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Afghanistan,
Gaza
and the battle for improved maternal and infant healthcare
Despite
a full-scale war, Afghanistan's maternal mortality has
dropped because of an increase in the number of midwives. In contrast,
in Gaza there has been a deterioration
in infant and maternal healthcare, thanks to the Israeli blockade.
WHEN
the first and only midwifery school was opened in 2004 in Bamyan city,
central Afghanistan,
not a single application was received for the 18-month course. Today,
the school has to turn down dozens of applications from women all over
the province because it cannot accommodate more than 25 students at
a time.
'We
have earned the people's trust in our work,' Saleha Hamnavazada, coordinator
of Bamyan
Midwifery School,
told IRIN news service. 'We have created a reliable learning environment
for women and have assured their men that women are totally safe and
protected here.'
Conservative
traditions in Afghanistan have restricted women's
and girls' access to education, work, healthcare and other social activities
across the country, albeit in varying degrees.
Women
and girls are often stopped from going to health centres or schools
because of a lack of female health workers and teachers.
The
consequences are severe: annually, 24,000 women die before, during or
just after childbirth because of a lack of healthcare; and the female
illiteracy rate is one of the highest in the world at more than 85%,
according to UN agencies.
Breaking
down barriers
'I
want to break superstitious taboos in our society which impede women's
education and work,' Masooma, a midwifery student from Daikundi
Province, told
IRIN. 'I saw the deaths of my two sisters-in-law during childbirth because
there was no midwife or doctor to save them.'
However,
the midwifery profession is starting to be considered both decent and
lucrative for women, particularly in rural areas.
'A
midwife works only for women so it is acceptable,' said one man in Bamyan
city, who requested anonymity.
The
number of midwifery schools in the country has increased from six in
2002 to 31 in 2009, according to Pashtoon Azfar, director of the National
Association of Midwives (NAM). Since 2002, more than 2,000 midwives
have been trained and employed by the Ministry of Public Health (MoPH)
and NGOs in health centres across the country, Azfar told IRIN.
Reducing
deaths
Midwives
are believed to have improved women's access to essential health services
and have reduced maternal mortality in some parts of the country.
'Maternal
death during child delivery has decreased by about 5%,' Zainab Rezayee,
an obstetrician in Bamyan
Provincial Hospital,
told IRIN, referring to her hospital. Both Bamyan
Provincial Hospital
and Bamyan
Midwifery School
are managed by the Aga Khan Development Network.
In
2004, two to four babies were born every month at health centres in
rural Bamyan. Today, more than 35 are born in medical centres every
month thanks to 41 graduated midwives in the province. Deliveries at
Bamyan Provincial
Hospital have increased
from 30 a month in 2004 to more than 130 in 2009, Rezayee said.
Across
the country, the percentage of women receiving antenatal care increased
from 4.6% in 2002 to 32% in 2006, while the rate of child deliveries
attended by a skilled health worker increased from 8% to over 19% in
the same period, according to NAM.
In
addition to facilitating childbirth, midwives increase women's awareness
about family planning, HIV/AIDS and transmittable sexual diseases.
Officials
in the health ministry say it is time to reassess Afghanistan's
poor maternal mortality record - rated the second-worst in the world
after Sierra Leone,
with 1,600 maternal deaths per 100,000 live births, in a 2006 nationwide
assessment.
'We
need a new assessment to gauge how much the ratio has dropped,' said
Azfar, who also heads the main midwifery school in Kabul.
No
quick fix
Afghanistan
has one of the highest fertility rates in Asia
and the average Afghan woman gives birth to six to seven children in
her life, according to the UN Population Fund.
There
are about 2,400 midwives in the country but about 8,000 are required
to provide basic obstetric services for all Afghan women, NAM
said.
'We
train 300-400 midwives every year at 31 midwifery schools in the country,'
said Azfar, adding that one school would be opened by the end of 2009
in the Paktika Province where women have very little access
to basic healthcare.
At
this rate, it will take at least 14 years to train the needed 5,600
extra midwives. Until then, thousands of women will continue to die
from preventable deaths. - IRIN news service
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Gaza
mothers, newborns affected by Israeli blockade
INADEQUATE
infrastructure, lack of equipment and a shortage of hospital staff
are contributing to the deterioration of hospital care for mothers
and newborns in Gaza, according
to a July 2009 assessment by the World Health Organisation (WHO)
in Jerusalem.
WHO
attributes the dismal state of Gaza's healthcare system
to the Israeli blockade since June 2007, when Hamas took over
control of the territory.
'The
Israeli blockade affects the supply of medical equipment and conditions
in the maternity wards, and perpetuates the isolation of healthcare
professionals, making it difficult to maintain international standards
of practice,' said Tony Laurence, head of the WHO West Bank and
Gaza Office in Jerusalem.
The
maintenance and updating of equipment is not adequate, and the
supply of drugs and laboratory materials is not constant, according
to WHO.
'Ten
types of essential medications for maternal care, like Prostin
gel that induces labour, are out of stock,' said Munir Al-Bursh,
head of Gaza's Department of Pharmaceuticals, adding that they
were unable to import spare parts for ultra-sound equipment and
Computed Tomography (CT) scanners.
Safa
Ahmed, aged 21, gave birth to her baby girl Rataj in August at
As-Shifa, Gaza's
primary hospital, but was discharged just two hours after the
delivery.
Mothers
stay an average of two hours in Gaza hospitals after delivery
due to a lack of beds, said the WHO report, which advocated that
they stay in hospital for at least six hours after delivery for
post-partum examinations.
As-Shifa's
overcrowded maternity unit deals with an average of 1,200 births
a month.
'There
were 7-8 women per room,' said Safa. 'My husband had to look in
pharmacies outside the hospital for Prostin gel and blood thinners
while I was delivering.' Patients say those drugs are not readily
available. If the drugs are provided by the hospital they are
covered by the patient's insurance, but if bought at a pharmacy
outside, the patient pays out of her own pocket.
The
International Committee of the Red Cross (ICRC) provides some
medications and medical supplies, but they are not always able
to bring things in, said ICRC's communications officer in Gaza
Mustafa Abu-Hassanain.
Few
trained midwives
There
is a lack of professional staff in maternity and neonatal wards,
particularly trained midwives, said Lubna Al-Sharif, a WHO officer
in Gaza. 'Knowledge is outdated regarding international
standards of proper mother and child healthcare, due to the isolation
created by prolonged border closures,' said Al-Sharif.
'There
is a lack of working foetal monitors and incubator parts, like
ultra-violet lamps,' said Al-Sharif, 'and there are problems with
infection control resulting from a lack of sinks, soaps and hand
towels.'
The
blockade prohibits imports of construction materials like cement
- without which it is difficult to rehabilitate and maintain hospitals,
according to WHO.
Shlomo
Dror, a spokesperson for Israel's
Ministry of Defence, said: 'Medical supplies have priority [as
imports into Gaza],
and secondly is food from international organisations. There is
a government decision not to allow a humanitarian crisis to occur
in Gaza.'
The
Israeli Defence Ministry says it is not obliged to allow into
Gaza anything other than basic humanitarian
supplies necessary for survival, and is concerned certain medical
technologies could be used for other, more sinister means. - IRIN
news service
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*Third
World Resurgence
No. 227, July 2009, pp 40-41
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