There is much more to maternal mortality in Afghanistan than the appalling statistics as Mahri Zohra Haider explains

Statistics on maternal mortality in Afghanistan are among the worst in the world, second only to Sierra Leone. There are 1,800 maternal deaths per 100,000 live births (or one maternal death for every 55 births) and Afghan women have a one in eight lifetime risk of maternal death. (1) The average birth rate is 6.75 children per woman and every pregnancy is associated with a risk of death that is 600 times greater than that of a woman who is pregnant in North America. (2) Although the problem of maternal deaths in Afghanistan is clear in the numbers, the solutions lie in the details beyond the numbers. However, all too often the majority of effort is spent on dissecting the problem, with merely an afterthought to what can actually be done. One study designed to verify the above statistics concluded that “deaths could be averted if complications were prevented through improvement of general health status” and if “complications that occurred were treated to reduce their severity.” (3) These recommendations are vague and fail to draw attention to the specific challenges of addressing maternal mortality in Afghanistan. (more…)

 Islean Kinghorn discusses the public health implications of this emotive issue

WHO defines unsafe abortion as ‘the termination of an unintended pregnancy either by persons lacking the necessary skills or in an environment lacking the minimal medical standards, or both.’ (1) According to their statistics 19.7 million women a year undergo unsafe abortions, contributing to 13% of maternal deaths worldwide. (2) If we are to achieve Millennium Development Goal 5 of reducing maternal mortality ratio by ¾ we must address the taboo of unsafe abortion.

The consequences of unsafe abortion on a woman’s health are many. Some such as haemorrhage or infection lead to mortality, while others, including pelvic inflammatory disease, can leave women with chronic pain and an increased risk of obstetric complications or infertility.(3) Such morbidity, easily avoided with safe practice, places a staggering strain on health systems, diverting scant resources from other essential programmes. It has been estimated that each year 5.2 million women are hospitalised worldwide due to complications following unsafe abortion. (4) The global cost to health systems could be as high as US$ 1.08 billion annually. (5) However it is not only the direct but indirect costs, through loss of productivity and the vulnerable position of motherless children, that burden society. (more…)

 Rachel Pope uses the story of a woman she interviewed in Tanzania to highlight the complex issues involved in the lack of appropriately trained health workers

Pili (her name has been changed to protect her privacy ) is a 27 year old woman from the Kara tribe. (1) She only made it to grade three in school, and was married at age 18. She was also 18 the first time she gave birth, but unfortunately for Pili, she does not have any children to this day due to complications in both of her labours that resulted in an obstetric fistula. (An obstetric fistula is the result of prolonged and obstructed labor. In cases where the fetus cannot pass through the birth canal safely, the constant pressure of the fetal skull in the birth canal reduces blood supply to the tissues, causing the tissues to disintegrate.  Fistulas - or holes - develop, resulting in constant leaking of urine and/or feces through the vagina.) (more…)