Mother & Child Morbidity & Mortality Rates in Afghanistan
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 by 3 years of drought, have had a severe impact on Afghanistan’s health sector. The health infrastructure was damaged throughout the country; health workers disappeared without being replaced, and demand for care increased at an exponential rate. high vulnerability to natural disasters, food deficit, limited safe water supply, poor standards of hygiene and sanitation, and restricted access to health care for women and girls have become important features of the situation in Afghanistan, exacerbated by difficulties of geographic access and by the limited delivery capacity of the existing health facilities, As might be expected, information is scarce but sufficient evidence exists to point to priorities in terms of burden of disease and local resources and capacity. The general health outlook of the Afghan people was bleak. Life expectancy at birth was 47 years for men and 45 years for women. The country was suffering from very high levels of child and maternal mortality – the under-five year old mortality rate was 257/1,000 live births/year, and the maternal mortality ratio was estimated at 1,600/100,000 live births/year, among one of the highest in the world. All these are adding to the complexity of health sector development. Back in 2002 the challenges facing the Ministry of Public Health (MOPH) included an infrastructure that had been almost entirely destroyed, lack of professionals and a paucity of health services to the population. The role it adopted, then, was to be a steward of the health sector. Six years ago, in 2002, if a child in a village in Afghanistan was very ill and needed to see a doctor, there was rarely a nearby facility or health worker to which the mother could take the child. There was a great chance that the child would die. The health sector is gradually being re-established by the Afghan Government with the help of the international community. The health services inherited at the end of 2001
were limited in capacity and coverage, and while the Ministry of Health has shown leadership and stewardship, the health status of the Afghan people is still among the worst in the world. The majority of the population lacks access to safe drinking water and sanitary facilities. Disease, malnutrition and poverty are prevalent and an estimated 6.5 million people remain dependant on food aid. The World Bank, the United States Agency for International Community are helping the Afghan Ministry of Health, through NGOs, to provide a basic healthcare service to the entire population devoid of any discrimination. The Basic Package for Health Services (BPHS) consists of services for maternal and newborn health; child health and immunisation; nutrition; communicable disease; mental health; disability; and the supply of essential drugs. The Ministry of Health has established a Child and Adolescent Health Department and a Department of Women and Reproductive Health to tackle high infant and maternal mortality rates. Definition of Maternal Mortality: Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to or aggravated by the pregnancy or its management. Maternal morbidity is any illness or injury caused or aggravated by, or associated with, pregnancy or childbirth. Mother & Child Morbidity & Mortality Facts: The crisis in reproductive health care is the leading cause of maternal mortality and reflects a destructive chain reaction that begins for Afghan women at a dangerously early age. A study showed that most Afghan women were forced into marriage before they were 16, with some as young as nine. The consequences are steep, impacting the young girl’s physical development and general health as well as her chances for education. Pregnant women must cope with poor nutrition and scarcity of food in Afghanistan. Weakened by malnutrition, they are vulnerable to anemia while lactating, and this puts their bodies at higher risk for hemorrhaging. Vitamin deficiencies lead to scurvy, while iodine deficiencies cause goiters in mothers and a thyroid condition called cretinism in their babies. Underlying these challenges is the fact that few Afghan women know how to recognize danger signs during pregnancy. For those who do, lack of money and transportation make getting to a hospital all but impossible. If
