Afghanistan: improving maternal health

Title  Improving maternal health in Afghanistan
Description Maternal health education for women and men in order to reduce the maternal mortality ratio and achieve access to reproductive health for 2,000 women in rural Afghanistan
Status  Completion
Dates  Start: 2014; End: 2017
Location  Afghanistan
Sector  Reproductive health care

Case study

Download a case study of this completed project, reflecting on the context, achievements and lessons learned.

Situation

In Afghanistan, one in 50 women will die of pregnancy-related causes. The rate is particularly high in rural areas, with the maternal mortality ratio estimated at over 500 deaths per 100,000 in the project location.

Mountainous terrain makes access to reproductive health services difficult. Many women therefore do not attend antenatal visits and give birth at home, running the risk of complications without skilled health personnel present.

If left unchallenged, many harmful traditional practices can put women and babies at risk from complications, injury or death persist. For instance, practices such as putting soot on the umbilical cord, or giving birth in the dirtiest room, can lead to neonatal tetanus.

Partner

This project was run by our partner in Afghanistan, an NGO building capacity in Afghanistan in the sectors of health and economic development. The project is funded by the UK Government.

Response

The project takes a preventative approach to tackling the major causes of maternal and child mortality through service delivery (training in basic birth and life-saving skills, and encouraging utilisation of existing health services) and empowerment through choice (educating men and women on the benefits of practicing basic health awareness and accessing health services).

Through Birth and Life Saving Skills (BLiSS) courses, women and men will gain knowledge and learn practical steps for family planning, antenatal care, safe birthing practices, nutrition, immunisations and general health care for mothers and young children.

BLiSS is a 16-week participatory learning exercise, which enables the mainly illiterate group to come to a consensual decision about healthy choices in pregnancy, birth and newborn care.

BLiSS for Men courses are an innovative aspect of the project, based on the gendered considerations of the local context. Men are the main decision-makers when it comes to providing more nutritious food for their families, reducing the work burden on their pregnant wives and saving money for visits to the clinic and in case of emergencies.

Outcomes

A total of 1,703 women and 889 men took part in the village-based BLiSS courses.

A significant achievement of this project is the abandonment of harmful traditional practices in relation to pregnancy, birth and care of newborns. The one-year post-course Knowledge, Attitudes and Practice (KAP) surveys and the independent evaluation both point to women recognising that their traditional practices were harmful; becoming knowledgeable about safe practices; and replacing the old practices with new practices in their own lives and as they advise and assist others in the community.

The impact of this is that women who are pregnant are not exposed to harmful practices, and are surrounded by women and other family members who encourage the practices which lead to safer health outcomes for mothers and babies. This includes attendance at health centres for antenatal appointments, use of hygienic birthing spaces and equipment, seeking professional assistance especially for complications, improved nutrition, getting vaccinations, and applying ‘first aid’ responses if complications arise at home.

Overall, the project has contributed to a decrease of the Maternal Mortality Ratio and Child Mortality Rate in the project location. It is anticipated that knowledge, attitudes and practices learnt on the BLiSS course will be passed on to other family members, with benefits continuing into future generations.

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