• Afghanistan's maternal mortality figures: too good to be true?

Afghanistan's maternal mortality figures: too good to be true?

03 December 2015

By the end of 2015, international leaders and donors are likely to claim achievement of some Millennium Development Goals (MDGs). Experts state that Afghanistan’s claims of a massive reduction in maternal mortality and of achieving MDG 5a are most likely premature, and misleading about the reality of Afghanistan’s maternal health.

An analysis paper, commissioned and written by BAAG member HealthProm, with BAAG's support, has found that MDG 5a is unlikely to have been reached in Afghanistan, as claimed by a survey quoted by the Afghan government and international donors. That survey may be flawed and does not provide conclusive proof of such a drastic reduction. Maternal mortality remains a serious issue in Afghanistan.

The paper reports that a USAID-funded Afghanistan Mortality Survey in 2010 may include information that has been derived from questionable practises in the survey methodologies, including the use of untrained and largely illiterate substitute surveyors in insecure areas.

Findings based on a 2002 survey and the 2010 survey show a significant change in maternal mortality in Afghanistan. It reports a decrease in maternal mortality from 1,600 women per 100,000 live births to 327, over the span of just eight years. The analysis paper titled, ‘Maternal mortality reported trends in Afghanistan: Too good to be true?’ states that there are ‘significant reasons to be sceptical of the figures generated by the survey.’

The paper, published on our website, has been written by three international maternal mortality specialists and Dr. Stewart Britten of HealthProm.

Afghanistan is one of the deadliest countries in the world for expectant mothers.  Much of the population lives in remote or mountainous areas, sometimes four or more hours journey on foot or by donkey to the nearest health facility. In 2010 two-thirds of deliveries still took place at home.  These are without the support of a trained and skilled birth attendant.    

 ‘A fall as steep as signified by these two surveys has never occurred in any country, except in industrialised countries related to the discovery of antibiotics,’ the paper notes, adding 'in Sri Lanka and Malaysia, which made massive investments in maternal and reproductive health care and were major successes, such progress took five to six decades.' Yet the 2010 survey claims this success in war-ravaged Afghanistan in just 8 years.

“I have worked in and visited Afghanistan since 1997,” states Rachel Arnold, a British midwife.

“My experience of women’s healthcare provision includes remote mountainous areas, provincial hospitals and the large tertiary Kabul maternity hospitals,” she continues. “I am convinced that there will have been a significant reduction in maternal mortality over the last decade. With the authors of the paper, however, I suggest that it is most likely that the reported maternal mortality ratio is ‘too good to be true.’”

She adds, “Family matters are very private in Afghan society, especially when it involves female members of the family. In my opinion it is likely that some families will not talk openly to strangers about the death of female relatives, especially if surveyors are not health professionals or skilled researchers.”

Dr Stewart Britten said he believes, from HealthProm’s work in Afghanistan, that maternal mortality can be rapidly reduced.  

“However, this relies not just on improving health services,” he states. “It also needs improvement of transport, decent roads and awareness by villagers of specific risks – and these improvements are not happening fast enough in Afghanistan to enable the drastic reduction of maternal mortality claimed.”

As world leaders begin to take stock of the Millennium Development Goal achievements, now is the time to celebrate some progress in reducing maternal mortality in Afghanistan - but it is not the time to claim success and provide an opportunity for donors to walk away from Afghan mothers.

Without a true understanding of the reality of motherhood in Afghanistan, the efficacy of maternal health programmes cannot be measured.  Those, like HealthProm, who work on the ground to support these vulnerable women and girls, know that ongoing support is needed.