This week, my colleague Gayle Lemmon and I published a new Council on Foreign Relations report, “Maternal Health in Afghanistan.” With all the bad news coming out of that country, it was refreshing for us to write about glimmers of hope on the maternal health front. Yes, the statistics are still grim: one out of eleven Afghan women is likely to die in childbirth during her lifetime; Afghan women are 200 times more likely to die giving birth than by a bomb or bullet. Not surprisingly, Save the Children this year ranked Afghanistan the worst country in the world to be a mother. Yet, there are some positive signs. Over the past decade, the international community has made some important investments to improve maternal care that are now just beginning to pay off.
At the heart of maternal health improvements in Afghanistan is a successful, thriving, and cost-effective midwifery program. In 2002, Afghanistan had fewer than 500 midwives, and less than 10 percent of pregnant women received any prenatal care. Today, the country has more than 2,400 midwives, and approximately 20 percent of pregnant women receive prenatal care. The number of midwifery schools has increased from five in 2002 to thirty-two serving every province today. Central to the success of the midwifery programs has been the community support they have garnered, even in Taliban-heavy areas. Building up the program has taken significant time and effort. The midwifery school in Bamiyan did not receive a single applicant for months after opening in 2004. Now it receives hundreds of applications. Fathers, brothers, and husbands are supportive of their female relatives attending because they have come to appreciate how midwives support their communities.
In addition to positive health outcomes, midwifery programs offer an entry point for girls and women to gain an education, earn an income, and increase their mobility. Midwifery is an important mechanism for women’s empowerment, especially in the countryside where few opportunities exist for women to find respectable work outside their homes.
When we started researching this topic, one of the questions we posed was can investing in maternal health in Afghanistan help improve the country’s stability? Given that maternal health improvements not only save lives, but also demonstrate the effectiveness of government, we think yes, and urge a continuation of support for these critical programs. Building on the gains already achieved in maternal health should be part of a responsible drawdown in Afghanistan. I hope you have a chance to read the report and let us know what you think.