Healthcare-seeking behaviour for childbirth in cases of stillbirths and neonatal deaths in rural Cambodia using social autopsy: a prospective cohort study

Abstract Introduction Perinatal mortality remains high in low-resource settings, with many deaths preventable. While clinical causes of perinatal deaths are often examined, non-medical factors such as care-seeking behaviours and barriers are less well understood. This study uses social autopsy (SA) to explore upstream, social factors associated with stillbirths and neonatal deaths in rural Cambodia. Methods A prospective, population-based cohort study over three years (2019–2022) in Preah Vihear province, Cambodia. For all stillbirths and neonatal deaths, SA interviews were conducted. The SA questionnaire examined socio-demographic characteristics, health-seeking behaviours, and delays in healthcare-seeking. Data were analysed descriptively, and the Three Delays model used to summarise barriers faced by pregnant women at the time of delivery. Results Social autopsy was completed for 315 out of 404 (78.0%) stillbirths and neonatal deaths. Most mothers (87.3%, 275/315) reached a health facility for delivery. However, 20.4% (56/275) of them bypassed their nearest facility. Among women attending their nearest facility, 64.8% (142/219) delivered there, and of these, 69.0% (98/142) delivered within one hour of arrival. In total, nearly half of all deliveries (49.5%) occurred either at home (28/315), enroute (12/315), or within one hour of arrival at the first facility attended (116/315). Delays to seeking facility-based care for delivery were common: 65.7% (207/315) of women reported experiencing at least one delay type, most often at home (43.5%), or at the facility (36.7%). Conclusion Healthcare-seeking behaviour was generally appropriate, but not timely. The high proportion of deliveries occurring soon after facility arrival suggests that women frequently presented late in labour, limiting the window for effective clinical intervention. Efforts to reduce stillbirths and neonatal deaths should therefore extend beyond increasing facility delivery coverage to also improving timely care-seeking and ensuring facilities are equipped to provide high-quality emergency obstetric and newborn care immediately on presentation.