Monday, April 30, 2007

Infant mortality in Afghanistan

According to a new Johns Hopkins University study:
Infant mortality in Afghanistan has fallen dramatically since the demise of the Taleban, [....] with 40,000 fewer babies dying every year.

Improvements in women's access to medical care since the Taleban were ousted from power five years ago was cited as the main reason for the death rate becoming significantly lower. [....]

According to the preliminary results of a Johns Hopkins University study, the infant mortality rate has declined to about 135 per 1,000 live births in 2006, down from an estimated 165 per 1,000 in 2001.

The researchers "found improvements in virtually all aspects of care in almost every province," the public health ministry and World Bank said in a joint statement on the findings. [....]

Benjamin Loevinsohn, a World Bank health specialist, said the survey results probably underestimated the improvement in infant mortality.

"It's a conservative estimate. This is the situation two and a half to three years ago ... It should be better than that now," Mr Loevinsohn said.

He said children were benefiting from a push in 2004 to improve health care and access to vaccinations for diseases such as measles, polio and tetanus.
Encouraging, if true--and I don't know of any reason why this result should seem implausible. If these findings are correct, that would be just one more piece of evidence that, despite all the continuing problems and dangers faced by Afghanistan, the overthrow of the Taliban regime was a great blessing to the Afghan people.

On the other hand, these improved infant-mortality figures indicate that in many respects Afghanistan is still in very bad shape. A mortality rate of 135 dead infants per 1,000 live births is pretty appalling.

To put this infant mortality rate in perspective, we might compare it to rates of 2.3 per thousand for Singapore, 2.76 for Sweden, 2.8 for Japan, 4.8 for the EU as a whole, 6.37 for the US, 19.63 for Mexico, 29.5 for Egypt, 34.61 for India, and 95.5 for Nigeria (figures from the CIA World Factbook). Aside from Afghanistan, the only other countries with (official) infant mortality rates higher than 100 per 1,000 are some of the poorest African countries (though I suspect that the official rates for some other countries, in Africa and elsewhere, are significantly understated).

And consider for a moment what these figures suggest (the boldings are mine):
The study found the number of women receiving prenatal care increased to 30 per cent in 2006 from 5 per cent in 2003.
Nineteen per cent of pregnant women were attended by a skilled health worker last year, up from only 5 per cent in 2003.
When a figure of 19% represents a dramatic improvement--which, in this case, it does--that's just a reminder of how awful the situation was before. As Afghanistan's health minister says, "there is a long way to go."

Nevertheless, this is good news. I hope Afghans get more of it. To reiterate some points I made in April 2005:

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Many people who opposed the 2001 anti-Taliban war continue to claim, in the face of all logic and evidence, that the war - which overthrew one of the most appalling, repressive, and reactionary regimes on the planet, as well as bringing a long-running Afghan civil war to an end - was somehow bad for Afghanistan and the Afghan people. It is time for such people to simply admit that, on this point, they were wrong. All the serious reports on life in Afghanistan since 2001, even the most critical and pessimistic, indicate otherwise. And as Peter Bergen pointed out in a New York Times op-ed piece on September 23, if there were any truth at all to this picture, then it would be difficult to explain why millions of Afghan refugees have returned home since the fall of the Taliban, and continue to do so, rather than fleeing in the opposite direction.

If they want, people who opposed the anti-Taliban war can continue to argue that the war was wrong, unjust, unwise, illegal, and/or imperialist on other grounds. Right or wrong, these arguments raise different issues. But people who make them should honestly face up to the reality that, on balance, the effects of the war were and continue to be beneficial, not harmful, for the great majority of Afghans.

At the same time, it is also true that by any reasonable standard (as distinct from the standard set by the Taliban regime), Afghanistan is still in a terrible mess. It remains devastated and impoverished, with barely rudimentary state institutions and public services. Security is uneven, literacy is low, infant mortality is high, and opium production is booming. As Ahmed Rashid - who knows what he's talking about - indicated in a recent piece for the BBC, it will still require a major effort just to rebuild the 'minimum basic infrastructure that was present in 1979 before the Soviet invasion.'

Ahmed Rashid's piece and two other recent discussions capture some of the complexities of the situation, from slightly different angles. On the one hand, Afghanistan is far from a lost cause, and overall things have gotten better since 2001. On the other hand, Afghanistan needs and deserves more effective help from the so-called international community - meaning not just the US, which could certainly be doing more, but also Europe, Japan, and others. (And, for that matter, why not Muslim countries as well? Much of the Islamic world rather shamefully opposed the war to overthrow the Taliban. Helping Afghans now would be one way to partly redeem themselves.)
------------------------------

--Jeff Weintraub

=========================
The Scotsman
Saturday, April 28, 2007
Afghan infant deaths fall by 40,000 a year since ousting of Taleban
ALISA TANG
In Kabul

Infant mortality in Afghanistan has fallen dramatically since the demise of the Taleban, according to a new study, with 40,000 fewer babies dying every year.

Improvements in women's access to medical care since the Taleban were ousted from power five years ago was cited as the main reason for the death rate becoming significantly lower.

Grim infant and maternal mortality rates have been regularly cited as evidence of Afghanistan's backwardness after decades of war.

They were also seen as a sign of the slow progress of the internationally funded reconstruction effort.

According to the preliminary results of a Johns Hopkins University study, the infant mortality rate has declined to about 135 per 1,000 live births in 2006, down from an estimated 165 per 1,000 in 2001.

The researchers "found improvements in virtually all aspects of care in almost every province," the public health ministry and World Bank said in a joint statement on the findings.

Mohammad Amin Fatimi, Afghanistan's public health minister, said the news was welcomed. "Despite many challenges, there are clear signs of health sector recovery and progress throughout the country," he said.

"But there is a long way to go to provide access to basic health services for Afghans in far remote, under-served and marginalised areas across the country. These infants are the future builders of our country."

Benjamin Loevinsohn, a World Bank health specialist, said the survey results probably underestimated the improvement in infant mortality.

"It's a conservative estimate. This is the situation two and a half to three years ago ... It should be better than that now," Mr Loevinsohn said.

He said children were benefiting from a push in 2004 to improve health care and access to vaccinations for diseases such as measles, polio and tetanus.

The researchers studied more than 600 health facilities annually since 2004.

Doctors and health professionals visited 8,278 households, using a standardised questionnaire to interview one mother per household about her birth history.

The study found the number of women receiving prenatal care increased to 30 per cent in 2006 from 5 per cent in 2003.

Nineteen per cent of pregnant women were attended by a skilled health worker last year, up from only 5 per cent in 2003.

The survey was conducted in 29 of the country's 34 provinces - excluding Helmand, Uruzgan, Kandahar, Zabul and Nuristan because of security concerns, Mr Loevinsohn said.

The ministry is working to set up small clinics, deploy mobile teams in remote rural areas, expand community midwifery training, and increase the number of female staff at health facilities.

However Afghanistan still has one of the world's highest maternal mortality rates.

One in 60 Afghan women dies of pregnancy-related causes, said UN Population Fund executive director Thoraya Ahmed Obaid.

"No woman should die giving life," she said during a visit to Afghanistan this week.

"No nation can be developed when its women are dying giving birth."

• Taleban militants have seized control of a district in south-east Afghanistan after a clash that killed five people, including the local mayor and his police chief, it was reported yesterday.

The Taleban launched the attack on Thursday evening on the Giro district of Ghazni province, setting fire to several buildings and cutting communication lines, according to the provincial deputy governor, Kazim Allayer.

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