Maternal Health in Afghanistan
Six years ago, the reality of Afghanistan’s maternal mortality rate (MMR) sent shockwaves through the international health community, and resolving the issue became a key priority in the interim government’s strategy. The poor state of maternal health in Afghanistan is due to a range of medical factors as well as social, political, economic and environmental determinants. To address the situation, Afghanistan’s Ministry of Health (MoH) introduced a nation-wide health service-focused package to help improve the health of the population. This essay will explore three key aspects of the government’s basic package of health services (BPHS) strategy: health service delivery, skilled birth attendants and community participation. These will be looked at through the lens of both the comprehensive and selective models of health care, and will determine which models have been utilized in the development of the BPHS. Current health situation When the Taliban’s rule ended in 2002, it left a country devastated by more than two decades of war. The health care system was nonexistent and today the maternal health situation remains poor. In 2002, Bartlett et al (2002) reported that in Afghanistan there are 1,600 maternal deaths per 100,000 live births, giving rise to one of the worst MMRs, an indicator of overall maternal health, in the world. This risk increases for women in rural areas with Bartlett et al (2002) reporting 6,500 deaths per 100,000 births in the rural province of Badakhshan. Factors influencing the poor health status of women There are numerous medical factors that can be attributed to the appalling state of maternal health in Afghanistan. Current research shows that 90% of births take place in the woman’s home rather than a health care centre and, furthermore, skilled birth attendants are present at only 20% of births (United Nations Development Plan 2008). This is primarily due to a lack of skilled female health care workers (HCWs). Additionally, women rarely receive pre-, or, postnatal checkups and there is a severe lack of emergency and obstetric services, particularly in rural regions (Turner 2006). Other medical reasons for the high
MMR include: unsafe abortions, limited access to family planning, malnutrition, tuberculosis and mental health problems. Afghanistan’s high MMR is only partly explained by medical factors; underlying this crisis is a complex web of political, economic, environmental and social issues. Afghanistan’s health service distribution is extremely imbalanced. The majority of women in rural areas have no access to obstetrics care, which is especially alarming considering 80% of women live in rural regions (Turner 2006). Afghanistan’s culture, specifically the low social position of women, has played a key role in the maternal health crisis. Strict religious and cultural beliefs have led to a lack of communication and education regarding reproductive medicine and sexual health, which has created a group of women with no knowledge regarding maternal health and certainly no believe that they have a right to adequate health care (Millennium Development Goals Oversight Committee 2005). There is also still a strong cultural preference for women to be seen by female HCWs, which given the shortage of these often leads to women not being attended to by any HCW (Dott et al 2005). Other aspects of Afghanistan’s culture, such as family violence and the absence of belief in the empowerment of women, further contribute to an already disastrous situation (Wali et al 1999). Further still, other factors, including: environmental, a drought destroyed the livestock and farming industry upon which communities depend (Turner 2006); education, literacy rates are low, especially among women where country-wide only 9% are illiterate (Mayhew et al 2008); severe poverty; ongoing violence and fundamentalist ideas; early age of marriage; and, finally, poor...