Background

Afghanistan has made significant progress in rebuilding its health system, despite years of continuous conflict. The National Reproductive Health Strategy 2006–2009 contributed to improving the health of the people of Afghanistan, especially women and children, through the implementation of the basic package of health services (BPHS) and the essential package of hospital services (EPHS) as the standard, agreed-upon minimum package of health care services to be provided at each level of the health system.

Between 2003 and 2012, the number of graduated midwives in Afghanistan increased from 467 to 3,001, according to the Afghan Midwifery Education and Accreditation Board report. In addition, there has been a gradual increase in the number of births attended by skilled birth attendants (SBAs). In 2006 the Afghanistan household survey showed that 19% of births were attended by SBAs, while the National Risk and Vulnerability Assessment 2007/2008 showed that 24% of women delivered with a skilled birth attendant. More recently, the Ministry of Public Health (MoPH) Partnership Contracts for Health 2010 Household Survey showed that about one-third (34%) of deliveries were attended by an SBA.

According to the Reproductive Age Mortality Survey (RAMOS), in 2003 Afghanistan had one of the highest maternal mortality ratios in the world, estimated at 1,600/100,000 live births (Bartlett 2005). The Afghanistan Mortality Survey (AMS) 2010 estimated that the ratio had fallen to 327 per 100,000 live births. The differences appear to be consistent with the level of skilled assistance during delivery, skilled birth attendance, and delivery in a health facility, all of which have increased rapidly in Afghanistan in recent years. Based on 1999–2002 data collected from four sites, Bartlett et al. (2005) estimated the lifetime risk of maternal death at between one in six and one in nine. According to the 2010 AMS, approximately one in every 50 Afghan women dies of pregnancy-related causes.

Use of family planning also has increased remarkably in the last seven years in Afghanistan. According to the AMS 2010, the total fertility rate is 5.1 per 1,000 and more than one-fifth of married women use some method of family planning (22%), with the vast majority (20%) using a modern method.

The 2010 National EmONC Assessment showed that none of Afghanistan’s health facilities has yet achieved the national goal of one skilled attendant for every 100 expected births. In district and regional hospitals, the ratio of midwives to 100 expected births was 0, and health facilities, regional hospitals, and specialized hospitals all had small ratios of 0.1 midwives per 100 expected births. The adjusted under-five mortality rate for Afghanistan is 97 deaths per 1,000 births and the infant mortality rate is 77 deaths per 1,000 births.