This thesis aims to explain why there is a high level of unmet need for contraception in Cambodia - a country where effective methods of birth control are cheaply available and morally acceptable. The research design takes a mixed methods approach, initially using data from the Cambodian Demographic and Health Surveys of 2000 and 2005 to assess trends in contraceptive use. Multivariate logistic regression is used to analyse factors associated with, firstly, unmet need, and secondly, use of traditional contraceptive methods. The likelihood of having an unmet need for contraception increased as education and wealth levels decreased; urban or rural residence had no significant effect. However, the likelihood of using traditional methods, rather than modern methods, increased as education and wealth increased. Taking these findings and the questions they raise as a departure point, 21 months of ethnographic fieldwork was conducted in one urban and one rural site in Northwest Cambodia between 2008 and 2010.
The study looks at women’s and men’s reproductive decision making with a focus on their experiences of and meanings given to contraception, situating these understandings within the broader social context. Fear of side effects, stemming from both contraceptive experiences and notions of health and the body, was found to be the greatest obstacle to use of modern contraceptives. This related more broadly to the pluralistic medical systems operating simultaneously and the varying levels of medicalization and trust in both biomedicine and the Cambodian health system. Behaviour that seemed counter-intuitive at the outset - not wanting to become pregnant but not using contraception, and wealthy educated women choosing traditional over modern methods – becomes understandable in light of the context and meanings highlighted by the ethnographic data. This thesis provides a unique empirical study which contributes to the emerging field of anthropological demography. By bringing approaches and methods from medical anthropology to the typically demographic phenomenon of unmet need, the study provides a new insight for social policies regarding reproductive health as well as contributing to the body of ethnographic literature on Cambodia.