1. Maternal Survival in Afghanistan: Progress and Challenges Mary Ellen Stanton Senior Maternal Health Advisor Bureau for Global Health, USAID Health in Afghanistan: How Can We Save Women’s Lives? Women’s Policy, Inc Canon House Office Building July 20, 2010

2. Health Situation (2001-2002)  Fertility 6.8 children/women  No access to health care services for 1/3 population  Crumbling health infrastructure  Vast human resource needs Photo: Linda Bartlett

3. Lifetime Risk of Maternal Death 1:8 Afghanistan 1:4,800 USA Source: WHO/ UNICEF/UNFPA, The World Bank. Maternal Mortality Estimates 2005, App 8, pub 2007 The chance of a woman dying as a result of pregnancy is 600 x greater in Afghanistan than it is in the United States.

4. Maternal causes of death in Afghanistan 4 regions (n=154), 1999-2002 Cause of deathLife Saving Interventions - Family planning Hemorrhage33%- Active management of the third stage of labor - Misoprostol Obstructed labor22%- Partograph - Cesarean section Pregnancy induced hypertension 8%- Calcium supplementation - Magnesium sulfate Sepsis5%- Tetanus toxoid - Infection prevention - Antibiotics Source: L Bartlett, 2002

5. Maternal Mortality and the Cycle of Poverty in Afghanistan

6. IndicatorPost- Taliban (2002) Current Situation (2009) Under-five mortality rate (deaths per 1,000 live births per year) 257/1,000191/1,000 (26% reduction) Access to basic services (% of population within 2 hours’ walk of a health facility) 9%64% Coverage of female health workers (% of facilities with a female health worker) 26%85% Use of antenatal services (% of pregnant women who use antenatal services) 5%32% Much has been achieved… much remains to be done

7. Ingredients of success for maternal and child health Government leadership Focus on rural health, equity BPHS: Basic Package of Health Services EPHS: Essential Package of Hospital Services Large-scale contracting capacity with NGOs Human resource policies Pharmaceutical policies Clinic construction Social marketing of health products Recruitment, training & support of female community midwives & community health workers

8. Looking ahead… Security Expanded attention to midwifery education Family planning — more services to meet unmet need Focus on quality improvement, especially at referral level – prevention & treatment of obstetric complications Accountability to communities – working with religious and community leaders – on availability and quality of interpersonal care Seizing the opportunities and developing strategy for innovation such as mobile health/telemedicine Measuring impact –RAMOS II a possibility –National survey — all cause mortality underway