A Needs Assessment of Health Issues Related to Maternal Mortality Rates in Afghanistan

Abstract

Maternal death rates in Afghanistan were among the highest in the world during the reign of the Taliban. Although these figures have improved, current rates are still alarming. The aim of this pilot study was to develop a needs assessment of the major health issues related to the high maternal mortality rates in Afghanistan. In-depth interviews were conducted with managerial midwives, clinical midwives, and mothers. Results of the interviews indicate that the improvement in the maternal mortality rate may be attributed to the increase in the involvement of midwives in the birthing process. However, barriers to decreasing maternal mortality still exist. These include transportation, access to care, and sociocultural factors such as the influence of the husband and mother-in-law in preventing access to midwives. Therefore, any programs to decrease maternal mortality need to address infrastructure issues (making health care more accessible) and sociocultural factors (including husbands and mother-in-laws in maternal health education). However, it should be noted that these findings are based on a small pilot study to help develop a larger scale need assessment.

Keywords

Afghanistan maternal mortality rates (MMR)midwives mothers needs assessment

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References

United Nations Children’s Fund. Afghanistan’s maternal and child mortality rates soar, www.unicef.org/media/media_27853.html (2005, accessed 14 February 2015).

WHO, UNICEF, UNFPA, The World Bank and UN. Maternal mortality in 1990–2010. Washington, DC: WHO, 2010.

Jokhio

Winter

Cheng

. An intervention involving traditional birth attendants and perinatal and maternal mortality in Pakistan. N Engl J Med 2005; 352: 2091–2099.

Maine

Rosenfield

. The safe motherhood initiative: why has it stalled? Am J Public Health 1999; 89: 480–482.

Miller

Sloan

Winikoff

. Where is the “E” in MCH? The need for an evidence-based approach in safe motherhood. J Midwifery Women’s Health 2003; 48: 10–18.

Sibley

Ann Sipe

. What can a meta-analysis tell us about traditional birth attendant training and pregnancy outcomes? Midwifery 2004; 20: 51–60.

Schroeder

. We can do better—Improving the health of the American people. N Engl J Med 2007; 357: 1221–1228.

Woolf

Johnson

Phillips

. Giving everyone the health of the educated: an examination of whether social change would save more lives than medical advances. Am J Public Health 2007; 97: 679–683.

McGinnis

Williams-Russo

Knickman

. The case for more active policy attention to health promotion. Health Aff (Millwood) 2002; 21: 78–93.

10.

Walsh

. Afghanistan’s midwives tackle maternal and infant health. Lancet 2007; 370: 1299.

11.

Egmond

Bosmans

Naeem

. Reproductive health in Afghanistan: results of a knowledge, attitudes and practices survey among Afghan women in Kabul. Disasters 2004; 28: 269–282.

12.

Currie

Azfar

Fowler

. A bold new beginning for midwifery in Afghanistan. Midwifery 2007; 23: 226–234.

13.

Campbell O, Graham W, Maternal survival series steering group. Strategies for reducing maternal mortality: getting on with what works. Lancet 2006; 368: 1284–1299.

14.

Fullerton

Severino

Brogan

. The international confederation of midwives’ study of essential competencies of midwifery practice. Midwifery 2003; 19: 174–190.

15.

Bartlett

Mawji

Whitehead

. Where giving birth is a forecast of death: maternal mortality in four districts of Afghanistan, 1999–2002. Lancet 2005; 365: 864–870.

16.

ICM/WHO/FIGO. International definition of the midwife 1992, http://mana.org/definitions.html#Definition (2013, accessed 14 February 2015).

17.

Speakman

Shafi

Sondorp

. Development of the community midwifery education initiative and its influence on women’s health and empowerment in Afghanistan: a case study. BMC Women’s Health 2014; 14: 1–12.