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 overcome."
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 health workers.
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 the following:
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 and midwives.
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 antenatal care.
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.