Over her lifetime, an Afghan woman has a one in 12 chance of dying in childbirth.
The Other Afghan Tragedy
We've seen the pictures and read the headlines. Tens of thousands of Afghans crammed in ramshackle refugee camps on the Pakistan border. Winter is here. Food and shelter are needed. People are dying and it could get worse unless foreign donors act quickly.
But did you know that nearly half of the deaths in the refugee camps are mothers dying from causes related to pregnancy or childbirth? That's right problem pregnancies and deliveries in some of the most squalid conditions imaginable. Poor sanitation. Few doctors. Midwives, yes, but little or no medicine.
According to colleagues who are in the camps sent by the United Nations to prioritize health needs 46 percent of these maternal deaths are due to hemorrhage after birth.
This preventable tragedy is associated with giving birth too young, too old, and too often. And this takes us to the cultural dimensions of this story factors that add to the impoverished conditions and exacerbate these tragic health trends.
The women in the camps, like women across Afghanistan, have had few choices in their reproductive lives. Thirty percent of the women in the camps have eight children or more. Contraception, while not forbidden under Islam, is very limited. In Afghanistan, marriage usually takes place right after young women reach sexual maturity. The birth rate is probably over seven children per woman, one of the world's highest.
All these factors being a wartime refugee, squalid living conditions, no health care and cultural assumptions limiting reproductive options combine to make Afghanistan one of the most dangerous places for women to be pregnant in the world.
The World Health Organization estimates that during the Taliban rule, maternal mortality that's death from pregnancy or childbirth doubled to 1,700 per 100,000. An Afghan woman has a one in 60 chance of dying every time she has a baby. Over her lifetime, she has a one in 12 chance of dying in childbirth. That mortality rate far exceeds most battlefields where men fight. As many as 16,000 Afghan women will die from pregnancy, childbirth, and abortion this year. This number exceeds the number of men, women and children who have died in the post-Sept. 11 bombing and fighting, as terrible as that has been. But there are no television cameras recording these deaths. This tragedy is a consequence of a culture that puts women's health issues far behind the priorities of men.
My colleagues in the refugee camps report only 10 percent of women have contraception, while 48 percent say they want to avoid pregnancy in the near future. That's a notable and striking figure, coming from women who've learned to say little as they've lived under one of the most extreme male-dominated cultures.
Under the reconstruction efforts now underway, officials from the UN and other groups say preventing maternal mortality will be given high priority. But realistically, it will take years to train the needed professionals and to rebuild basic services. Meanwhile, the most effective way to help women will be to make contraception available around the country.
Many Westerners want to see women emerge in leadership roles in Afghanistan. That's laudable, and I agree, but I'd like to help women where they are now most vulnerable. That means preventing the unnecessary deaths during pregnancy and childbirth, especially among refugees, and then more widely, giving women means to space their pregnancies.
The Afghan women have many needs, of which family planning is only one. But this long overdue freedom, the ability to determine whether and when to have a next child, is critical to the health of these women and their families. Without it, most hoped-for benefits of political change will be beyond their reach.
Family planning doesn't just save lives, it enables them to begin again.
Martha Campbell , Ph.D., is co-director of the Center for Entrepreneurship in International Health and Development at the University of California-Berkeley's School of Public Health
Copyright 1999-2001 The Florence Fund
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