The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #57502

Linda A. Bartlett, MD, MHSc¹, Shairose Mawji, BN, MPH², Sara Whitehead, MD, MPH³, Chadd Crouse, MSc⁴, Denisa Ionete, MBBS, MPH², Peter Salama, MBBS, MPH², and Afghan Maternal Mortality Study Group¹. (1) Division of Reproductive Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS -K-23, Atlanta, GA 30341, 770-488-6250, ltb7@cdc.gov, (2) UNICEF Afghanistan, House No. 81, Nawhi Watt, Shar-e-Nau, Kabul, Afghanistan, (3) Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, CDC, And Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, 4770 Buford Highway, K-23, Atlanta, GA 30341, (4) Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, CDC, 4770 Buford Highway, NE, Mailstop K-35, Atlanta, GA 30341

Introduction: For over two decades, Afghanistan has been challenged by war, drought and famine, devastating the health care system. Afghan women are particularly vulnerable to limited health services because of restricted mobility and reduced numbers of both female health care providers and facilities that treat women. To guide maternal health services, we conducted a study to measure the magnitude and causes of maternal mortality, risk factors, barriers to health care access, and preventability. Methods: All deaths which occurred in a three year study period from 1999 to 2002 were identified during a household survey in four provinces selected to represent urban and rural settings. Data, including deaths by age and gender, were collected on >85,000 persons. Deaths (n=357) among women of reproductive age (WRA: 15-49 years of age) were further investigated by verbal autopsy interviews. Results: Among our study population of WRA who died, over 40% died from maternal causes. Important differences exist between urban and rural areas in our study: the proportion of women who died of maternal causes ranged from 16% in Kabul to 64% in Badakshan. About 70% of the women who died experienced barriers to health care access and nearly 90% of maternal deaths were considered preventable. Conclusion: The high rate of maternal mortality in Afghanistan highlights the importance of this health issue and that great variation in health outcomes exists within the country. The prevalence of barriers indicates important opportunities for prevention, taking into account the differing needs of urban and rural settings.

Learning Objectives:

At the conclusion of the session, the participant (learner) in this session will be able to:
• Describe the magnitude of maternal mortality in Afghanistan and differences in magnitude between urban to rural settings.
• Discuss what factors account for these differences, including health care access.
• Describe common barriers to health care access and methods to reduce the barriers.

Keywords: Maternal Health, Access to Health Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.