of poor nutrition start from pregnancy to birth and after birth. Due to hunger in the rural areas, some families in Cambodia do have access to food. Lack of balanced diet affected pregnant women in different ways (White & Speizer, 2007). The unborn child fails to develop well due to lack of the required nutrients. According to research conducted, only 15% of the Cambodian infants who are between the ages of zero to three months are exclusively breastfed (Ikeda et al., 2013). Nutrients in the mother’s milk help them to boost their immune system. Early weaning does not give the child the chance to fully develop their immune system. A survey conducted shows that one in 10 babies born in Cambodia does not get the chance to celebrate his or her first birthday.
During that time, Cambodia did not have properly trained health workers. Most of its health centers were not equipped with the best facilities required. The United Nations Population Fund helped the country to come up with better medical facilities that would see the people and the children benefit from the services provided. The program initiated by the UN body started in the year 1994. The government with the help of UN began to implement a family planning program. The program carried other different programs in it (Medhanyie et al., 2012). The program introduced family planning services in different health centers. Family planning education and training of the health workers was also included in the program. The training gave the health workers the knowledge of the different types of contraceptives as well as how to use them. The knowledge was passed on to couples who had different myths about contraceptives (Sajid & Malik, 2011).
Many families in Cambodia are not financially stable. However, due to the lack of the family planning knowledge, they ended up having many children whom they cannot support fully. Child health care is also a big problem. A survey conducted showed the reason why many women and couples in the area feared to use contraceptives as birth control mechanism. Women were especially misinformed about the services. They believed that the programs may make them infertile. It was a fear in many couples. It was not true but due to lack of education about the contraceptives, many couples in Cambodia believed in it. The program initiated by the government was aimed at improving the health of women in the region thus improving reproductive health (Millennium Project, 2006).
How the Concept is Articulated in Previous Studies and how the Current Study Benefits from the Framework
The concept of family planning and improved child healthcare has been articulated in many nations like America and Europe. The successful articulation of the concept in these nations has acted as a light to many other countries like Cambodia. In the previous research about America and Europe, the concept has successfully been applied through intense campaigns and education of couples. In the current study about Cambodia, similar concepts have been applied to improve healthcare and family planning. The variable in this literature is the age of the women and children. The ages vary depending on different situations. The introduction of different polies has also worked great for them. The first policy to be introduced in relation to family planning in Cambodia was the National Birth Spacing policy (Ahn et al., 2012). The policy was introduced in the year 1995. According to the policy, couples were required to use reversible methods of contraception. The methods stipulated in the policy included the use of oral contraceptives, use of condoms, Depo Provera, and the intra Uterine Devices (IUDs). The oral contraceptives were made available to couples at very affordable prices.
According to the laws of the nation, abortion is not a birth control mechanism. At that time, implants had not been developed. Pills, injections, condoms, and UIDs were availed through health institutions in various countries. The Ministry of Health in Cambodia was responsible for making awareness on the use and importance of the contraceptives to the women (World Health Organization & Cambodian Ministry of Health, 2012). Apart from the National Birth Spacing Policy, other policies were introduced. The National Policy and Strategies of Safe Motherhood, the Abortion Law, National Policy for Prevention of Mother-to-child Transmission of HIV, the Policy on Voluntary and Confidential Counseling and testing for HIV were other policies that were introduced by the government of Cambodia to aid in the process of family planning and child healthcare utilization.
The Ministry of Health and other government agencies have hailed the policies. They have educated the public about family planning and child healthcare. As such, public health is likely to improve in the country. HIV is an issue affecting the health of many children in Cambodia. Lack of awareness of the problem brought negative impacts to the society. Many people in Cambodia do not make good use of the health facilities. By 2014, different ways to study the public health in Cambodia have been adopted. Few changes have been implemented in regards to the family planning process and child health care (World Food Program, 2014).
Studies Related to the Constructs of Interest and the Chosen Methodology
There are many studies related to family planning and child healthcare that have done. A study on the integration of family planning with other health services of December 2010 is a good example of a related study. The study by Anne Sebert, Loretta Gavin, and Christine Galavotti evaluated the integration of family planning with other types of health services by searching five databases. The study covered databases between 1994 and 2009. Comparison method was used to gather information on the existing health services. Combination design methods were used as well as quasi-experimental designs. Single-group pre- and posttest designs were also used and the results indicated that there was an improvement in the awareness and use of different family planning methods (Yao, Murray & Agadjanian, 2013).
A family centered round in Pakistani pediatric intensive care is another related study. The study of 2012 is aimed at assessing whether patients and children in Pakistan get professional medical help and education from the medics. The study is done in a private hospital in Karachi, Pakistan. The methodology used is the non-randomized before-after study design. The study shows that communication with parents regarding the health of their children when done in a professional way helps in reduction of death cases among children. In Cambodia, situations are not different. It is noted that early pregnancies, regardless of whether they were intended or not, are associated with risks of adverse health and socio-economic outcomes (White & Speizer, 2007). The issue affects women and their families. It may emanate from lack of access to information about family planning and other health services (White & Speizer, 2007). The study continues to state that the unmet needs of family planning among general population are high in Cambodia (Nair et al., 2012).
