Afghan Women Die Giving Birth at Staggering Rate

, Nov.6, 2002

UNITED NATIONS (Reuters) - Women in war-shattered Afghanistan are dying during childbirth at a staggeringly high rate, U.N. and U.S. researchers reported on Wednesday, recommending broad improvements in maternal health care.

While maternal death rates vary considerably from region to region and are significantly higher in rural areas than in cities and towns, they are overall among the highest in the world, the researchers found.

In rural Badakshan province in northern Afghanistan, mothers are dying while giving birth at the highest rate ever documented -- 6,500 maternal deaths for every 100,000 live births, according to their survey.

Widespread women’s rights violations are partly to blame for high maternal mortality rates in Afghan women, according to a study appearing in the September 11 issue of the Journal of the American Medical Association. Researchers from Boston’s Brigham and Women’s Hospital and Physicians for Human Rights interviewed 4,886 women from the northwestern Afghan province of Herat. They estimated that 593 out of 100,000 Herati women die during pregnancy or childbirth. Countrywide, Afghan maternal mortality rates are the second highest in the world (Sierra Leone is highest) with 1,700 deaths out of 100,000 Afghan pregnancies compared to 12 out of 100,000 in the US.

Study Author Dr. Lynn Amowitz explained that trained professionals and medical facilities and supplies are scarce, plus many roads are inaccessible in the war-ravaged nation. In Herat, 35 physicians serve a population of 793,214. No hospitals exist in 20 of Afghanistan’s 31 provinces. Amowitz also cited the lack of women’s rights in hindering women’s access to medical care and family planning. In some cases, husbands force their wives to deliver in their own homes, because the culture considers treatment by strangers in public places “shameful.” “What appears to be simply a public health catastrophe in Herat Province also speaks to the many years of denial and deprivation of women’s rights in Afghanistan,” Amowitz said in a statement.

In addition, the study also noted that 80 percent of the women interviewed considered sex with their husbands obligatory. Nearly half said that a husband had the right to physically abuse his wife for disobedience

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September 12, 2002

"Among the women who died in this study, about 87 percent of maternal deaths were considered preventable," said the study conducted jointly by the U.N. Children´s Fund UNICEF and the U.S. Centers for Disease Control and Prevention.

The United Nations is guiding the rebuilding of Afghanistan, with significant financial help from Washington, after decades of internal warfare, years of drought and a U.S.-led bombing campaign that drove the Taliban from power after the Sept. 11, 2001, hijack attacks on the United States

The research team visited some 13,000 families in four Afghan provinces, Badakshan in the north, Kandahar province in southern Afghanistan and Kabul and Laghman provinces in eastern Afghanistan.

Researchers first identified those families in which a woman between 15 and 49 years old had died between April 1999 and March 2002, and then sought to identify the cause of death through interviews.

Access to any type of health care at all was a key gauge of maternal survival. While in Kabul, there was at least one functioning maternity hospital, health care access in Badakshan was "profoundly limited," the study found.

The high death rate for mothers also had profound implications for their children, the researchers reported.

A newborn baby had only one chance in four of surviving until its first birthday if its mother died in childbirth, the study found. "Most of these infants died in the first month of life from acute malnutrition due to lack of breast milk."

Only 5 percent of the women studied could read or write and only 36 percent of the families interviewed owned a radio, the researchers found.

In addition to generally improving health services and increasing access to skilled caregivers, they recommended that women be taught ahead of time about healthy pregnancies and delivery and be screened for preventable causes of maternal complications such as pre-eclampsia, malaria and anemia.

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