she does manage to recognize the signs, acquire transportation, survive the broken roads and reach a hospital, the care and facilities a pregnant woman would find would almost certainly be inadequate, if not downright dangerous. An expert of the UN Population Fund (UNFPA) warned; “Afghanistan has the highest fertility rate in Asia - 6.7 - which not only means the deaths of thousands of young mothers and infants every year but also poses long-term challenges” Ramesh Penumaka, UNFPA’s country representative, said the average Afghan woman gives birth to 6-7 children and if this trend were to continue Afghanistan’s current estimated population of 26 million would surpass 56 million by 2050. “If the fertility rates are not reduced, Afghanistan’s population will more than double by 2050; from 47th most populous country, Afghanistan would become the 31st most populous country in the world,” Penumaka said. A substantial increase in the population rate would more than double demand for land and water, exacerbate pressure on the infrastructure and adversely affect the environment, experts said. “Continued rapid population growth poses a bigger threat to poverty reduction in most countries than HIV/AIDS,” the UNFPA said in a statement on World Population Day, 11 July. The UNFPA said slower population growth would help the least developed countries like Afghanistan to invest properly in children’s health, education and progress, and reduce the maternal and infant mortality rate, as well as HIV infection rates. High maternal mortality After Sierra Leone, Afghanistan has the highest maternal mortality rate in the world with at least 1,600 deaths per 100,000 live births, according to UNFPA and the UN Children’s Fund (UNICEF). “That is a staggering 24,000 women dying every year, and 87 percent of them [deaths] are preventable,” Ramesh Penumaka told reporters in Kabul on 14 July. Lack of access to obstetric and health services, early marriages and multiple short-term pregnancies are the main reasons why about 60 mothers die every day. UNFPA said birth intervals of at least 36 months would
contribute to a considerable reduction in maternal and infant mortality rates. “Research shows that birth spacing saves lives by allowing mothers to space their children to healthier intervals, improving the lives of women and their children,” UNFPA said. “Access to contraceptives empowers women. It can also save their life.” Poor health services Afghanistan’s Public Health Ministry says basic health services reach up to 85 percent of the country, but only 18 percent of deliveries were attended by skilled birth attendants in 2007, UNFPA’s statistics show. Most pregnant women do not have access to skilled health care and obstetric services due to a lack of awareness, access problems and/or men’s unwillingness to take females to health centers. “The key to better maternal health lies with the men, who have to be sensitive to the health problems and the needs of women,” Penumaka said. Early marriages Up to 50 percent of Afghan girls get married before they are 15; some are married at the age of eight or nine, UNFPA has found. Consequently many young mothers, who also have little access to health care, nutrition and other services, die due to pregnancy-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 children under age five can increase by as much as 50 percent if the mother dies in some less developed countries. Maternal mortality continues to affect the woman’s children as they become older. Comprehensive safe motherhood package, which are made for the better treatment and safety of mother during pregnancy and at the time of delivery, which includes:
Education and information services comprise community education about safe motherhood, education about pregnancy danger signs and complications, and reproductive health and family planning information and services for adolescents and adults. Prevention services include nutrition and vitamin supplement counseling, prenatal and general health care and monitoring, and screening and treatment for STDs, HIV and other infections. Subsequent to skilled assistance during childbirth, follow-up care encompasses care for complications and emergencies, and postpartum care. Safe abortion and postabortion services are also components of Safe motherhood and women’s health initiatives have had great success.
The way forward- Reducing Morbidity and Mortality in Afghanistan • Improve the quality of maternal and reproductive health care through strengthening the delivery of care, especially emergency obstetric and gynecological care and of routine reproductive health services. Improve the quality of child health interventions through introducing integrated management of childhood illnesses (IMCI) and enhancing the control of vaccine preventable diseases. Strengthen the management of cost effective integrated communicable disease control programmes through capacity building and effective guidelines and supervision. Ensure effective delivery of nutritional interventions through the basic package of health services and social marketing.
Compliments: I would like to thank all NETRUM colleagues and especially those who took active part and contributed to the discussion Mother & Child Morbidity & Mortality Rates in Afghanistan My special gratitude goes to Dr. Vijay Thawani for his kindness, insights, candor and perpetual support and would like to express my gratefulness to Dr. Shazia Jamshid, Dr. Sayed Zia-ur-Rahman, Dr. Santosh, Chetna Desai and Anupama for their valuable inputs.
I recommend, that, please go through the attached files, sent by Dr. Shazia Jamshid, if you want to know more about Mother & Child Morbidity & Mortality Rates in Afghanistan. Thanks and Best Regards Mohammad Bashaar Afghanistan