Title: Maternal Survival in Afghanistan: Progress and Challenges
1Maternal 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
2Health 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
3Lifetime 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
4Maternal 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
5Maternal Mortality and the Cycle of Poverty in
Afghanistan
6Much 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
7Ingredients 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
8Looking 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