Joint Press Release
Afghanistan is among worst places on globe for women's
health, say UNICEF and CDC
NEW YORK / KABUL, 6 November 2002 - Surveys conducted
by UNICEF and the U.S. Centers for Disease Control and
Prevention (CDC) in four parts of Afghanistan have found
that Afghan women suffer from one of the highest levels
of maternal mortality in the world, with almost half of
all deaths among women aged 15 to 49 coming as a result
of pregnancy and childbirth.
UNICEF Executive Director Carol Bellamy said the surveys
- the largest of their kind ever conducted in Afghanistan
- reveal an "ongoing humanitarian tragedy for Afghan
women and children, one that needs to be publicized and
US Department of Health and Human Services Secretary
Tommy G. Thompson, who recently visited Afghanistan, said,
"War and the Taliban have devastated Afghanistan
and its medical infrastructure, and the nation's health
challenges are most serious for its women and children.
The United States is committed to reversing these heartbreaking
conditions and to helping restore health to the women
and children in Afghanistan." The US Department of
Health and Human Services oversees the CDC.
The surveys, conducted jointly by UNICEF and CDC, cover
four provinces ranging from rural to urban settings: Kabul,
Laghman, Kandahar and Badakshan. The research was carried
out between March and July 2002, together with the Afghanistan
Ministry of Health and with support from female Afghan
The surveys found an average of 1,600 maternal deaths
per 100,000 live births - a figure that suggests Afghanistan
may well be the worst place in the world for a woman to
become pregnant. Globally, little progress has been made
in reducing maternal mortality. An estimated 515,000 women
still die each year as a result of pregnancy and childbirth.
"For the Afghan women of childbearing age included
in our surveys, the leading cause of death was pregnancy
and childbirth," said Linda Bartlett, M.D., a medical
officer with CDC's reproductive health program and leader
of the surveys. "These women are dying needlessly.
Most of these deaths could have been avoided, which suggests
important opportunities for prevention."
In some remote regions, UNICEF and CDC health workers,
including Bartlett, traveled house-to-house for several
days on horseback to interview families about the deaths
of women in their communities. The report examines data
from 13,000 households, where family members provided
information on an estimated 85,000 women. Families were
asked about causes of death among women of reproductive
age who died during the years 1999 to 2002.
"These extraordinary surveys speak volumes about
the challenges facing women and girls in Afghanistan,"
Bellamy said. "Taliban restrictions on women, coupled
with 20 years of war, have set back women's health status
immeasurably. With new leadership and ongoing assistance
from the international community, Afghanistan has a prime
opportunity to reverse this record, starting now. But
investment in basic health care will only be beneficial
to women if they are supported in accessing that care."
Link Between Mothers and Children
In issuing the report today at UNICEF headquarters, the
two agencies stressed that maternal mortality is not just
a "woman's problem." The study revealed that
when the mother of a newborn infant dies, the child has
only one chance in four of surviving until its first birthday.
"The loss of a mother at birth is one of the most
traumatizing and critical events of a child's life,"
Bellamy stated. "Maternal mortality not only affects
women, it affects children, fathers, families and entire
communities. Maternal mortality is arguably the most neglected
health problem in the world," she said.
Additional findings of the report:
- Most maternal deaths were preventable.
- Only 7 percent of women who died gave birth with
the help of a skilled birth attendant.
- Many of the women who died were between the ages
of 20 and 29. Only 4 per cent of them were literate;
26 per cent of their husbands were literate.
- Maternal mortality rates varied substantially by
region, reflecting differences in access to resources
and health care between urban and rural areas.
As a result of the findings, UNICEF and CDC recommended
- Establishing health care services in remote areas
properly equipped with essential drugs and equipment,
with capacity to undertake cesarean sections, assisted
delivery, and safe blood transfusions, and with efforts
to increase women's use of such support services.
- Training skilled female birth attendants, nurses
- Providing education programmes for women and their
families to help them recognize the signs of normal
as well as abnormal pregnancies and pregnancy complications.
- Providing treatment for complications such as pre-eclampsia,
anemia and malaria and increasing access to quality
- Building and repairing roads to improve access to
health care facilities in rural areas.
"It is terrible that women are dying in the act
of giving birth," said UNICEF Representative Eric
Laroche, who leads UNICEF's country program in Afghanistan.
"UNICEF is deeply committed to helping Afghanistan
improve the health of women and children, and a key to
progress is lowering maternal deaths. This must be a priority."
Background on the situation of children in Afghanistan:
Millions of Afghans, at least half of them children,
are at high risk. Under-five mortality in Afghanistan
is estimated at about 257 per 1,000 live births, or one
in every four children. This is the fourth highest child
mortality rate in the world after Sierra Leone, Angola
and Niger. Meanwhile, one of every two Afghan children
is malnourished and an estimated 40 per cent of children
die from diarrhoea and acute respiratory infections. Clean
water and adequate sanitation facilities are also in short
supply -- with only 13 per cent of the population with
access to safe drinking water and 12 per cent with access
to adequate sanitation facilities.