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Mother & Child Morbidity &Mortality Rates in Afghanistan

Summary

Moderator: Dr Mohammad Bashaar- Afghanistan

Discussion Period: 20-24 Aug 2008

Discussion Participants: Dr. Vijay Thawani, Dr. Shazia Jamshid, Dr.Sayed Zia-ur-Rahman, Dr. Santosh, Chetna Desai and Anupama

Overall Health Situation:

Decades of conflict and human displacement, compounded by3 years of drought, have had a severe impact on Afghanistan’shealth sector. The health infrastructure was damagedthroughout the country; health workers disappeared withoutbeing replaced, and demand for care increased at anexponential rate. high vulnerability to natural disasters, fooddeficit, limited safe water supply, poor standards of hygieneand sanitation, and restricted access to health care for womenand girls have become important features of the situation inAfghanistan, exacerbated by difficulties of geographic accessand by the limited delivery capacity of the existing healthfacilities, As might be expected, information is scarce butsufficient evidence exists to point to priorities in terms ofburden of disease and local resources and capacity. Thegeneral health outlook of the Afghan people was bleak. Lifeexpectancy at birth was 47 years for men and 45 years forwomen. The country was suffering from very high levels ofchild and maternal mortality – the under-five year old mortalityrate was 257/1,000 live births/year, and the maternal mortalityratio was estimated at 1,600/100,000 live births/year, amongone of the highest in the world. All these are adding to thecomplexity of health sector development.

Back in 2002 the challenges facing the Ministry of PublicHealth (MOPH) included an infrastructure that had beenalmost entirely destroyed, lack of professionals and a paucityof health services to the population. The role it adopted, then,was to be a steward of the health sector. Six years ago, in2002, if a child in a village in Afghanistan was very ill andneeded to see a doctor, there was rarely a nearby facility orhealth worker to which the mother could take the child. Therewas a great chance that the child would die.The health sector is gradually being re-established by theAfghan Government with the help of the internationalcommunity. The health services inherited at the end of 2001

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were limited in capacity and coverage, and while the Ministryof Health has shown leadership and stewardship, the healthstatus of the Afghan people is still among the worst in theworld. The majority of the population lacks access to safedrinking water and sanitary facilities. Disease, malnutrition andpoverty are prevalent and an estimated 6.5 million peopleremain dependant on food aid.The World Bank, the United States Agency for InternationalCommunity are helping the Afghan Ministry of Health, throughNGOs, to provide a basic healthcare service to the entirepopulation devoid of any discrimination. The Basic Packagefor Health Services (BPHS) consists of services for maternaland newborn health; child health and immunisation; nutrition;communicable disease; mental health; disability; and thesupply of essential drugs. The Ministry of Health hasestablished a Child and Adolescent Health Department and aDepartment of Women and Reproductive Health to tackle highinfant and maternal mortality rates.

Definition of Maternal Mortality:

Maternal mortality is defined as the death of a woman whilepregnant or within 42 days of termination of pregnancy fromany cause related to or aggravated by the pregnancy or itsmanagement. Maternal morbidity is any illness or injurycaused or aggravated by, or associated with, pregnancy orchildbirth.

Mother & Child Morbidity & Mortality Facts:

The crisis in reproductive health care is the leading cause ofmaternal mortality and reflects a destructive chain reaction thatbegins for Afghan women at a dangerously early age. A studyshowed that most Afghan women were forced into marriagebefore they were 16, with some as young as nine. Theconsequences are steep, impacting the young girl’s physicaldevelopment and general health as well as her chances foreducation.

Pregnant women must cope with poor nutrition and scarcity offood in Afghanistan. Weakened by malnutrition, they arevulnerable to anemia while lactating, and this puts their bodiesat higher risk for hemorrhaging. Vitamin deficiencies lead toscurvy, while iodine deficiencies cause goiters in mothers anda thyroid condition called cretinism in their babies.

Underlying these challenges is the fact that few Afghanwomen know how to recognize danger signs duringpregnancy. For those who do, lack of money andtransportation make getting to a hospital all but impossible. If

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contribute to a considerable reduction in maternal and infantmortality rates.

“Research shows that birth spacing saves lives by allowingmothers to space their children to healthier intervals, improvingthe lives of women and their children,” UNFPA said. “Accessto contraceptives empowers women. It can also save theirlife.”

Poor health services

Afghanistan’s Public Health Ministry says basic health servicesreach up to 85 percent of the country, but only 18 percent ofdeliveries were attended by skilled birth attendants in 2007,UNFPA’s statistics show.

Most pregnant women do not have access to skilled healthcare and obstetric services due to a lack of awareness, access

problems and/or men’s unwillingness to take females to healthcenters.

“The key to better maternal health lies with the men, who haveto be sensitive to the health problems and the needs ofwomen,” Penumaka said.

Early marriages

Up to 50 percent of Afghan girls get married before they are15; some are married at the age of eight or nine, UNFPA hasfound.

Consequently many young mothers, who also have littleaccess to health care, nutrition and other services, die due topregnancy-related complications.

Early marriages also contribute to high infant mortality rates;165 in every 1,000 infants die before their first birthday,according to UNICEF.

Maternal Mortality and Morbidity – Larger Implications

Maternal mortality has immediate and serious consequences

for young children. The risk of death for a mother’s childrenunder age five can increase by as much as 50 percent if themother dies in some less developed countries. Maternalmortality continues to affect the woman’s children as theybecome older.

Comprehensive safe motherhood package, which are madefor the better treatment and safety of mother during pregnancyand at the time of delivery, which includes:

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• Education and information services comprisecommunity education about safe motherhood,education about pregnancy danger signs andcomplications, and reproductive health and familyplanning information and services for adolescents andadults.

• Prevention services include nutrition and vitaminsupplement counseling, prenatal and general healthcare and monitoring, and screening and treatment forSTDs, HIV and other infections.

• Subsequent to skilled assistance during childbirth,follow-up care encompasses care for complicationsand emergencies, and postpartum care.

• Safe abortion and postabortion services are alsocomponents of Safe motherhood and women’s healthinitiatives have had great success.

The way forward- Reducing Morbidity and Mortality inAfghanistan

• Improve the quality of maternal and reproductive healthcare through strengthening the delivery of care,especially emergency obstetric and gynecological careand of routine reproductive health services.

• Improve the quality of child health interventions throughintroducing integrated management of childhoodillnesses (IMCI) and enhancing the control of vaccinepreventable diseases.

• Strengthen the management of cost effectiveintegrated communicable disease control programmesthrough capacity building and effective guidelines andsupervision.

• Ensure effective delivery of nutritional interventionsthrough the basic package of health services andsocial marketing.

Compliments:

I would like to thank all NETRUM colleagues and especiallythose who took active part and contributed to the discussionMother & Child Morbidity & Mortality Rates in Afghanistan

My special gratitude goes to Dr. Vijay Thawani for hiskindness, insights, candor and perpetual support and wouldlike to express my gratefulness to Dr. Shazia Jamshid, Dr.Sayed Zia-ur-Rahman, Dr. Santosh, Chetna Desai andAnupama for their valuable inputs.

I recommend, that, please go through the attached files, sent by Dr. Shazia Jamshid, if you want to know moreabout Mother & Child Morbidity & Mortality Rates in Afghanistan.

Thanks and Best Regards

Mohammad BashaarAfghanistan