- The Washington Times - Thursday, July 30, 2009

One in eight women die in childbirth in Afghanistan. This statistic prompted a gathering of congressional representatives, foreign diplomats and leaders of U.S. nonprofit organizations on Capitol Hill this month to address the issue.

The briefing, which drew Afghan Minister of Public Health S.M. Amin Fatimie, was considered a major effort between the U.S. and Afghanistan governments to address maternal mortality in the war-torn country.

Two panels, made up of three speakers each, addressed about 250 people, including members of Congress and their staffs.

Women’s Policy Inc., a nonprofit, nonpartisan, public policy organization, works closely with women in Congress to stage monthly briefings on key policy issues, such as July’s event, “Maternal Health in Afghanistan: How Can We Save Women’s Lives?” The gathering was made possible by a grant from the Bill and Melinda Gates Foundation.

The U.S. Agency for International Development (USAID) and Jhpiego, an international nonprofit health organization affiliated with Johns Hopkins University, participated. USAID has focused on supporting the Afghan Society of Obstetricians and Gynecologists and other midwifery-education programs. Jhpiego offers prenatal care, skilled birthing services, newborn care, emergency obstetrics and postpartum hemorrhage care, among many other services.

Afghanistan has the second-highest maternal mortality rate in the world - with 80 percent of the deaths preventable if women had access to primary care and basic obstetrics, according to UNICEF. Maternal death is primarily caused by postpartum hemorrhage, or excessive bleeding after childbirth, according to Jhpiego. The condition, Jhpiego says, can be easily treated with clinical care or with an inexpensive drug called misoprostol.

Jhpiego called misoprostol “a viable component in a comprehensive global strategy” for preventing postpartum hemorrhage.

“When a woman has to die in the process of giving life, that is not acceptable,” Harshad Sanghvi, vice president of technical leadership and innovation and medical director for Jhpiego, said during his panel speech.

Prenatal education for women would reduce infant mortality by 50 percent, according to Mr. Fatimie, and the training of midwives would increase the safety of both the mother and the infant.

The Afghan Midwives Association was represented by its president, Pashtoon Azfar, in the second panel. The association has grown from five midwifery-education programs in 2002 to 27 in 2009, and has deployed 85 percent of its midwives successfully into their own communities.

In 2005, the association held its first congress in Kabul, adopting a constitution and electing officers, and has been accepted by and registered with the Afghan government, according to Jhpiego. The association was admitted into the International Confederation of Midwives in 2006 and works closely with USAID.

Mrs. Azfar said more than 5,000 midwives are needed to staff health clinics throughout Afghanistan.

Paula J. Dobriansky, who served as undersecretary for democracy and global affairs in President George W. Bush’s administration, listed several ways in her address in which the U.S. could make a difference: health education, supporting midwifery programs and hospitals.

USAID senior maternal health adviser Mary Ellen Stanton asked for support of the Afghan government’s “very wise” programs that will have a great effect on public health. “They made a decision early on to work in rural areas and … further expanding access for those areas,” she said.

The only way to know whether quality improvement is being made is by looking at the birth ratio, Mrs. Stanton said. The maternal mortality ratio in Afghanistan is 1,600 deaths out of 100,000. In the United States, it’s eight deaths out of 100,000.

Amanda Baker is a writer residing in Washington.

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