Working for Women Worldwide - Embassy of the United States

of hospitals and health centers
to provide basic, essential
obstetric care. This approach
has been successful in reducing
maternal mortality in a number
of USAID-assisted countries.
In Egypt, for example, maternal
mortality has declined by 52
percent since the late 1980s.
Maternal mortality rates have
decreased by 41 percent in
Honduras and by 30 percent in
Guatemala.
Most countries in sub-
Saharan Africa, however, have
had little or no reduction in the problem in the last
decade, and recent demographic and health surveys
indicate that maternal deaths have increased in
Zimbabwe and Malawi. To help combat this problem,
USAID is developing programs to increase positive
birth outcomes and improve maternal health in the
region.
In Afghanistan, which has one of the highest
maternal mortality rates in the world, the United
States is helping to develop programs to address the
problem. It has launched a $5-million initiative to provide
accelerated instruction in health care and literacy
for women and girls. The training, which has taken
place in women’s centers supported by the U.S.-
Afghan Women’s Council, focuses on provinces with
the highest maternal mortality rates. The first class of
village midwives from Jalalabad graduated in April
2004, having completed an 18-month program. This
pilot curriculum is being replicated across Afghanistan.
The council’s Health Advisory Committee,
which includes leaders in government, medicine, and
other health-related fields, matches public- and private-sector
resources for Afghan women and children
with health needs on the ground.
In August 2004, then U.S. Secretary of Health
and Human Services (HHS) Tommy Thompson told
the advisory committee about an innovative U.S.
maternal and child health-training program for physicians
and other specialists at Rabia Balkhi Women’s
Hospital in Kabul. Since 2003, successive teams of
U.S. physicians, nurse-midwives, hospital administrators,
and other medical experts have rotated through
that hospital. These “faculty consultants” helped open
a fully functional pediatric nursery and a 24-hour
emergency room to conduct
classes, lectures, workshops,
and teaching rounds to improve
the staff ’s clinical skills. HHS
also implemented initiatives to
improve hospital management
and administration, including
basic systems for infection control,
inventory control, personnel,
and pharmacy management.
As a result of these efforts,
there has been an 80- to 90-
percent decline in maternal
deaths at the Rabia Balkhi
Hospital. In April 2004, the hospital celebrated its
first-ever month with no maternal deaths.
HHS also sponsored a public-private partnership
to develop and disseminate health information to
women in Afghanistan, where illiteracy rates for
women run as high as 80 percent. An interactive
Afghan Family Health Book was developed to provide
more than 350 messages on good health practices,
including pregnancy, breastfeeding, childhood immunization,
water-boiling, and nutrition, in the Dari and
Pashto languages.
The 42-page book conveys its lessons in an accessible,
story-like format that allows the user to interact
with recorded conversations. Information is provided
through pictures, audio, and—for those who read—
text. Since the spoken and written word are presented
together, the book helps encourage reading—one step
toward increasing literacy in Afghanistan—in addition
to giving vital health information.
Helping Victims of
Obstetric Fistula
One complication of pregnancy that disproportionately
affects young and poor women, predominantly
in Africa and the Indian subcontinent, is
obstetric fistula, an abnormal tearing that can occur
during obstructed and prolonged labor or from repeated
violent rape. It is estimated that some two million
women suffer from fistula and that, each year, another
50,000 to 100,000 are affected, most under age 20.
Untreated, women with fistula are often deserted by
their husbands and cut off from family, friends, and
daily activities. The loss of the baby adds to the mother’s
physical and emotional stress.
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