Conceiving and dying in Afghanistan

Abstract

Since the first International Safe Motherhood Conference in 1987 there has been increased focus on maternal health and maternal mortality. The design and implementation of effective programmes for maternal health require data of adequate quality despite the challenges of generating such data. Typical approaches have produced data of low quality and limited usefulness. Therefore Linda Bartlett and colleagues’ report in today’s Lancet is of particular merit for its use of rigorous methodology. The methodology of the reproductive-age mortality study (RAMOS) while costly and cumbersome represents the gold standard for measuring maternal mortality. Bartlett and colleagues should be commended for their efforts under difficult circumstances to identify all deaths in women of reproductive age in the study area and further assess whether the deaths were due to maternal causes. With their two-stage methodology Bartlett and colleagues recorded 154 maternal deaths in a population of more than 90000 a national maternal mortality ratio of 1600–2200 maternal deaths per 100000 livebirths in Afghanistan and 6500 maternal deaths per 100000 livebirths (in Badakshan province)—the highest maternal mortality ratio ever reported. Maternal mortality compared with other causes of mortality remains a relatively rare event and for this reason is commonly expressed per 100 000 rather than per 1000. (excerpt)