Today, when we think of Afghanistan, a cauldron of chaos comes to mind: massive international counterinsurgency and counternarcotics operations, countless NGOs struggling to maintain neutrality and operational integrity amidst the militarization of aid and development, and the sheer deprivation of dignity suffered by the overly-occupied Afghan people, among other such indictments of the international community's historic and present-day involvement. While these issues continually make above-the-fold headlines, today is International Women's Day (IWD), and I wish to highlight yet another travesty in Afghanistan: maternal mortality.
With more than half a million women dying each year from largely preventable complications related to pregnancy and childbirth, Afghanistan is now ranked second worst in the world when it comes to maternal mortality behind Sierra Leone. In fact, in 2006, Badakhshan province in northeast Afghanistan had the worst incidence of maternal mortality ever recorded in history. According to UNICEF, Afghanistan's maternal death rate is 1,800 per 100,000 live births, compared to the U.S. rate, which is 11 per 100,000. While those of us living in free and open societies would agree that the rights of women in Afghanistan are in dire straits, we must also agree that this particular situation demands special attention. Indeed, with regard to these statistics, President of CARE USA Dr. Helene Gayle famously stated, “We have to stop being polite about this issue – we need to start marching in the streets. Post-partum hemorrhage is a nice way of saying we let women bleed to death.”
Addressing this challenge is compounded in difficulty when we begin to understand the landscape of the geography, culture, history, and politics of Afghan society. Intermittent access to basic healthcare and education; religious influence, tribal lines, customs and tradition; and living in perpetual states of war and occupation make it particularly difficult to approach the problem of maternal mortality. But there is hope on the horizon.
In a previous piece I wrote on the Aga Khan Development Network (AKDN), which focused on their efforts with regard to women and girls in Afghanistan and Pakistan, I made note of their 18-month midwifery training program. Developed in Badakhshan province, the program is showing signs of success in both health promotion and education, in addition to their community nursing initiatives. Efforts of this sort will have an effect on both maternal and infant health explained John Tomaro, Director of Health Programs for the Aga Khan Foundation (AKF), to the BBC. Intensive training of this nature is not the only method to achieving lasting and positive health outcomes; educating the populace on the use and benefits of contraception can also make an enormous difference.
With Afghanistan averaging more than six babies per woman and UNICEF estimating that a mere 10 percent use some form of birth control, improving such damning statistics may not be as hard as it seems. Just last week, the World Health Organization's journal, Bulletin, published a study conducted in 2005-2006, which involved 3,700 families in three rural areas with different ethnic groups, including both Sunni and Shia Muslims. In this case, the Health Ministry collaborated with nonprofit organizations to spread the word that using contraception was 300 times safer than giving birth in Afghanistan. The results of the study indicated that over the course of eight months, the use of the pill, condoms and injected forms of birth control rose to 27 percent in all three areas — and up to half of the women in one area — once the benefits were explained one-on-one by health workers. “The fastest, cheapest, easiest way to reduce maternal deaths in Afghanistan is with contraception,” said lead author Dr. Douglas Huber to the Associated Press.
Funded by the William and Flora Hewlett Foundation and conducted for the U.S.-based nonprofit Management Sciences for Health, the report noted that the key to such societal shifts rested largely in the hands of the mullahs — local religious leaders. Quotes were used from the Quran to promote breast-feeding for two years, while mullahs joined community and health leaders to explain the importance of spacing out births to give mothers and babies the best chance at good health. “All the mullahs at the community level knew of these things that the Prophet Muhammad himself advised his followers,” Huber continued. “This was not a hard sell.”
But it is certainly a long process. Great strides have been made in bringing the plight of women to the forefront of societal awareness and policy debates around the world since IWD first began in 1911, and one upcoming forum in particular vows to carry the baton even further. Positioning women's maternal and reproductive health as a global priority, the Women Deliver 2010 conference is being held June 7-9 in Washington, D.C. It expects a lineup of government officials, experts and advocates destined to attract national and international headlines, including Hillary Clinton, Ban Ki-moon, Sarah Brown, and Melinda Gates, among many others. In an interview with Jill Sheffield, the founder of Women Deliver, she said, “Women are an asset to their families, to their communities, and to their economies. On the eve of the G8 summit, the Women Deliver conference will seek to reinforce the idea that investing in women makes economic sense as well as good common sense, mobilizing historic action on this issue and bringing it directly to policymakers.”
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The loss of 36,000 jobs in February is better than expected but it's still miserable. 26,000 were lost in January, according to the government's revised figures. And the “underemployment” rate — including jobless workers who have given up looking for work and part-time workers who want full time jobs — rose from 16.5% in January to 16.8% in February, offsetting some of January's gains.
And don't blame it mostly on the weather. Although the surveys on which the report is based were done in mid-February during winter snowstorms in the east, the major impact of bad weather was on hours worked, not the numbers of jobs. If you had a job in February but were snowed in, the Bureau of Labor Statistics reported you as having a job.
This complicates the president's final push for health care reform. With employers still shedding jobs and consumer confidence down, Americans are worried first and foremost about paying their bills. Because most people aren't aware of how much of their paychecks are being eaten up by rising health care costs, but can easily be persuaded they'll be paying more to cover those who don't have health insurance under any new health plan, the continuing bad news on the jobs front makes it harder for the president to make his health-care sale.
The bad news on jobs also allows economic illiterates (and scoundrels who know better) to continue to claim the stimulus is failing and what's needed is less government rather than more, including not only a smaller “jobs bill” but less or no health care reform.
In politics as in economics and love, timing is everything. Obama can't wait much longer if he wants to convince wavering and worried conservative Democrats to join him in a last ditch 51-vote reconciliation measure to get health care through the Senate. We're already in the gravitational pull of November's mid-term elections. But the economy is taking a longer time to turn around than anyone expected, and telling Americans the jobs numbers are getting worse more slowly isn't exactly reassuring.
One small political consolation is the worst job numbers continue to be on the coasts and the old rust belt where Democrats are relatively safer, and the best numbers in the midwest and mountain states and south where Democrats are weakest. So at least Blue Dog Democrats who are under the most pressure from their conservative constituents on health care aren't grappling with the biggest job losses.
Another is that all across the nation, the people being hit worst by this continuing jobs recession/depression are poor and the lower-middle class who Republicans are trying to court. They're in greatest danger of losing health care coverage if they haven't lost it already, and in greatest need for subsidies to allow them and their families to afford it. Wavering and worried congressional Dems should be reaching out to them.
Americans desperately need health care reform. They also desperately need jobs. Even if it's difficult for many to make the connection, it's still possible for the nation to try to do two important things at the same time. We need a big jobs bill — including especially extended unemployment insurance, aid to hard-hit states and cities — and we need health care reform. The sooner we do the former and get the economy moving into positive job numbers again, the more quickly and easily we can afford the latter. The big question is whether the president can make the case.
Cross-posted from RobertReich.org
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