Maternal Survival in Afghanistan:Progress and Challenges
Mary Ellen StantonSenior Maternal Health AdvisorBureau for Global Health, USAID
Health in Afghanistan:How Can We Save Women’s Lives?
Women’s Policy, IncCanon House Office Building
July 20, 2010
Health Situation (2001-2002)
Fertility 6.8 children/women
No access to health care services for 1/3 population
Crumbling health infrastructure
Vast human resource needs
Photo: Linda Bartlett
Lifetime Risk of Maternal Death
1:8Afghanistan
1:4,800USA
Source: WHO/ UNICEF/UNFPA, The World Bank. Maternal Mortality Estimates 2005, App 8, pub 2007
The chance of a woman dying as a result of pregnancy is 600 x greater in Afghanistan than it is in the United States.
Maternal causes of death in Afghanistan 4 regions (n=154), 1999-2002
Cause of death Life Saving Interventions
- Family planningHemorrhage 33% - Active management of the
third stage of labor- Misoprostol
Obstructed labor 22% - Partograph- Cesarean section
Pregnancy induced hypertension
8% - Calcium supplementation- Magnesium sulfate
Sepsis 5% - Tetanus toxoid- Infection prevention- Antibiotics
Source: L Bartlett, 2002
Maternal Mortality and the Cycle of Poverty in Afghanistan
Financial and Human Cost
Hospital and funeral expenses
Lost wages
Lost education
Milk/formula expense plusmedical expenses
Lost education
Medical expenses
Remarriage expenses
Medical expenses andsocial exclusion
Family debt andcommunity impoverishment
Mother delivers life twins inhospital and dies
Father - Time off for birthand funeral
11-year old daughter -Leaves school to care for twins
Twins feed on goat milk andinfant formula, often ill
13-year old son -Leaves school to work
At 7 mos., smaller twin dies
Father remarries
At 13 years, surviving twinmarries, at 15, gives birth tobrain-damaged baby, suffersobstetric fistula, is cast out byhusband and returns to her father
Event in the Cycle of Poverty
Indicator Post-Taliban (2002)
Current Situation
(2009)Under-five mortality rate (deaths per 1,000 live births per year)
257/1,000 191/1,000 (26% reduction)
Access to basic services (% of population within 2 hours’ walk of a health facility)
9% 64%
Coverage of female health workers (% of facilities with a female health worker)
26% 85%
Use of antenatal services (% of pregnant women who use antenatal services)
5% 32%
Much has been achieved… much remains to be done
Ingredients of success formaternal and child health
• Government leadership
• Focus on rural health, equity
• BPHS: Basic Package of Health Services
• EPHS: Essential Package of Hospital Services
• Large-scale contracting capacity with NGOs
• Human resource policies
• Pharmaceutical policies • Clinic construction
• Social marketing of health products
• Recruitment, training & support of female community midwives & community health workers
Looking ahead…
• Security
• Expanded attention to midwifery education
• Family planning — more services to meet unmet need
• Focus on quality improvement, especially at referral level – prevention & treatment of obstetric complications
• Accountability to communities – working with religious and community leaders – on availability and quality of interpersonal care
• Seizing the opportunities and developing strategy for innovation such as mobile health/telemedicine
• Measuring impact– RAMOS II a possibility– National survey — all cause
mortality underway