If you are a mother living in rural Afghanistan today, what is the most important thing that can be done to ensure your health, and the health and survival of your children?
This question may seem rather distant and difficult to consider as we sit here today, but the answer is critical to effectively rebuilding Afghanistan's health system. We congratulate Dr. Firoz and his team, along with Management Sciences for Health, for their report, which provides an excellent basis for moving forward with this challenging task. We also appreciate the discussion on maternal mortality. At Save the Children we know from 70 years of experience around the world, that when mothers survive and thrive, their children survive and thrive.
So allow me to ask the question again: For you as a mother in Afghanistan today, what is needed to ensure the health and survival of your children?
- Is there a skilled birth attendant who
can help to deliver your baby cleanly and safely right in your own home?
- Is your newborn baby kept dry and warm
to prevent hypothermia?
- Are you breastfeeding your baby, beginning
from the first minutes after birth and exclusively breastfeeding for six
- Are your children fully immunized during their first year of life?
- Can you make choices about when, how
often and how many times you become pregnant?
- When you are pregnant, can you get the
care you need, such as immunization against tetanus or advice about nutrition
- Do you have support after your baby is born to ensure that you and your baby remain healthy?
Surely all of these things are important to the health and survival of you and your children. Each of the decisions and actions I have just mentioned is feasible, affordable, and has been proven effective in many communities around the world where Save the Children works, including in Afghanistan.
Save the Children has been providing humanitarian assistance to the Afghan people for more than 15 years, including programs for health, education, micro-credit for women, drought response, food distribution and cash-for-work. In partnership with local communities and the Ministry of Public Health we have learned several key lessons for achieving health improvements for women and children. Allow me to briefly relate a recent experience of our health workers in northern Afghanistan which brings to light some of these factors.
Over the past year, our staff, along with Ministry of Public Health staff and local communities, had been discussing the need to have female vaccinators who could go door to door in remote villages to immunize women against tetanus, a significant cause of death among newborns. The Ministry recently obtained the support of UNICEF to hire and equip several female vaccinators. It soon came to light that these outreach workers were to be provided bicycles as a means of transport, something that is not culturally acceptable in that setting. A dialogue took place, and a decision was made to provide donkeys for the female vaccinators. This enables them to do their job appropriately and effectively.
This simple example illustrates three essential factors for providing effective health care to the women and children of Afghanistan:
- First of all, women must play a critical
role in planning and implementing health programs that address the most
important needs of women and children.
- Secondly, communities must be involved
as partners in bringing about real and lasting change.
- Thirdly, health services in Afghanistan must focus on feasible and affordable interventions that address the most critical causes of illness and death among the most vulnerable people.
It is often surprising how simple the action may be that will save lives. Consider the case of a mother, let's call her Naseema, in northern Afghanistan this past August. At age 38 she had already lost seven out of 11 children. Of her surviving children, the youngest two were 6-week-old twin boys, who appeared severely malnourished when our health workers first saw them. Naseema held up the dirty bottle from which she fed her babies sugar water. Sometimes, when she could afford it, she added a bit of powdered milk to the bottle. Naseema reported that she did not have sufficient breast milk, but further discussion revealed that she had never been taught or supported to effectively breastfeed. Our health workers were able to spend time helping Naseema to breastfeed - not always a simple task, especially with twins. They also ensured that a community health worker made regular follow up visits for the next several weeks. A month later when Naseema brought her twins to the health center for a check-up, they were much healthier, and the smiling mother was observed happily breastfeeding both babies.
We all can do more
After all the pain and tragedy in the life of Naseema, and millions of mothers like her in Afghanistan over so many years, her happiness and her two thriving infants need not be an unusual success story. We in this room, and the organizations and governments we represent, have the capability and the responsibility to ensure better health and survival for Afghanistan's mothers and children.
At Save the Children we appreciate that the government of the United States has shown its commitment to investing in the health of women and children in Afghanistan through the passage and enactment of the Afghanistan Freedom Support Act. But now the government must follow through on this commitment by providing the necessary funding for Afghanistan's health infrastructure, and for effective and affordable health programs. The survival and health of mothers and children in Afghanistan depend on it.
© 2002 Save the Children