Cambodia & Health: After Childbirth, the Herbal Wines That Worry Doctors
In Cambodia, many new mothers drink roots and bark steeped in rice alcohol to get their strength back. A study led in part by the Institut Pasteur du Cambodge and Calmette Hospital links these remedies to liver damage. Yet sra thnam remains a pillar of Khmer tradition.
An Institut Pasteur du Cambodge study on new mothers' livers
The study was published in August 2023 in PLOS ONE. It brings together Phnom Penh's University of Health Sciences, the Institut Pasteur du Cambodge and Calmette Hospital, with researchers from Toulouse and Geneva. It covers 75 women with hepatitis B, followed in five Cambodian maternity units between 2017 and 2019.
More than two in three had taken at least one traditional remedy after giving birth. Infusions, decoctions, steam baths, and also macerations in rice alcohol. Nearly one in four had drunk at least one alcohol-based preparation.
The finding is striking. Among women whose liver showed damage six weeks after giving birth, one third had taken an alcohol-based remedy. Among the others, barely one in eight had. Several of the plants used contain compounds known to be toxic to the liver.
The authors are cautious. The sample is small and the amounts of alcohol are unknown. The study shows an association, not a cause. It also concerns women with hepatitis B, who are more vulnerable than others. But they call for these plant mixtures to be properly assessed.
Sra thnam: “warming” the body after childbirth
Sra means alcohol, thnam means medicine. Roots, bark, vines and sometimes animal products are steeped in rice alcohol. People drink these preparations for fatigue or pain, but above all after giving birth.
An ethnographic study published in 2020 in PLOS ONE followed mothers of babies under six months old in Takeo province in 2016. It describes tonics made with rice alcohol, boiled herbs, roots and sometimes beeswax. A bag of herbs or roots cost about 30,000 riel, or 7 to 8 dollars.
The mothers saw several benefits. Restoring the body's warmth. More breast milk and a better appetite. Relief for back and leg pain. Above all, preventing toas, the ailments believed to strike later a woman who has not recovered properly. Many said they were following older generations. One mother said she avoided alcohol because it made her ill.
Dose matters. White rice alcohol is 20 to 30% proof, against about 5% for beer, public health specialist Dr Ly Chenghuy told the Phnom Penh Post in 2016. A practitioner interviewed by the paper advised two tablespoons a day and warned against dependence.
Bear bile and porcupine: wildlife in the jars
Some remedies go beyond plants. In the 2023 study, one woman in seven had taken a maceration of porcupine stomach after giving birth.
In 2020, the Journal of Ethnobiology and Ethnomedicine published a survey of 122 women in seven provinces, carried out between 2016 and 2019. Bear bile and gallbladder were used mainly by new mothers, against toas. The women mentioned wines made from bear bile, bone or blood.
Family pressure weighs heavily. Older women in the family often push new mothers to take them. One respondent said her relatives had forced it on her sister after she gave birth. The authors refuse to blame these women. Instead, they suggest encouraging older relatives to support new mothers through traditional ang pleung or medical care.
A second study, published in 2022 in the same journal, interviewed traditional medicine practitioners in Stung Treng, Mondulkiri and at the National Center for Traditional Medicine in Phnom Penh. It lists 28 wild animal species in use, with lorises and porcupines the most sought after. The main reason given: women's health after childbirth. Practitioners say, however, that these products are getting scarcer, and some are turning to plants.
Methanol: the other danger of rice alcohol
A sra thnam made at home with alcohol of known origin is not a poison. The fatal poisonings reported in recent years involved adulterated rice alcohol, often served at funerals, not the macerations as such. But the line can blur.
In May 2021, ten people died and around fifty were poisoned in Kampot province after drinking rice alcohol at funerals. According to Radio Free Asia, a buyer had taken white alcohol and added traditional herbs to make it stronger. The methanol content had become dangerous. Within two weeks, 24 people had died of alcohol poisoning across the country. Then health minister Mam Bunheng urged people to stop drinking homemade rice alcohol.
The whole region is affected. In November 2024, six foreign tourists died in Vang Vieng, Laos, after drinking alcohol suspected of being laced with methanol. On 7 October 2025, the Pan American Health Organization, the WHO's regional office, issued an alert after 16 confirmed cases in Brazil.
Methanol is insidious. According to Médecins Sans Frontières, symptoms often appear 12 to 24 hours after drinking: blurred vision, shortness of breath, abdominal pain. About 30 ml can be enough to kill. In a typical outbreak, 20 to 40% of victims die.
Dr Ly Chenghuy summed up the ambivalence in the Phnom Penh Post: traditional alcohol works “as both a cure and a weapon”. Some producers are betting on quality. In November 2024, Cambodianess profiled a farmers' group in Siem Reap backed by the French NGO Agrisud. It double-refines rice alcohol bought from villagers, for aroma, taste and hygiene, then brings it down to 40% for sale.
Before you raise a glass
• Sra thnam is still 20-30% alcohol. The dose practitioners recommend is two tablespoons.
• After giving birth, it is best to tell the midwife or doctor about any traditional remedies, especially with hepatitis B.
• Choose alcohol from a known producer. Alcohol of unknown origin is the riskiest.
• Blurred vision, shortness of breath or stomach pain a few hours after drinking: go to the emergency room at once.
• Wildlife products threaten vulnerable species. Plant-based remedies exist.
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