The Media Line, May 5, 2010
Afghanistan ‘Worst Country’ for Mothers
Lack of education, poor access to healthcare, malnourishment and no safe water all put Afghani mothers and babies at high risk, report says
By Rachelle Kliger
Afghanistan is the worst county in the world for a woman to be a mother, a new report says.
The Mothers’ Index in Save the Children’s report, State of the World’s Mothers 2010, compares the well-being of mothers and children in 173 countries and concludes that the well-being of mothers and children is at the highest risk in Afghanistan.
According to the report, social and cultural barriers often prevent women from visiting health providers, even when they know that they or their children are ill and need help. (Photo: USAID)
Norway, Australia, Iceland and Sweden received top rankings this year, while the bottom ten included mostly African and Middle Eastern nations.
Save the Children says that Afghanistan’s low ranking is a result of its record-high rate of under-five mortality; the lowest female life expectancy; and the worst gender disparity in primary education in the world.
The disparities are ever more apparent when comparing Afghanistan with Norway, which ranked the highest.
While skilled health personnel are present at virtually every birth in Norway, only 14 percent of births are attended in Afghanistan, creating a need for training more health workers. There is especially a need for more female health workers, who can help overcome problems caused by social or religious barriers and norms.
A typical Norwegian woman has more than 18 years of formal education and will liveto be 83 years old; 82% are using some modern method of contraception; and one in 132 will lose a child before the child’s fifth birthday.
By contrast, in Afghanistan a typical woman has just over four years of education and will live to be 44. Sixteen percent of women are using modern contraception, and more than a quarter of the children will die before their fifth birthday, meaning that every mother in Afghanistan is likely to suffer the loss of a child.
One in eight Afghani women will die during pregnancy or in childbirth and 78% of Afghanistan’s general population does not have access to safe water.
Thirty-nine percent of Afghan children are malnourished; and only two girls for every three boys are enrolled in primary school.
Nadia Hussein, a former U.N. human rights officer who traveled extensively in Afghanistan, said security problems also make it difficult for Afghani women to access healthcare.
“What struck me was how far the hospitals were and that women in rural areas had to travel hours and sometimes for days,” she told The Media Line.
“A lot if work has been done, but over the last three years the security and access has gotten worse, especially in rural areas. Training was being done and projects were out there, but delivering the services is a big problem for the NGOs and the U.N., so it’s a question of finding the appropriate organizations that can go into these areas,” she said.
Where personal safety is a concern, governments and international organizations must go the extra distance to ensure that female health workers do not have to risk their lives in order to do their jobs, the report said.
This has been applied in Afghanistan, where security has been provided to facilities where women health providers work at night. Male family members sometimes accompany female health workers when they travel.
Hussein said one area that needs special focus is midwifery. “It does exist but it’s used very traditionally and the midwives there are not necessarily trained in all areas. They also need to work within cultural guidelines and a lot of women are illiterate,” she said.
Afghanistan’s Ministry of Public Health, with support from USAID, has launched a program designed to rapidly train and deploy midwives to rural areas where there has been little access to formal health care, according to the report.
Since 2002, the number of midwifery schools in Afghanistan has increased from 6 to 31.
About 2,400 midwives have been trained and an additional 300-400 midwives are being trained each year. Most are employed by the government and NGOs across the country, servicing their home communities.
This has resulted in an increase in the percentage of women in rural areas of Afghanistan who are receiving pre-natal care, from 5% in 2003 to 32% in 2006.
Also, the number of deliveries attended by skilled personnel has increased from 6% to 19% during the same period.
According to the report, social and cultural barriers often prevent women from visiting health providers, even when they know that they or their children are ill and need help.
In many countries in South Asia, the Middle East and Africa, women typically are not empowered to make independent decisions. Husbands and elder family members often decide whether a woman may go for health care outside the home and this is especially apparent in rural areas.
As a result, women in these countries encounter hurdles by decision-makers within the household, even though they are usually the first to notice problems with their own health or the health of their children.
This can cause delays which can become life threatening for infants or for the mothers who experience complications during birth.
Also, if there is no female health care provider available, a woman can be denied permission to seek healthcare. The women themselves often choose to abstain from health care if the provider is male, due to embarrassment or social stigma.
In Afghanistan, for instance, women are unable or unwilling to receive potentially lifesaving tetanus toxoid vaccinations because it is considered shameful to expose their arm to a male vaccinator, according to the report.
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