In the last two decades, millions of Afghan girls have avoided childhood diseases, gone back to school, continued their education to become doctors, nurses and midwives, and reclaimed the dignity and respect that they deserve. As a mother of a young girl, I see a future where she will be heard and allowed an opportunity to contribute to the prosperity of Afghanistan equally (to men)—and this makes me hopeful. Our partnership with the international development community has made this possible.
It’s time that everyone recommit to this partnership, because now we need it more than ever.
We have a lot to be proud of. Maternal deaths have become almost one third of what it was 20 years ago. We now have more than 20,000 midwives who are competent and confident in providing professional care. Just last year, half a million women received essential care during pregnancy, gave birth at a health facility and had their children immunized. A half million women used contraceptives to space births.
A year ago, at one of the hospitals Jhpiego supports through the Helping Mothers and Children Thrive Project a 28-year-old woman, nine months pregnant, arrived complaining of severe headache and nausea. She was diagnosed with preeclampsia, a potentially life-threatening condition of hypertension. Thanks to the availability of a loading dose of magnesium sulfate, she was treated in a timely manner and gave birth to a beautiful baby. Two years earlier, her previous pregnancy ended in a stillbirth.
Together, we can save lives.
In the past six months, COVID-19 has brought new pain and suffering to the lives of women in Afghanistan. This spring, women’s use of prenatal and delivery services declined by half from the previous quarter, as well as from the same time period in 2019. Communities have stayed away from hospitals for fear of getting infected. Women’s mobility has been further restricted, limiting access to contraceptives and essential prenatal and postpartum services. The United Nations projects that maternal and newborn deaths will rise significantly because of increased barriers to essential maternal and family planning services.
Female health workers ensuring essential care at primary facilities have been affected disproportionately by COVID-19. They attempt to protect themselves despite lacking personal protection equipment (PPE) and lab facilities for testing. At the same time, they are the primary caregivers for sick family members, and look after children staying home from schools that were closed.
A woman’s work doesn’t stop because she is sick. In June at Herat Regional Hospital in the west, one third of the service providers that we work with—all of them women—were infected with COVID, and the hospital struggled to maintain essential maternity services.
The two largest causes of maternal deaths in Afghanistan are mostly preventable. Postpartum hemorrhage (PPH), which is excessive bleeding after birth, can be prevented and managed if a woman gives birth in health facilites. Eclampsia, caused by high blood pressure during pregnancy, can also be managed through routine prenatal services in the third trimester. And in a low resource setting like Afghanistan, contraceptives are a critical intervention, as pregnancies delayed will also protect a woman from dying during pregnancy. We know the solution, but we need resources to raise awareness, strengthen referral and ensure quality care closer to home. COVID-19 has devastated our primary care infrastructure, and its effects will be felt for a long time.
Jhpiego, as a champion of maternal health, has taken several steps to ensure that the essential health care workers are supported. When it wasn’t possible to meet face-to-face, we used mobile phones and WhatsApp and Viber to follow up and support the providers. We, jointly with Ministry of Public Health, developed protocols to treat women suspected with COVID-19 who came for pregnancy-related services. We have worked hard to ensure that care and commodities remained available closer to home.
But we can only do so much by ourselves, and now we need your support.
We have had a long journey the past 20 years. We ensured women’s health and education. COVID-19 threatens to roll back our gains. Our girls need to be educated and have a role in rebuilding the society after this pandemic. This is a society that didn’t allow girls to go to school, but still looked for women doctors to take care of their wives.
I leave my family every morning to go to work, earn a living and serve my community. Many women in Afghanistan do not have this choice because of COVID-19. I strongly believe that bringing our girls back to school, protecting our health workers, and empowering women to obtain health services are the critical first steps if we want to see meaningful change. I am hopeful that together we can make this a reality.
Dr. Rita Hashemi Salem presented a version of this talk at a briefing in October at the Women’s Congressional Policy Institute.