Success in reducing maternal and child mortality in Afghanistan

Abstract

After the collapse of the Taliban regime in 2002, Afghanistan adopted a new development path and billions of dollars were invested in rebuilding the country's economy and health systems with the help of donors. These investments have led to substantial improvements in maternal and child health in recent years and ultimately to a decrease in maternal and child mortality. The 2010 Afghanistan Mortality Survey (AMS) provides important new information on the levels and trends in these indicators. The AMS estimated that there are 327 maternal deaths for every 100,000 live births (95% confidence interval = 260-394) and 97 deaths before the age of five years for every 1000 children born. Decreases in these mortality rates are consistent with changes in key determinants of mortality, including an increasing age at marriage, higher contraceptive use, lower fertility, better immunisation coverage, improvements in the percentage of women delivering in health facilities and receiving antenatal and postnatal care, involvement of community health workers and increasing access to the Basic Package of Health Services. Despite the impressive gains in these areas, many challenges remain. Further improvements in health services in Afghanistan will require sustained efforts on the part of both the Government of Afghanistan and international donors.

Bypassing Primary Care Facilities for Childbirth: Findings from a Multilevel Analysis of Skilled Birth Attendance Determinants in Afghanistan

“…Antenatal care may increase the likelihood of skilled birth attendance by introducing women and their families to the formal health system and by increasing knowledge of danger signs of obstetric complications that can only be addressed with timely care seeking . The increased odds of skilled birth attendance seen with literacy and higher wealth status are also consistent with national and global findings . Education has been shown to have a consistently positive dose‐response effect on maternal health service utilization and similar associations with all types of health behavior …”

“…Health services help to reduce maternal morbidity and mortality, and the decline in maternal mortality in Afghanistan is largely attributed to increases in skilled birth attendance achieved through investments in health infrastructure, midwifery education, and provision of a standardized package of priority health services. Substantial disparities exist within the country, however, and the vast majority of women still do not have access to consistent, high‐quality maternity care …”

Trends in infectious disease incidence among children in Afghanistan at a time of public health services expansion

“…Table 3 (15). These investments, aimed at improving service delivery, especially for women and children (16), have produced results that may be associated with reduced childhood morbidity, including: a reduction of almost threequarters in the maternal mortality rate (17), which is attributed to better antenatal and postnatal care (18); an increase of 4000% in the number of births attended by a skilled birth attendant (7); and improved family planning services (19). Another relevant development may be the improvements in water supply, sanitation and hygiene.…”

U.S. Health Diplomacy in Afghanistan: A Development Tool in Health System Reconstruction of a Fragile and Conflict-Affected State

“…In response to Afghanistan's historical deficit of female health workers, and with the consent of the MoPH, a former international health consultant noted that USAID was a galvanizing force in uniting the respective initiatives of other external donors wherein NGOs recruit midwives and other female allied health professionals from neighboring territories such as Tajikistan (International public health consultant and former independent consultant to USAID, personal communication, October 15, 2014). The proliferation of community health workers and rural health facilities has led to a larger percentage of women delivering at health clinics, greater access to ante-and postnatal care, further utilization of nutrition programs, and expanded immunization coverage and communicable disease surveillance for children (Rasooly et al, 2014;Mayhew et al, 2014;Ikram et al, 2014). Therefore, U.S. health diplomacy has had a considerable impact on improving health outcomes for women and children (Former Senior Afghanistan and Pakistan Health Officer of USAID, personal communication, September 23, 2014), as the MMR has been reduced five-fold (Afghan Public Health Institute, 2011), the respective IMR and under-five mortality (U5MR) rates being decreased by 60% (Afghan Public Health Institute, 2011), and life expectancy at birth has risen from 42 years to 62 years since 2002 (Murphy, 2013).…”