Intersectional Socioeconomic Inequalities in Maternal and Reproductive Health Outcomes Among Cambodian Women: A Secondary Analysis of the 2022 Demographic and Health Survey

BackgroundHealth inequalities in low- and middle-income countries (LMICs) often reflect compounding social disadvantages. Intersectionality theory emphasizes that multiple axes of disadvantage can interact to shape health experiences in ways not captured by single-factor analyses (Crenshaw, 1989, 1991). Understanding how poverty and low education combine to affect maternal and reproductive health is essential for advancing universal health coverage and "leaving no one behind" under the Sustainable Development Goals (United Nations, 2015; World Health Organization, 2023). This study examined intersectional socioeconomic inequalities in maternal and reproductive health outcomes among Cambodian women. MethodsWe conducted a secondary analysis of women aged 15-49 years interviewed in the Cambodia Demographic and Health Survey (CDHS) 2021-22, a nationally representative household survey implemented by the National Institute of Statistics (NIS) in collaboration with the Ministry of Health, with technical assistance from ICF (National Institute of Statistics et al., 2022). Women were classified into six intersectional socioeconomic status (SES) groups by cross-classifying household wealth (poor/middle/rich) and education (no/primary vs. secondary+). Outcomes included antenatal care (ANC) [≥]4 visits, facility delivery, skilled birth attendance, modern contraception use, unmet need for family planning, and teenage childbearing. Multivariable logistic regression estimated adjusted odds ratios (aORs) with 95% confidence intervals (CIs), accounting for the complex survey design (National Institute of Statistics et al., 2022). ResultsAmong 6,968 women with recent births, 82% attended [≥]4 ANC visits and 96% delivered in facilities, but only 20% had skilled birth attendance. Compared with women with both high wealth and secondary+ education (reference), women with poor wealth and no/primary education had substantially lower odds of [≥]4 ANC visits (aOR = 0.33, 95% CI [0.23, 0.48]), facility delivery (aOR = 0.29, 95% CI [0.13, 0.63]), and skilled birth attendance (aOR = 0.20, 95% CI [0.14, 0.27]). For reproductive health, poor/low-education women had higher odds of modern contraception use (aOR = 1.24, 95% CI [1.06, 1.43]) and no difference in unmet need (aOR = 0.99, 95% CI [0.85, 1.16]). Teenage childbearing showed strong educational gradients (35% in poor/low-education vs. 16% in rich/high-education). ConclusionsIntersectional socioeconomic disadvantage creates compounding barriers to quality maternal healthcare in Cambodia. Despite near-universal facility delivery, skilled attendance--defined in global monitoring as births attended by trained health personnel such as doctors, nurses, or midwives--remains highly unequal and concentrated among advantaged groups (United Nations Statistics Division, 2023). Policies should prioritize equitable quality of delivery care, target multiply disadvantaged women, strengthen rural health workforce distribution, and invest in girls secondary education as a long-term maternal health strategy (National Institute of Statistics et al., 2015; World Health Organization, 2023).