Maternal mortality in Afghanistan

Story by BBC reporter Jill McGivering for PRI’s “The World”

Over half a million women die each year from complications during pregnancy, delivery or shortly afterward. To address the problem, the UN Population Fund is holding a high level maternal health meeting in Ethiopia. One of the Millennium Development Goals is to reduce maternal mortality by 75% by 2015.

So which countries of the world are rising to the challenge and which are showing little evidence of improvement?

Badakhshan in northeast Afghanistan is now ranked second worst in the world when it comes to maternal mortality. And just a few years ago in 2006, Badakhshan had the worst ever recorded incidence of maternal mortality ever recorded in history. And yet there are many NGOs working here.

John Tomaro is the director of the health programs for the Aga Khan Foundation, which is very active in Badakhshan.

He says the statistics still are so grim there because, “it takes a long time to really have a change in the maternal mortality ratio. There are a couple of techniques that will indicate whether or not we’re on the right course — that is that the maternal mortality ratio is going down. But it takes a significant amount of time to measure it. We do think, however, that we’ve begun to put in place some of the measures that will have an effect in reducing the ratio.”

One of the measures Tomaro’s group is working on is a community midwife school that recruits young women from the villages in Badakhshan.

“They have come to a school where they are introduced to a course which lasts 18 months, and they’re given basic midwifery training,” said Tomaro. “At the end of that, they go back to their villages. They work in what are known as basic health centers. They’re supervised very carefully by the staff there, and then they’re supervised on a twice annual basis by staff who comes out from the school, to make certain that what they’re doing is in compliance with the appropriate instruction. So we think it’s measures like that, measures like health promotion.

“Also some of the work that we’re doing in terms of introducing community nursing, that these will have an effect both on maternal health and will have an effect also on infant health as well.”

According to Tomaro, culture and tradition are the biggest barriers to change; but his organization and other NGOs believe education is the best solution.

“These are very traditional societies in which changing practices and changing beliefs takes an awful lot of time. But that’s a part of what we’re also trying to do by introducing a health promotion and disease prevention interventions. This is also what we’re trying to do in terms of introducing safe water programs and good sanitation programs, because these will have an effect on the status.

“We’re also heavily involved in education, and that’s education across the board. This is for boys, this is for girls, because we do need — clearly — there’s a clear correlation between the education of women, for example, and their health and the health of their children. So you have to proceed on multiple fronts and I think that’s what we, that’s what the government is interested in, and that’s what a lot of NGOs are doing.”

Tomaro says the local government supports, and is involved in, the efforts.

“I just came from a meeting with … Dr. Momin … the provincial health authority. He’s the man who represents the Ministry of Public Health here in Badakhshan. I would say two things: One, he’s very current on the issues and two, he’s very committed to using the means at his disposal in order to improve the situation. So I would give him very high marks.”

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