USAID Maternal and Neonatal Health Programs in Afghanistan

The health status of Afghanistan is among the worst in the developing world. More than 20 years of war and conflict have created a humanitarian crisis and denied the people of Afghanistan, particularly their children, a safe and healthy life. Currently, 40 percent of deaths among women of childbearing age in Afghanistan are caused by preventable complications related to childbirth. In addition, an estimated one in four children dies before reaching their fifth birthday.

Over her lifetime, a woman in Afghanistan is more than 400 times more likely to die as a result of pregnancy and childbirth than a woman in the United States. In Afghanistan's Badakshan province, the maternal death rate is the highest ever recorded in human history -- 6,500 deaths for every 100,000 live births.

Childbirth is riskier than many deadly diseases. Particularly in Afghanistan, which has inadequate basic facilities to care for normal and complicated deliveries, inadequate supplies of medication and equipment for complicated pregnancies and births, requirements of traditional society that women deliver at home, and lack of transportation to hospitals in urban centers and poor roads in rural areas.

Leading factors in infant and child mortality include diarrhea, acute respiratory infections, malaria and micronutrient deficiencies/malnutrition. Major causes of maternal mortality include hemorrhaging and obstructed labor, and malnutrition. Lack of access to adequate health care, especially for women and children, remains a widespread problem in Afghanistan and is particularly acute in rural areas.

The youngest Afghans die from cholera, diarrhea, dysentery, malaria, pneumonia, polio and tuberculosis-opportunistic diseases that often follow chronic undernourishment. Thousands die at birth.

The United States has financed health care programs in Afghanistan totaling more than $87 million. These programs include the provision of basic and preventive health care services to families living in remote areas, training women as health care workers, community midwives and midwives; maternal/neonatal tetanus immunizations; and improving the quality of care in district and provincial hospitals.

The U.S. supports basic health services in 250 health clinics; each clinic averages 989 patients per month, primarily women and children, totaling 247,000 patients served monthly. Overall, the U.S. has provided basic health services to about 7 million people in 13 provinces. Most of the recipients are women and children.

The U.S. Agency for International Development (USAID) has taken a lead role in rebuilding the country’s health infrastructure, and training and equipping a new cadre of health care providers by supporting midwifery training, and the training of health workers at all levels, including physicians, nurses, community health workers and others. This rapid effort improves women’s access to skilled birth attendants, basic essential obstetric services, family planning services and antenatal and postpartum care, as well as increasing the numbers of health workers and improving their skills at all levels.

USAID is also supporting curriculum development to rapidly increase the numbers of skilled female maternal and newborn health care providers for women to access.

Reconstruction assistance has been heavily invested in the restoration of health facilities, with an emphasis on small rural clinics. In the health field, working with the Afghan Ministry of Health, USAID has established the goal of opening and staffing a functioning health clinic within four hours travel of every part of Afghanistan's scattered and isolated rural population.

In addition, USAID helped re-establish a functioning Ministry of Health through capacity building and policy development. USAID also supports the private sector distribution of health-related products through the vibrant system of private pharmacies. This includes the sale of oral rehydration salts (ORS) for dehydration due to diarrhea, clorin for purification of drinking water, bednets for prevention of malaria, and a variety of contraceptives.

To date, other health sector achievements in Afghanistan include the rehabilitation of 72 health clinics, birth centers and hospitals; the vaccination of 4.2 million children against measles and polio, likely preventing some 20,000 deaths; providing basic health services to more than 2 million people in 21 provinces -- 90 percent being women and children.

Sources:

Management Sciences for Health (MSH) is a private, non-profit organization that works collaboratively with health care policy makers, managers, providers, and clients worldwide to improve the delivery of health services through the application of practical management tools.

JHPIEGO Corporation, a not-for-profit Johns Hopkins University affiliate that works in more than 30 countries to improve health care access for women and their families.

Physicians for Human Rights (PHR), based in Boston, MA, mobilizes the health professions to promote health by protecting human rights.