Archives for February 2017

Maternal death rates in Afghanistan may be worse than previously thought

 Unpublished research from the UN Population Fund suggests the country’s maternal mortality figures may be higher than reported writes  Sune Engel Rasmussen in Kabul

For years, declining death rates among pregnant women have been hailed as one of the great gains of foreign aid in Afghanistan.

In reality, however, Afghan women dying in pregnancy or childbirth may be more than twice as high as numbers provided by donors would suggest.

Since 2010, published figures have shown maternal mortality rates at 327 for every 100,000 live births, a significant drop from 1,600 in 2002. Yet recent surveys give a different picture.

In one unpublished study, the Afghan government found an average level of maternal deaths between 800 and 1,200 for every 100,000 live births, according to aid workers in Kabul who have seen the research.

If accurate, this would mean that women in Afghanistan – despite more than 15 years of international aid aimed at improving maternal mortality figures – may be dying from maternal complications at rates similar to those found in Somalia and Chad, and only surpassed by South Sudan.

In another review, the UN Population Fund (UNFPA) found as many as 1,800 maternal deaths a year in the remote Afghan province of Ghor. Nine out of 11 provinces had higher death rates than the number normally used by donors.

Both the UNFPA mortality numbers and the government’s own survey have yet to be released. A spokesman for the ministry of public health said the survey was not ready to be publicised yet, and declined to discuss findings.

The country’s emphasis on training midwives in recent years is slowly building numbers. Yet, despite this improved capacity, driving up numbers of health personnel is only half the solution, according to Bannet Ndyanabang, UNFPA’s Afghanistan representative: “Training is not the only thing. They have to be deployed in the areas where they are needed. It doesn’t matter that you have health centres if they’re not staffed with skilled personnel. [Midwives and nurses] have to be given incentives to work in rural areas.”

One reason for the discrepancy in the figures is a lack of reliable data. Collecting such information in Afghanistan is notoriously difficult. Worsening security prevents even officials from the ministry of public health, let alone foreigners, from travelling to rural areas.

In a recent audit of $1.5bn (£1.2bn) donated by the US to Afghan healthcare, the Special Inspector General for Afghanistan Reconstruction – the US congressional watchdog – criticised the use of unreliable data to prop up claims of progress in Afghanistan.

According to Sigar, “missions are required to be transparent and communicate ‘any limitations in data quality so that achievements can be honestly assessed’. In all cases Sigar reviewed, USAid did not disclose data limitations.”

Sigar said similarly selective data use lay behind USAid claims that life expectancy in Afghanistan has risen by 22 years. More recent surveys by the World Health Organization show relatively modest increases of six and eight years for men and women respectively.

A USAid spokesperson said: “In Afghanistan, a country suffering from decades of conflict, reliable health and population data is scarce and difficult to obtain. USAid strives to use the best available data for programming decisions and invests to improve data quality for measuring progress. This commitment includes our continued support for independent nationwide surveys on the state of the health sector. These surveys, and the methodology they use, are publicly available.”

More reliable data is available, however.

While numbers used by international donors were based on samples from three of the 360 districts in existence at the time, the UNFPA survey was much more extensive, covering 70% of households in 11 of the country’s 34 provinces.

The UNFPA did not survey southern and eastern provinces, where rates are almost certainly high because conflict and poor infrastructure make healthcare inaccessible to millions of women.

In addition, a 2013 study by the Institute for Health Metrics and Evaluation at the University of Washington reported 885 annual maternal deaths in Afghanistan. According to the researchers, that was an increase of 24% on a decade earlier.

In Afghanistan, reality often conflicts with official statistics. The UK government, for instance, claims that 85% of Afghans are now covered by basic health services.

Yet, in a 2014 Médecins Sans Frontières report, four out of five Afghans said they did not use their closest public clinic because they believed the quality of services and availability of staff was so poor. According to the UN Office for the Coordination of Humanitarian Affairs, 9 million Afghans are without access to basic health services.

Healthcare has also been a key priority for the British government in Afghanistan, though it’s not clear exactly how much money goes specifically to reducing mortality among pregnant women.

Since 2002, the UK has provided more than $1.7bn (£1.4bn) to the Afghanistan Reconstruction Trust Fund, which allocates a significant portion to healthcare. Healthcare for mothers is a key priority, the UK embassy in Kabul said.

In a country where reliable data is so elusive, a stronger focus on monitoring progress, and further investment in it, is desperately needed, or the benefits of the large amount of aid going into healthcare will remain unclear.

See original article here: https://www.theguardian.com/global-development/2017/jan/30/maternal-death-rates-in-afghanistan-may-be-worse-than-previously-thought

Afghan woman’s ears cut off by husband

A 23-year-old Afghan woman has described to the BBC how her husband tied her up and cut off both her ears in a domestic violence attack in the northern province of Balkh.

The woman – Zarina – is now in a stable but traumatised condition in hospital.

“I haven’t committed any sin,” she said. “I don’t know why my husband did this to me.”

The woman’s husband is on the run in Kashinda district following the attack, police have told local media.

Zarina told Pajhwok news that the unprovoked attack took place after her husband suddenly woke her up.

She was married at the age of 13, and told BBC that “relations with her husband were not good”.

Zarina complained that her husband had tried to prevent her from seeing her parents, she said in another interview, with Tolo News. She said she no longer wanted to remain married to him.“He is a very suspicious man and often accused me of talking to strange men when I went to visit my parents,” she said.

She has demanded his arrest and prosecution.

Her account is the latest in a series of high-profile domestic abuse incidents and cases of violence against women in Afghanistan.

  • In January 2016, a young woman, Reza Gul [pictured, below], had her nose cut off by her husband in the remote Ghormach district of north-western Faryab province
  • Some months later, a woman was critically ill after being nearly beaten to death by her husband
  • In November 2015, a young woman was stoned to death in Ghor province after she had been accused of adultery
  • Earlier that year, a young Kabul woman, Farkhunda, was beaten and burned to death by a mob over false allegations she had set fire to a Koran
  • In September 2014, a man cut off part of his wife’s nose with a kitchen knife, in central Daykundi Province, according to police. It is not clear whether he was ever caught
  • The case of Aisha featured on the front cover of Time magazine in 2010, after the 18-year-old was mutilated by her husband who cut off her nose and ears as punishment for running away

The Afghan government has repeatedly tried to introduce laws to protect women from domestic abuse.

But President Hamid Karzai during his time in power was unable – or unwilling – to sign off legislation even though it had been approved by both houses of parliament.

In 2014, for example, he ordered changes to draft legislation that critics said would severely limit justice for victims.

Mr Karzai’s successor, Ashraf Ghani, has also yet to give his assent to legislation passed by Afghan parliament late last year. It was drafted to protect women and children from violence and harassment.read original BBC News report HERE.