Maternal Survival in Afghanistan: Progress and Challenges

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Maternal Survival in AfghanistanProgress and
Challenges

• Mary Ellen Stanton
• Senior Maternal Health Advisor
• Bureau for Global Health, USAID
• Health in Afghanistan
• How Can We Save Womens Lives?
• Womens Policy, Inc
• Canon House Office Building
• July 20, 2010

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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
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Lifetime Risk of Maternal Death
14,800 USA
18 Afghanistan
The chance of a woman dying as a result of
pregnancy is 600 x greater in Afghanistan than it
is in the United States.
Source WHO/ UNICEF/UNFPA, The World Bank.
Maternal Mortality Estimates 2005, App 8, pub
2007
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Maternal causes of death in Afghanistan 4
regions (n154), 1999-2002
Cause of death Cause of death Life Saving Interventions
- Family planning
Hemorrhage 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 Source L Bartlett, 2002 Source L Bartlett, 2002
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Maternal Mortality and the Cycle of Poverty in
Afghanistan
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Much has been achieved much remains to be done
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
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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

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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