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Maternal Health in Afghanistan

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Joanna McNeilly

on 11 September 2013

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Transcript of Maternal Health in Afghanistan

photo credit Nasa / Goddard Space Flight Center / Reto Stöckli
By Joanna, Heather, and Winnie
Promoting Maternal Health in Afghanistan
A Global Issue
Our Video
Maternal mortality is defined as the death of a woman while pregnant, or within the time frame of forty two days postpartum
(Bartlett et al., 2005; World Health Organization, 2013).
Afghanistan in Action
-Afghanistan has recognized the severity of this global problem (Skolnik, 2012).
Maternal Health
"Every minute of every day a mother dies while giving birth due to poor maternal condition [in Afghanistan]" (Olinger & Trainer, 2012).
Three Delays Model
The Three Delays Model outlined by Hirose et al. (2011), identifies the barriers that women face in three main time periods of child birth including: decision to access care, transportation to a health facility, and receiving adequate treatment.
The Three Delays Model
Health Determinants
Afghanistan in Action
Nurse Recommendations
The Three Delays Model
(Hirose et al, 2011)
First Time Period

Second Time Period

Third Time Period
Nursing Recommendations
As nurses and global citizens it is our responsibility to address the global issue of maternal mortality by implementing interventions throughout our practice.
You are an 18 year old woman in Afghanistan, who is 35 weeks gestation and you have started progressing in labor. You notice a large amount of bleeding which you know to be abnormal. You recognize that you may need medical attention to save your life and your baby's life. When you arrive to the hospital, after two hours of traveling you are exhausted and light headed. You discover that there are only male physicians available and due to cultural reasons, your husband refuses for the male doctors to treat you. You are told that you need an emergency Caesarean section but the hospital does not have the equipment needed to perform the surgery....
How is maternal health in Afghanistan similar or different in comparison to Canada?
First Time Period

Begins at the occurrence of complications and ends at the decision to acquire care (Hirose et al., 2011).
Second Time Period

Takes place after the decision is made to acquire care and ends with the woman traveling to an appropriate health facility (Hirose et al., 2011).
The Third Time Period

