Afghanistan has one of the highest rates of maternal mortality in the world: 327 out of every 100,000 women who give birth die during childbirth. Despite some recent improvements, political, social, cultural, and economic factors present enormous challenges. Last month, the Center for Population and Development Activities hosted an online viewing and dialogue discussion of the PBS Independent Lens film Motherland Afghanistan, which follows Afghan-American filmmaker Sedika Mojadidi and her father, Dr. Qudrat Mojadid, as they return to their home country and visit the Laura Bush Maternity Ward in Kabul. The conditions they find are devastating and underscore not only the need for greater commitment to reproductive health services, but also the advancement of women’s and girl’s access to education, security, and political participation.
Like most health facilities in Afghanistan, Dr. Mojadid found that the ward lacks sufficient human resources and adequate health supplies. Health care workers were limited, most with out-of-date skills, and no functional training. “Most of these doctors don’t have the basic knowledge to take care of their patients. They’re so thirsty for just one word of wisdom, but there’s nobody to give them that,” he says.
According to the United Nations Population Fund (UNFPA) only 14 percent of births in Afghanistan are attended by a skilled healthcare worker. Qualified birth attendants ensure a continuum of care through pregnancy and birth, leading to healthier mothers and children. One strategy to address the human resource shortages in places like Afghanistan is to expand and acknowledge the skills and responsibilities of non-physician health workers through task-shifting (redistribution of tasks to persons with a baseline set of skills). Task-shifting can help lighten the load, but trained midwives are essential, as panelist Jeffrey Smith, regional technical director for Asia Jhpiego pointed out during the Wilson Center’s Advancing Dialogue to Improve Maternal Health series.
“The most important decision made early in the reconstruction [of] Afghanistan was that midwives would be the backbone of the reproductive health workforce and they would be empowered with the skills to perform the tasks necessary for provision of basic emergency obstetric care,” said Smith.
Due to population growth and existing shortfalls, the UNFPA estimates that Afghanistan needs an additional 4,000 midwives in order to attain a 95 percent skilled birth attendance by 2015. Although it is a long road to progress, the government of Afghanistan has worked with UNPFA and other international donors such as USAID to create the first National Policy and Strategy for Nursing and Midwifery Services, which provides nurses and midwives with a comprehensive education and skillset to address preventable causes of maternal deaths.
While improving the overall health system is imperative to decreasing maternal mortality rates in Afghanistan, I found it impossible to ignore the cultural and political backdrop of Motherland Aghanistan’s setting. Forced marriages, lack of education and political participation, violence, insecurity, and patriarchal cultural norms clearly play a large role.
Women for Afghan Women – a women’s rights organization based in Kabul and New York – joined the video discussion and had a strong message about the prospects for women in ongoing negotiations with insurgents. “Afghan women have been left out of any formal talks,” said Executive Director Manizha Naderi:
We are trying to get our voices heard by doing media interviews and speaking anywhere we can. We are against any form of negotiation with the Taliban because they can’t be trusted. Our position against negotiating with the Taliban does not mean we are giving in to a permanent war or that we want war. It means we look for strategies that are not destined to failure before the ink is dry on the settlement pages.
The most important point is that the subjugation of women is not a sidebar, something that can be avoided through negotiations, it is the linchpin of Taliban strategy, having nothing to do with religion. The subjugation of half a country is the straightest path to subjugating the whole. Just forbid women from going to work or school or leaving the house without a mahram (male escort), beat them with whips or guns on the street because a square inch of ankle shows below the burkha, drag a few into the Kabul stadium, force them to their knees and shoot them in the head, and a terrorized country will submit.
Although we believe women must be at all negotiations and decision making tables, we also believe these negotiations are doomed to failure. They have not worked in the past, they will not work in the future. Let’s invest our considerable energies and experience in other solutions to the Afghan situation. Security, infrastructure, economic, and civic development are essential for Afghanistan as well as advancement of women’s and girls’ economic, educational, health, civic participation, and political rights. Funding from NATO countries is necessary to secure these goals.
Just this April, Afghan Minister of Health Suraya Dail said at the Wilson Center that “the gains we have made [in reducing maternal mortality rates] are remarkable; however, gains are fragile and donor resources are declining. Substantial investments must be maintained to safeguard these hard-wins.” The film reiterates her point.
Indeed, exposés like Motherland and the work of photographer Lynsey Addario, who presented at the Wilson Center last year, show the precariousness of women’s rights and development in ways that statistics and politicking sometimes mask.
Sources: MEASURE DHS, PBS, UNFPA, World Health Organization.