White Ribbon Alliance

Afghanistan

White Ribbon Alliance Afghanistan

Capital City
Kabul
Population
29.8 million
Lifetime risk of maternal death
1 in 32
Maternal Mortality Ratio
460
Births attended by skilled personnel
urban 74.3; rural 30.5
Source: UNICEF


UN Secretary General’s Every Woman Every Child commitment:

Afghanistan will increase public spending on health from $10.92 to at least $15 per capita by 2020. Afghanistan will increase the proportion of deliveries assisted by a skilled professional from 24% to 75% through strategies such as increasing the number of midwives from 2400 to 4556 and increasing the proportion of women with access to emergency obstetric care to 80%.

The above statement is an edited commitment. Read the full commitment here.


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In Afghanistan, decades of war, civil strife and a weakened economy, coupled with repressive attitudes towards women had led to a tragically high number of maternal and newborn deaths. In the mid-90s, women’s access to health services dropped drastically, and the number of birth related fatalities spiked. By 2006, according to UNFPA, for every 100,000 live births in the country, 1,600 women died from causes related to pregnancy and childbirth. Considerable progress has been made with many international aid organizations investing in and supporting the development of the country’s health system. By 2014, this resulted in a four-fold decline in the maternal mortality ratio, but Afghanistan still remains a very dangerous place to give birth.

In 2013, the Afghan Midwives Association brought together policymakers, civil society organizations, and community members to celebrate progress that was made to improve maternal health in the country, and to give women an opportunity to talk about the standards of maternity care that they have received in Afghanistan. While these women decided to remain anonymous, their stories are powerful.

“Wherever we go, healthcare providers ask for money. Without it they don't provide better services. I appeal to the responsible authorities to please improve the quality of services so the poor can also get them.”

“I went to a hospital with labour pains and the healthcare providers did not even provide basic care. I had severe pain and no doctor came to attend me. I delivered by myself, but my baby was in very bad condition.”

“When a doctor, midwife or any healthcare provider perform wrong practices, there should be a system and a law to take away their license so they cannot cause harm to others.”



LAUNCHING THE ALLIANCE

To reverse this trend, a group of passionate maternal health advocates came together in Kabul to discuss viable solutions to the multitude of issues affecting the health of mothers and newborns. In early 2014, they met with White Ribbon Alliance founder Theresa Shaver. At that time, the Executive Director of the Afghan Midwives Association remarked, “Our mothers still face many challenges and need a forum that unites them and allows their voices to be heard.” This group of health workers, maternal health advocates, government employees and general community members joined forces to discuss the formation of White Ribbon Alliance Afghanistan (WRA Afghanistan).

In early 2015, WRA members in Afghanistan invited representatives from USAID, World Health Organization, CARE International, Swedish Committee for Afghanistan, Cordaid, Afghan Midwives Association, Marie Stopes International, Save the Children, BRAC International, Terre des Hommes, and governmental bodies to learn more about WRA’s approach to citizen engagement. During this workshop, members identified that the country’s health system lacks a Nursing and Midwifery Council, which protects the health and safety of the public by ensuring that midwives and nurses are competent and fit to practice their profession.

WRA members in Afghanistan believe that this has had a negative impact on the quality and safety of maternal and newborn health services, leading to higher rates of maternal mortality. To address this issue, WRA members identified that the government must change the existing health law and create a Nursing and Midwifery Council. It was this meeting that ultimately formed WRA Afghanistan, and we are now sharing this news with our members and supporters worldwide.

MOVING FORWARD

Over the next few months, with support from the USAID-funded Health Policy Project, the Alliance will work on removing obstacles that prevent the legislation on instituting a Nursing and Midwifery Council from being passed, and will ensure that the new legislation is approved by the President of Afghanistan. At a later stage during the campaign, WRA Afghanistan will ensure that the Nursing and Midwifery Council is created and operates effectively throughout the country.

To achieve this reform, WRA will build on its experience in Tanzania, Uganda, Nigeria, and India, among many other countries, to inform and mobilize citizens to demand their rights, amplify their demand for government accountability, and support policymakers to respond to citizen demands.


AFGHANISTAN IN THE NEWS

Birthing in Afghanistan: State of the World's Midwifery 2014 Report