Occurs when the woman arrives at the health facility to recieve treatment (Hirose et al., 2011).
Barriers of Determinants During the First Time Period
Education &
Families are not adequately educated about signs and symptoms of pregnancy complications, therefore they do not know when to seek medical attention (Bartlett et al., 2005).
The women are educated about complications however, they do not have the authority to make a final decision to seek care (Bartlett et al., 2005).
Males in the household often make the final decision but are are not educated on women's health (Bartlett et al., 2005).
Barriers of Determinants During the Second Time Period
Accessibility &
They have to endure a walk or ride that ranges from two hours to ten days in order to access appropriate medical facilities (Bartlett et al., 2005; Hirose et al., 2011).
Lack of roads, rugged terrain, unsafe weather conditions, and the threat of post-war residual mines that make travel by donkey or horse impossible (Ayotte, 2002; IRIN Humanitarian News and Analysis, 2013; Samar, 2004; Stanhope, 2008).
Barriers of Determinants During the Third Time Period
Gender &
Physical Environments
There is a lack of female physicians which creates a problem as many husbands do not want their wives to be treated by a male doctor (Viswanathan et al., 2012; Walther, 2010).
Conflicting Issue: Some women are not allowed to pursue post-secondary education, and those who do are required to quit when the get married to resume family life (Walther, 2010).
Physical Environments
During the Taliban reign many health care facilities, including emergency rooms and gynecology units were destroyed and midwifery schools closed (Hirose et al., 2011; Samar, 2004)
Only 10% of hospitals have Caesarean equipment (Bartlett et al., 2005).
A study showed that out of 357 women, 154 passed away due to maternal complications such as post-partum hemorrhage or obstructed labor (Ayotte, 2002)
Maternal mortality is a global issue that varies in severity throughout the world, with Afghanistan being one of the worst places to give birth
(IRIN Humanitarian News and Analysis, 2013; Skolnik, 2012; Stats Canada, 2011; Walther, 2010).
- Involved with organizations such as BRAC (Skolnik, 2012).
-In 2003, government introduced a basic package of primary health care services (For women and children) (Bartlett et al., 2005; Viswanathan et al., 2012).
-Levels of Prevention
The United Nations Fifth Millennium Development goal to be achieved by year 2015 was to improve maternal health (United Nations, 2003)
This goal has achieved the least amount of progress.....
Upgrading and expanding the roads while introducing the use of transportation vouchers for emergency obstetric care can reduce the cost and encourage them to seek care (IRIN Humanitarian News and Analysis. 2013; Hirose et al., 2011).
A way to promote cultural competence in care is to have male community health workers educate male family members on information pertaining to birth complications in order to increase access and willingness to use reproductive services (Viswanathan et al., 2012).
Implementing safe motherhood programs would function to empower women to reduce the social disparity between men, and increase social support in the community (Hirose et al., 2011).
A woman comes in in critical condition asking for care; however there are only male physicians available and her husband refuses to have her treated by the male physician. Do you continue to provide care against the cultural wishes of the husband in order to abide by the wishes of the woman who is asking for the care?
Afghanistan: mortality rate of 1800/100 000 live births each year (IRIN Humanitarian News and Analysis, 2013; Skolnik, 2012; Stats Canada, 2011; Walther, 2010).
Canada: mortality rate of 7.8/100 000 live births each year
(IRIN Humanitarian News and Analysis, 2013; Skolnik, 2012; Stats Canada, 2011; Walther, 2010).
As Global citizens, what can be done internationally, nationally, and locally in order to decrease the rates of maternal mortality and the factors causing these rates?
How might the scenario have been different if the woman was a Canadian resident?
(Olinger & Trainer, 2012)
Ayotte, B. (2002). Women's health and human rights in Afghanistan: continuing challenges. Journal Of Ambulatory care Management, 25(2), 75-77. Retrieved from http://web.ebscohost.com.login.ezproxy.library.ualberta.ca/ehost/pdfviewer/pdfviewer?sid=af96a2df-6086-4bfe-928d-d04f4ffca6fa%40sessionmgr15&vid=2&hid=24
Bartlett, L., Mawji, S., Whitehead, S., Crouse, C., Dalil, S., Ionete, D., & Salama, P. (2005). Where giving birth is a forecast of death: maternal mortality in four districts of Afghanistan, 1999-2002. Lancet, 365(9462), 864-870. Retrieved from http://ehis.ebscohost.com.login.ezproxy.library.ualberta.ca/ehost/pdfviewer/pdfviewer?sid=ac398e6a-4d23-4a5a-9639-e6c871afdc72%40sessionmgr110&vid=10&hid=115
Hirose, A., Borchert, M., Niksear, H., Alkozai, A., Cox, J., Gardiner, J., Somani, K. R., & Filippi, V. (2011). Difficulties leaving home: A cross-sectional study of delays in seeking emergency obstetric care in Herat, Afghanistan. Social Science & Medicine, 73(7), 1003-1013. doi:10.1016/j.socscimed.2011.07.011
IRIN Humanitarian News and Analysis. (2013). Afghanistan: maternal health needs more than healthcare. Retrieved from http://www.irinnews.org/Report/89419/AFGHANISTAN-Maternal-health-needs-more-than-healthcare
J Olinger & M Trainer. (2012, Oct 15). Global citizen: maternal health. Retrieved from
Samar, S. (2004). Despite the odds -- providing reproductive health care to Afghan women. New England Journal Of Medicine, 351(11), 1047-1049. doi: 10.1056/NEJMp048170
Skolnik, R. (2012). Health, Education, Poverty, and the Economy. In M, Gartside (Eds.). Global health 101 (pp.50-66). Burlington, MA: Jones and Bartlett Learning
Skolnik, R. (2012). Working Together to Improve Global Health. In M. Gartside (Eds.). Global 101 (pg. 335-361). Burlington, MA: Jones and Bartlett Learning
Stanhope, M., Lancaster, J., Jessup-Falcioni, H. And Viverais-Dresler, G. A. (2008). Community Health Nursing. In M. Van de Velde, D. Du Quesnay, R. Herbert, & S. Harrison (Eds.), Community Health Nursing in Canada (pp.11-13). Toronto, ONT: Elsevier Canada.
Stats Canada. (2011) Maternal mortality in Canada. Retrieved from http://www.phac-aspc.gc.ca/rhs-ssg/maternal-maternelle/mortality-mortalite/index-eng.php
United Nations (2013). Goal 5: improve maternal health. Retrieved from http://www.un.org/millenniumgoals/maternal.shtml
Viswanathan, K., Hansen, P. M., Hafizur Rahman, M., Steinhardt, L., Edward, A., Habib Arwal, S.,Peters, D. H., & Burnham, G. (2012). Can community health workers increase coverage of reproductive health services?. Journal Of Epidemiology & Community Health, 66(10), 894-900. doi:10.1136/jech-2011-200275
Walther, C. (2010). ‘Healthy women, better world’- tracking maternal, newborn, and child survival. Retrieved from http://www.unicef.org/infobycountry/afghanistan_53815.html
World Health Organization. (2013). Maternal mortality ratio (per 100 000 live births). Retrieved from http://www.who.int/healthinfo/statistics/indmaternalmortality/en/
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