The Infant Mortality Rate: What It Says About Afghanistan’s Health System
Image Source: Jim Huylebroek for The New York Times
The infant mortality rate measures the number of deaths of children under the age of 1, for every 1000 births. This metric is an indicator of overall well-being and health infrastructure in a country and can potentially illustrate shortcomings in dealing with health issues at a young age. It was the first focus of the Federal Children’s Bureau when it was established because it is the gateway to many other public health concerns. It exposes the differences in access to healthcare, varying levels of community health engagements, and differing socioeconomic statuses between and within countries.
For the year 2000, the infant mortality rate in Afghanistan was about 100 deaths, amongst the highest in the world. That means that 1 out of every 10 babies died at infancy. To put that into comparison, Japan had a rate of about 2 deaths per 1000 babies. In 2018, Afghanistan was able to cut that number in half turning it into 47.9 deaths instead, while the rates of most other countries stayed the same. This still puts Afghanistan at the top of the list but no longer as troubling as the decade prior. This shift can be attributed to better healthcare for mothers and a greater acknowledgement by the Afghan government that this was a big problem. The Afghan minister of public health said that this was in part due to a huge effort to train and recruit midwives in rural areas where doctors and hospitals weren’t available. In 2002 there were only 400 midwives whilst in 2018 that number had grown to 5,000. This increase was especially important because infant mortality rates are the highest in those rural areas. The minister has noted, however, that in order to provide safe baby deliveries for these areas there needs to be at least 11,000 midwives, indicating that there is still a long way to go. Through midwife training these individuals also pass down much needed education to the birthing mothers. They provide lessons in infant care, hygiene, and general women’s health that most Afghan rural women do not otherwise have access to.
Women’s education, in addition to the health infrastructure of the country, is an extremely important contributor to the infant mortality rate. The countries with the highest levels of female education are mostly consistent with the lowest infant mortality rates. According to Human Rights Watch, “In Afghanistan, only 37 percent of adolescent girls are literate, compared to 66 percent of adolescent boys. Among adult women, 19 percent are literate compared to 49 percent of adult men.” This disparity in access to education has persisted throughout the years and has not been a priority to the Afghan government. This is due to long-standing gender norms but also the fact that Afghanistan has been impacted by international conflict and poverty for the past decade. However, despite these challenges the infant mortality rate was still reduced by half, which is a promising sign for the future. There has been even more improvement in urban areas where more hospitals are being built and pre- and post-natal care has improved. In these areas, vaccinations are common whilst that is not the case in rural areas, further contributing to such regional disparities.
There is also a lot of mistrust among the Afghan people in the country’s healthcare system. As a result of this, many go abroad to receive treatment for their medical conditions. This takes away money from the public health service and makes it hard to improve their practices or build new facilities. It also leads to more difficulty in convincing qualified doctors to serve in the country’s hospitals, which perpetuates the cycle of residents distrusting the health system and seeking healthcare abroad. The minister of public health said that the country loses around $300 million a year in the form of Afghans receiving treatment elsewhere. These individuals usually go to the UAE, Iran, or Pakistan. However, this is only possible for those with the resources and funds to do so, which leaves poor individuals stuck with a defunded and deteriorating health care system. Poor mothers especially usually elect to not even go to the hospital and give birth at home instead, which further contributes to increased infant deaths. Optimistically, the new healthcare officials in the country seem willing to address these underlying issues rather than implement temporary fixes. They are looking at ways to increase revenue and funding for healthcare services in order to once again legitimize them. This is going to be a long process but the improvement in the infant mortality rate is an encouraging indicator of more positive change to come.
Sources:
https://data.worldbank.org/indicator/SP.DYN.IMRT.IN?locations=AF