Infant and maternal mortality is an extremely important health issue to examine in any country. Many factors such as social, cultural, environmental, political and economic factors greatly affect this health issue. I chose to look at this health issue in Afghanistan. According to many world reports, Afghanistan is ranked among the top of the worst places for women to live ( Bohn , 2018). These lists look at education, health care, justice, economics and politics. Additionally, Afghanistan has the highest infant and maternal mortality rate in the world and the leading cause of women’s death in Afghanistan was pregnancy and childbirth .
Infant mortality is defined as the number of deaths per 1,000 live births of children under the age of one in a given year. It is calculated by dividing the number of infant deaths in a year divided by the total number of live births in that same year and then this number is multiplied by a thousand (Gonzales and Sawyer, 2017). Maternal mortality is defined as the “ death of a woman while pregnant or within 43 days of termination of pregnancy per 100,000 live births but that is not from accidental or incidental causes”( WHO). It is calculated by dividing all maternal deaths occurring within a period by the total number of live births occurring within that same period and then multiplying that number by 100,000. The maternal mortality rate is around 396 deaths per 1000 live births. The infant mortality rate is about 108.5 deaths per 1,000 live births. According to borgen project about half a million Afghan women die in childbirth a year.
Infant mortality rates are extremely important to look at because these rates are used as a measure of health in the society. These rates not only indicate risk of infant death but also are used as an indicator of community health statues, poverty and socioeconomic status levels in a community and availability and quality of health services and medical technology ( AMCHP ). Looking at these extremely high rates in Afghanistan, it is easy to see that there are many factors that need to be addressed. The rate of infant mortality is used as an indicator of the “wellness of a society” and reflects the type of care, education, and importance society places on the health of both women and children (Allotey, 2003). Learning about infant mortality is extremely important because these numbers are indicative of women’s disparities and women’s health.
Today, conditions in Afghanistan are not great. The United States has been at war with Afghanistan since 2001. Additionally, Afghanistan has experienced many economic and social problems as well as political instability. In addition to the war in Afghanistan, the Taliban group has created even more devastating conditions. Fighting between the Taliban and the Afghan government has resulted in numerous tragedies, especially in the civilian population. In general, Afghanistan relies heavily on foreign aid due to the poor economy. In 2012, Afghanistan’s international aid declined leading to worsening conditions. Today, almost 54% of the Afghan population live under the poverty line. The extreme poverty combined with the unequal distribution of food and lack of clean drinking water leads to many poor health outcomes. These factors together significantly impact Afghanistan’s lack of resources, jobs, education and most importantly health care.
While, conditions in Afghanistan can significantly affect everyone, women were affected the worst. I will be using the feminist perspective to look further into infant and materanl mortality rates. Feminist theorist look at how gender impacts different situations and the inqeualities that are present due to gender. It also looks at how someone could be treated differently socially, economically or politically and how people should behave. Most importantly, the feminine perspective looks at the disadvantages of the barriers that can be based in receiving health care or information ( Lecture Feminist Theory). Afghanistan is a country where everything in a person’s life in dictated by what gender they are, from the education they receive, to the type of work they take part in and the autonomy they have over themselves.
Although, it was not always like this because women in Afghanistan were actually treated much better in the past. In the 1920s King Amanullah, advocated for women’s rights. He introduced criminal and civil codes which promoted female education, abolished child marriage and forced marriage, required men to get judicial permission to marry more than one women and even encouraged women to dress in more western style clothing (HRW Background). Women during the 1950s were even working as teachers, doctors and scientists. By 1964, the constitution of Afghanistan allowed women equal rights and universal suffrage. But this all changed during the 1990’s when the Taliban took control of Kabul, Afghanistan. Before the Taliban control of Afghanistan, women made up 50% of government workers, 70% of teachers and 40% of doctors( Ray of Hope). The Taliban imposed very harsh rules made from their interpretation of the shari’a law which severely restricted women’s rights. Because of what gender they are, under Taliban control, it was forbidden for women to go to work, leave the house without a male family member escorting them and women were forced to wear the burqa. They denied women a formal education and forced women to stay home. Women during the taliban rule were under house arrest. If women were to break these rules they were subjected to cruel punishments such as public lashings ( HRW Background ). Even after the Taliban control of Afghanistan has decreased, conditions for women are still extremely bad. President Karzia signed a law which left Afghan Shi’a women with few rights (Kissane, 2012 ). This law only basically puts women in house arrest and it forces women to seek permission from their husband or male relative to do anything. Additional it permits marital rape and gives women almost no rights over thier children. Because these individuals are women in Afghanistan, they face extremely harsh conditions that are detrimental to their health.
