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Maternal Mortality in Afghanistan: A Way Forward

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Today, when we think of Afghanistan, a cauldron of chaos comes to mind: massive international counterinsurgency and counternarcotics operations, countless NGOs struggling to maintain neutrality and operational integrity amidst the militarization of aid and development, and the sheer deprivation of dignity suffered by the overly-occupied Afghan people, among other such indictments of the international community's historic and present-day involvement. While these issues continually make above-the-fold headlines, today is International Women's Day (IWD), and I wish to highlight yet another travesty in Afghanistan: maternal mortality.

With more than half a million women dying each year from largely preventable complications related to pregnancy and childbirth, Afghanistan is now ranked second worst in the world when it comes to maternal mortality behind Sierra Leone. In fact, in 2006, Badakhshan province in northeast Afghanistan had the worst incidence of maternal mortality ever recorded in history. According to UNICEF, Afghanistan's maternal death rate is 1,800 per 100,000 live births, compared to the U.S. rate, which is 11 per 100,000. While those of us living in free and open societies would agree that the rights of women in Afghanistan are in dire straits, we must also agree that this particular situation demands special attention. Indeed, with regard to these statistics, President of CARE USA Dr. Helene Gayle famously stated, "We have to stop being polite about this issue - we need to start marching in the streets. Post-partum hemorrhage is a nice way of saying we let women bleed to death."

Addressing this challenge is compounded in difficulty when we begin to understand the landscape of the geography, culture, history, and politics of Afghan society. Intermittent access to basic healthcare and education; religious influence, tribal lines, customs and tradition; and living in perpetual states of war and occupation make it particularly difficult to approach the problem of maternal mortality. But there is hope on the horizon.

In a previous piece I wrote on the Aga Khan Development Network (AKDN), which focused on their efforts with regard to women and girls in Afghanistan and Pakistan, I made note of their 18-month midwifery training program. Developed in Badakhshan province, the program is showing signs of success in both health promotion and education, in addition to their community nursing initiatives. Efforts of this sort will have an effect on both maternal and infant health explained John Tomaro, Director of Health Programs for the Aga Khan Foundation (AKF), to the BBC. Intensive training of this nature is not the only method to achieving lasting and positive health outcomes; educating the populace on the use and benefits of contraception can also make an enormous difference.

With Afghanistan averaging more than six babies per woman and UNICEF estimating that a mere 10 percent use some form of birth control, improving such damning statistics may not be as hard as it seems. Just last week, the World Health Organization's journal, Bulletin, published a study conducted in 2005-2006, which involved 3,700 families in three rural areas with different ethnic groups, including both Sunni and Shia Muslims. In this case, the Health Ministry collaborated with nonprofit organizations to spread the word that using contraception was 300 times safer than giving birth in Afghanistan. The results of the study indicated that over the course of eight months, the use of the pill, condoms and injected forms of birth control rose to 27 percent in all three areas -- and up to half of the women in one area -- once the benefits were explained one-on-one by health workers. "The fastest, cheapest, easiest way to reduce maternal deaths in Afghanistan is with contraception," said lead author Dr. Douglas Huber to the Associated Press.

Funded by the William and Flora Hewlett Foundation and conducted for the U.S.-based nonprofit Management Sciences for Health, the report noted that the key to such societal shifts rested largely in the hands of the mullahs -- local religious leaders. Quotes were used from the Quran to promote breast-feeding for two years, while mullahs joined community and health leaders to explain the importance of spacing out births to give mothers and babies the best chance at good health. "All the mullahs at the community level knew of these things that the Prophet Muhammad himself advised his followers," Huber continued. "This was not a hard sell."

But it is certainly a long process. Great strides have been made in bringing the plight of women to the forefront of societal awareness and policy debates around the world since IWD first began in 1911, and one upcoming forum in particular vows to carry the baton even further. Positioning women's maternal and reproductive health as a global priority, the Women Deliver 2010 conference is being held June 7-9 in Washington, D.C. It expects a lineup of government officials, experts and advocates destined to attract national and international headlines, including Hillary Clinton, Ban Ki-moon, Sarah Brown, and Melinda Gates, among many others. In an interview with Jill Sheffield, the founder of Women Deliver, she said, "Women are an asset to their families, to their communities, and to their economies. On the eve of the G8 summit, the Women Deliver conference will seek to reinforce the idea that investing in women makes economic sense as well as good common sense, mobilizing historic action on this issue and bringing it directly to policymakers."

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