How Researchers have Approached the Problem
Apart from the above models, the Ecological model is also used in the study. The ecological model postulates that no one factor can satisfactorily explain why some groups are more vulnerable than others. The core concept of an ecological model is that behavior has multiple levels of influences, including intrapersonal (biological) and community, and physical environment, among others. The ecological model is explained above and how it influenced the whole. Many healthcare researchers have approached the problem in different ways. The researches have had also different strengths and weaknesses in their approaches (Rahman, Kielmann, McPake & Normand, 2012). Many researches have tried to build the methodology depending with the question. Like in the problem of family planning and child healthcare in Cambodia, many researches have employed the ecological model as it is the suitable method. As per the question, the method is able to give facts and details relating to the individual behavior and the relationship they have with the community. In trying to find out information using the model, some researches have encountered problems with language barrier. Some of the respondents from the rural parts of Cambodia are illiterate and they do not have a good command of English language (Rahman et al., 2012).
Researchers have been forced to look for translators. Hiring the translators for them is extra cost for them (Sharma, Mohan, Das & Awasthi, 2012). Financing the researches is another problem that many researchers have encountered. Some of these methodologies used by the researchers in different places not only in Cambodia have increased the cost of the research. Some have contributed to delays thus making the research to take long than it was expected. Many researchers have encountered with these problems in the methodologies they used. The main strength in the methodologies used is that they are simple to use (White & Speizer, 2007). Studying the community using the ecological model is much easier than applying other methodologies that might prove to be complicated for the user.
Rationale for Selection of the Variables and Concepts
The variable in the literature is the age. Family planning has been applied only by few couples in Cambodia. The ages of these couples varies. The rationale for the selection of the variable is determined by the problem statement. According to statistics from researchers, there is that group of couples under a certain age that have seemed to approve the use of family planning methods even though they are very few (Rahman et al., 2012). Child healthcare has also mostly affected children of 0-5 years. Others of the age 6-12 have also been affected negatively. The reason why they do not get better healthcare is attributed to many reasons one of them being poor utilization of the health facilities. Some facilities are distances away from the people and therefore accessing them becomes a problem. From the explanation, it is easy to note that the variable is the age of the respondents because it varies with the problem (Rahman et al., 2012).
Dependent and the Independent Variables
A well-designed research has to contain the dependent and the independent variables. The proposed study has dependent, independent, and covariate variables. The dependent variable in the proposed study can be regarded to population control while the independent variable is the family planning and child healthcare program. The covariate in this study can be the reduced maternal and child mortality as well as a controlled population growth. The covariate shows the outcome of the study. In this study, the dependent variables can be two (Sharma et al., 2012). A study of the family planning and child healthcare in Cambodia can have the population control as well as the child and maternal mortality rate as the dependent variable (Singh, Singh & Mahapatra, 2013). The dependent variables work with the independent variables to give a solution which is the covariate. Covariate variables are related to the dependent variables. The efficacy of many studies in this field is tied to the variables. It is evident that a reduced growth in population is related to the control of population (Nair et al., 2012). Control of population depends on the programs that the government of Cambodia will put into place that may include the use of contraceptives. The three variables give a good flow to the thesis of the research.
Studies Related to the Research Questions
Studies related to the research question all synthesize about the control of population through the use of contraceptives and the reduction of child and maternal mortality in different nations. A good example is the study by United States Agency for International Development (USAID). The study by the agency is not different in any way to the study about Family planning and child healthcare in Cambodia. The study by USAID is aimed at ensuring that the health of women in USA is protected by reducing high risk pregnancies and ensuring that the pregnancies are properly planned (UNICEF Cambodia, 2011). The study by the agency is also aimed at protecting the children by giving them the right medication and allowing enough time from one pregnancy to another. Mitigating the population growth in America to promote economic growth is another area focused by the agency. Reducing abortion and protecting the women rights also relates to the problem in Cambodia (Nair et al., 2012). The study shows that family planning could prevent up to 35% of maternal deaths that occur every year in different nations. USAID has carried out similar studies in different places not only in America but all have similar objectives (Oliver & Mossialos, 2004). The research question is that similar to the one in the current study.
Summary of the Themes in Literature
In conclusion, the major themes in this study are the use of contraceptives and proper utilization of child healthcare. The high maternal and child mortality rate in Cambodia is characterized by lack of education of the use of family planning methods as well as having risky pregnancies. The study tries to establish how the causes of the problems in Cambodia. The study tries to seek solutions to the problem. The theme runs from the beginning of the end of the study. In summary, the problems in Cambodia can be solved through proper education. It is known that many married people in Cambodia do not have access to different types of contraceptives. The main reason of not having them at their disposal is attributed to underutilization of the medical facilities (Yao et al., 2013).
Illiteracy among many people in Cambodia is yet another problem known to cause the problems associated with family planning and poor child healthcare. Through education, it is possible to reduce infant mortality and control the population of the nation. Many people do not understand the importance of healthcare during pregnancy and after childbirth (Malhotra & Upadhyay, 2013). Screening among women during and after pregnancy improves the health of the mother and her child (Oliver & Mossialos, 2004). Apart from medical help, utilizing the health centers also helps in providing advice to mothers on how to take care of the young children. Mothers are taught on how to improve their nutrition during and after pregnancy.
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