While there are many aspects of Afghan’s women’s life that were affected by the factors mentioned above, women’s education was severely impacted and I believe that this is one of the most important causes of infant and maternal mortality. Due to their gender, women are restricted to many activities, which included going to school and getting an education. While the literacy rate in Afghanistan is very low in general, the literacy rate in males is about 52%, while in females is only about 24%. Today, about 3.7 million children are out of school due to the many conflicts. Of those 3.7 million children, the majority, about 60%, are girls. Additionally, the Afghan government provides more school for boys than for girls for both primary and secondary levels (HRW, 2017). Additionally, of those few schools available for girls, around 41% have no buildings, lack boundary walls, water and toilets (HRW, 2017).
Another factor that restricts women and girls from receiving an education is Afghan culture. “A successful marriage and many sons is the principal goal” in this society for many women ( Wikipedia). Additionally, the risk of kidnapping and rape and severe poverty has made many families to marry this daughters at a very young age. Most commonly , married girls cannot continue their education and are illiterate. Currently, many girls in Afghanistan face child marriage, about 50% of girls are forced to marry by the of age 12. Another cultural factor that leads to high infant and maternal mortality rates is that in Afghan culture most females can only interact with other females. Looking at education, this means that girls can be only taught by females and cannot be taught by men. This is extremely problematic because only about 20% of the teachers in Afghanistan are female. There is an extreme shortage of women teachers because of the harsh rules already in place. If women cannot get access to education and are illiterate, they cannot become teachers to teach the next generation of students. This directly leads to a decrease in women’s education.
Without an education, women cannot go on to become doctors , government workers, or take part in any other job. Infant and maternal health are extremely dependent on the type of health care they receive. In general, 60% of Afghans don’t have access to basic health services and only 10% of hospitals are able to handle caesarean deliveries (Bartlett, 2005). and the physician density to population density is around .28 physicians for a 1,000 people. Less that 1% of people in the study reported having a trained health professional help them during childbirth (Amowitz, 2002). Due to the harsh rules, imposed by the Taliban, it could be said that there are very few female doctors. Women’s access to education directly influences their access to health care. Because of their gender, women are denied a formal education and are illiterate. Due to this lack of education, women cannot find a job even if they were allowed to. In a health care setting, especially for pregnancy and childbirth, this means that there are rarely going to be trained, professional doctors, nurses or other health care attendants that are female. This would mean that there are going to be no medical professionals that a women could go for treatment because in Afghan culture women should only be treated by another female. Unless access to education for females changes, this is going to be a never ending cycle. In fact, according to Dr. Salim, the only trained gynecologist in southern Afghanistan, some men would rather their wives die than be treated by a male doctor. But for women to be treated by a female doctor, midwife or nurse is extremely difficult. This is probably one of the leading causes of Afghanistan’s extremely high maternal and infant mortality.
Even after birth, education is extremely important to both maternal and infant mortality. Due to the lack of education, many women will follow traditional Afghan cultural practices which is extremely detrimental to both mother and child. One practice is that it is common for infants to be washed in cold water after birth which could lead to pneumonia. Babies are also places on the dirty floor to “ ward of evil spirits” and this could led to infection. Additionally only a few women breastfeed this children which is important for the babies immune system and instead are fed melted butter. This practice could led to extremely negative health outcomes for the infants (Nadene 2011) .
Infant and maternal mortality is an extremely important issue to address in Afghanistan. As mentioned above, Afghanistan has the highest infant and maternal mortality rates in the world. This health issue is very clearly caused by social, political, economic and cultural determinants of Afghanistan. All these causes have one common factor which that because women are female they are treated as second class citizen. They are essentially forced into house arrest, cannot work, have a voice in the government and most importantly denied an education. This lack of education, starts a never ending cycle which is extremely detrimental to not only their health but also the health of their children. I believe that by helping women in Afghanistan receive an education , many of the problems women face will decrease. WHO stated “ the health impact of early development and education lasts a life time” (Wiklinson).After the over throw of the taliban, women are slowly returning to their jobs. Today conditions in Afghanistan are slowly improving. In 2017, around 16% were working in industry jobs and30% of women were working in employment services ( World Bank ). They are starting small business. Unfortunately , because they are women, the men in their lives still have significant control over them. For example, they can control how the business is operated as well as profits earned. Additionally, women are going back to being teachers, doctors and are becoming judges and lawyers to improve the lives of Afghan women. By having more control over their life than before, women can now slowly start making decisions for themselves , especially in regards to health care. An article from Carolyn Kissane stated that women’s education is essential for raising their standard of living and through education women have the “ unlimited potential to change the course of history” (Kissane 2012).
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