Islam and Maternal Mortality in Afghanistan: A Religious and Cultural Approach to Saving Lives

"When Afghan people are given instruction based on their religious values, they will listen and accept," explained Maulawi Amanudin, an official in Afghanistan's Ministry of Religious Affairs. Using religious values is essential when trying to change behavior in a devout society like Afghanistan. "The Afghan people believe in resolving issues from a religious perspective," said Mawlawi Saddiq, a senior Supreme Court official. Religious teachings can serve as a tremendous lever for societal change, particularly for convincing men to promote women and children's health. "Having a healthy mother and a healthy family is what it means to have a healthy marriage in Islam," Saddiq noted. "Our religion clearly states that there should be 30 months between births to protect the health of children and mothers. When our religious leaders and communities understand that this is what the prophet Muhammad says, then all the misconceptions that exist within families can be resolved and dealt with."

A faith-based education initiative launched in 2007 by the Afghan Ministry of Women's Affairs, the UN Population Fund (UNFPA) and the Asia Foundation has evolved from its original goal of reducing domestic violence by emphasizing healthy family relationships to its current aim of reducing maternal and infant mortality. Involving religious leaders is a key component, for which reason the Ministry of Religious Affairs and the Supreme Court were brought into the campaign. The effort illustrates UNFPA's culturally sensitive approaches in advancing women's health and rights, which is a focus of the 2008 UNFPA report titled Reaching Common Ground: Culture, Gender and Human Rights -- required reading for human rights activists and government policymakers alike itching to understand and engage discriminatory social policies or practices in developing societies. Activating local religious and community leaders to address misconceptions of Islam from a health perspective, including the belief that using contraception is forbidden, paves the way in societies where faith and daily life are lived one and the same.

With global estimates indicating that up to 35 percent of maternal deaths could be averted by preventing unintended pregnancies, addressing the contraception crisis in Afghanistan is urgent -- only 10 percent of Afghans use some form of birth control and the average Afghan woman rears six children. The involvement of society's elders is critical for any maternal health intervention to be successful. In fact, in December 2009, a study was published by the U.S.-based nonprofit Management Sciences for Health discussing exactly this kind of intervention. Following the education and engagement of religious leaders, some mullahs began distributing condoms while others quoted the Quran to encourage longer breaks between births. According to the report, use of the pill, condoms and injected forms of birth control rose to 27 percent over eight months in three rural areas -- with up to half the women in one area using birth control -- once the benefits were explained one-on-one by health workers.

"Regretfully, the UN for many years has often presented culture as an insurmountable obstacle, when in reality, culture has both positive and negative attributes. Indeed, we can invoke the positive to change the negative," UNFPA Executive Director Thoraya Obaid said recently at the Women Deliver conference in Washington. As the first Saudi Arabian woman to receive a government funded scholarship to study in the United States nearly 50 years ago, Obaid has firsthand experience of how religion and culture profoundly chart the course of one's life. "I'm here because my father interpreted Islam to promote women," she said.

While Afghanistan's overall maternal mortality rate stands at 1,800 deaths per 100,000 live births, one province is also home to the worst maternal mortality rate in recorded history: 6,500 per 100,000 in the province of Badakshan. The U.S. rate is 11 per 100,000. In other words, giving birth in Badakshan is 600 times more deadly than giving birth in the United States. One in 15 Badakshani women die of pregnancy-related causes not simply due to poor health infrastructure, limited transport, rugged terrain, and extreme weather, but equally due to the lack of maternal education, unchallenged cultural practices, and misinterpretations of Islam. Dying to give life is not merely an international "silent scandal" in the words of UN Secretary General Ban Ki-moon, but it is a true felony on the criminal record of modern civilization.

Recently, Melinda Gates announced a new $1.5 billion, five year commitment from the Gates Foundation to support maternal and child health, family planning, and nutrition programs in developing countries, with a portion of the funds dedicated to conducting social and behavioral research on promoting lifesaving practices. In light of the successful engagements described above, I would hope the Foundation dives into the research and practice of educational interventions grounded in faith as they continue to fight maternal and infant mortality worldwide. With 70 percent of the world identifying themselves as members of a religious or spiritual community, and with 40 to 50 percent of healthcare in developing countries provided by faith-based organizations, religious conviction is the largest untapped means to promote and advance women and children's health around the world.

For more articles by Rahim Kanani, click here.