Maternal Morbidity in Maidan Shar, Afghanistan

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Maidan Shar is an agricultural based city in the eastern part of Afghanistan in Wardak province. This area is plagued with insurgent activity and has been at war for several decades. There is one hospital, Swedish Committee for Afghanistan Provincial Hospital, which serves the population of approximately thirty-five thousand people. There is a forward operating base that is occupied by the Afghan National Security Force and the U.S. military. In this warring country its people are suffering the most, which is shown by current indictors such as maternal morbidity.

“Across Afghanistan, every two hours a woman dies due to pregnancy related causes. Under the current conditions, approximately one in 50 women in Afghanistan has a lifetime risk of dying due to pregnancy related causes.”http://www.unicef.org/afghanistan/health_nutrition_2179.htm

 

Causes of maternal deaths

The table shows the major causes of maternal morbidity which are the most common in third world countries. There are 3 major issues related to such a high maternal morbidity rate: 1. access to care, 2. poorly trained providers and 3.lack of supplies and medications to manage obstetric emergencies. Any western trained provider would be considered an expert in managing these conditions and the United States military should use their obstetricians that are deployed to the nearby forward operating bases to train their providers located at Swedish Committee for Afghanistan Provincial hospital. I am advocating for the use of currently available U.S. resources with supplementation of training materials through UNICEF. There are currently approximately 4 western trained military obstetricians in Afghanistan, who could be used to significantly improve the maternal morbidity through training midwives and birth attendants. The key to Afghanistan and its future stability and security is through its people.

Here are some links with more information

http://www.buddhasemptyplace.com/2012/05/29/reproductive-health-in-afghanistan/

http://tribune.com.pk/story/611875/brave-staff-but-grim-outlook-after-afghan-hospital-attack/

 

 

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4 Responses to “Maternal Morbidity in Maidan Shar, Afghanistan”

  1. sseopaul Says:

    An unfortunate and all too common issue plaguing many countries today, where bring life into the world can be a death sentence. For clarification are you advocating for a formal training program involving the US doctors and UNICEF training materials to train the local doctors, midwives and birth attendants? As in doctors, midwives and birth attendants who have already been trained through the local Afghan system, but it was probably inadequate training (so supplemental training) or a completely new training system?

    Maybe in this area some consideration should be given to a village health worker system, has had demonstrated success in other countries such as India. Of course special consideration would have to be given to the customs and culture in order to make this feasible.

  2. ksole1 Says:

    Thanks for posting about the maternal mortality situation in Afghanistan. As a US-trained OBGYN who has delivered a lot of babies both in the USA and Qatar, I wholeheartedly agree with the your idea of training birthing attendants, and if US and/or UN trained providers are already in the area, it would make sense to use the available resources. Unfortunately, training birthing attendants is not enough to decrease maternal mortality. Access to care and provision of supplies/medications are equally important. The best trained birthing attendant is quite helpless if a pregnant woman cannot get to the clinic or hospital, or there are no medications or equipment on site when she does arrive. This is such a complicated issue influenced by cultural taboos, the low social status of women, war, lack of infrastructure, inadequate training, insufficient funding, and low political will.

  3. deepskhanna Says:

    This is a topic very close to my heart,being a pediatrician and working in a government setup in India,i have witnessed a high number of maternal mortality and infant mortality.I totally agree with the idea of training people to become trained midwives and birthing attendants,despite that i still do believe we need more doctors even if they are medical graduates- after MBBS if not specialists like Gynecologists and pediatricians.I have seen many pregnant women being brought to the hospital right at the time of delivery or a few hours before with shooting blood pressures or Eclampsia which leaves doctors in a very stressful position.Spreading Awareness is one of the keys to bring this mortality down, and this can be achieved with the help of village health workers who can talk to pregnant women and explain to them how important it is for them as well as the baby to follow certain guidelines for a health and safe delivery.It can be a community driven intervention where the older people with power can be made to understand and the community can then contribute to medical supplies or have a midwife at all times or a transport system which will take all the pregnant women to the near by clinic once a month for checkups.

  4. elizabethchung2014 Says:

    As an OB/GYN here in the US and personally keeping in touch with colleagues who are deployed as military personnel around the world, I can wholeheartedly agree that more needs to be done. However, the few doctors usually have other responsibilities and would need more personnel/time and specific goals in order to set up programs for the local people. Training lay people or native healers would be the most effective given the shortage of resources and trained providers. Furthermore, the language and cultural barriers would also have to be addressed. As deepskhanna states, any sustainable change would have to be community driven with the elders in power supporting training and actively recruiting more resources. Without the community support, any change would be transient.

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