Pregnancy and childbirth a major cause of death among Afghan refugee women
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A survey of Afghan refugees done before the events of September 11, 2001, published in this week's issue of THE LANCET, highlights how a lack of access to health care for women of reproductive age results in pregnancy and childbirth being major risk factors for death among these Afghan women.
There are an estimated 3.6 million Afghan refugees, the largest refugee population in the world. Linda Bartlett and colleagues from the National Centres for Disease Control and Prevention, Atlanta, USA, did a study among Afghan refugees in Pakistan to investigate the burden of deaths among women due to maternal causes, risk factors for death among women of reproductive age, preventability of deaths, and barriers to health care faced by these women.
A census of 12 Afghan refugee settlements was done from January 1999 to August 2000, in which all deaths were recorded. Deaths among women of reproductive age (15--49 years) were further investigated by verbal autopsy interviews with family members. The census identified 134,406 Afghan refugees and 1197 deaths; a crude mortality rate of 5.5 per thousand population. Among the 66 deaths in women of reproductive age, there were 27 deaths (41%) due to maternal causes--a greater proportion than any other cause. 16 liveborn and nine stillborn infants were born to women who died of maternal causes; six of the liveborn infants died after birth. Therefore, 60% (15 of 24) of infants born to these women were either born dead or died after birth. Compared with women who died of non-maternal causes, women who died of maternal causes had a greater number of barriers to health care, and their deaths were more likely to be preventable.
In an accompanying Commentary (p 639) Gilbert Burnham from Johns Hopkins Bloomberg School of Public Health, Baltimore, USA, considers the broader issue of the need for rebuilding Afghanistan's health-care infrastructure. He concludes: "The challenge of returning refugees and the internally displaced to their homes in Afghanistan is great, and the challenge of rebuilding health care formidable. Despite the seemingly vast sums of aid funds pledged for Afghanistan, there is a real danger that, without effective health-sector coordination, assistance can be dissipated and only modest long-term impact realised. Although many relief organisations are preparing to meet the immediate needs within Afghanistan, the less glamorous and ultimately more arduous task of rebuilding national capacity must always remain the clear goal. This opportunity to create a health system free of past inequities that will make the country safe for women and children must not be lost."
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Dr Gilbert Burnham, Johns Hopkins Bloomberg School of Public Health, Center for International Emergency, Disaster and Refugee Studies, Baltimore, MD 21205, USA; E) firstname.lastname@example.org