Saving Futures: How Boosting Maternal and Newborn Care Could Transform Afghanistan by 2030

Alright, let’s talk about something incredibly important, something that really pulls at the heartstrings: the health of mothers and their tiny newborns, especially in a place like Afghanistan. We often hear about the challenges there – the poverty, the instability – and it’s easy to feel overwhelmed. But amidst all that, there’s a story of progress, and more importantly, a story of immense *potential* if we keep pushing forward.

The Starting Point: A Tough Reality

You see, despite some truly remarkable strides made between 2003 and 2020 – and seriously, kudos to everyone involved in that – Afghanistan still faces some of the highest rates of maternal and neonatal deaths in the world. It’s a stark reality. Many pregnant women just don’t have easy access to the basic care they need, like check-ups before and after birth, or having a skilled helper present when the baby arrives. Can you imagine? Over a third of births still happen at home, and getting life-saving emergency care is a huge hurdle for so many, tangled up in issues like cost, where you live, and even gender norms.

We’ve seen efforts to standardize healthcare, like the Basic Package of Health Services and the Essential Package of Hospital Services. The country even signed up for global strategies and action plans aimed at improving things. But the challenges are persistent. Substandard care has been an issue, and honestly, the experience people have when they *do* get to a facility isn’t always what it should be. And then, of course, the political shifts since 2021 have thrown everything into an unprecedented humanitarian and economic crisis, putting those hard-won gains at risk. Millions need help, and healthcare is right at the top of that list.

Crunching the Numbers: What If We Do More?

This is where the science comes in, and it’s pretty fascinating. Researchers used a tool called the Lives Saved Tool (LiST) – basically a sophisticated model – to figure out what could happen if things *really* improved. They weren’t just looking at increasing access; they were also trying to factor in the *quality* of the care provided, which is a more nuanced way of looking at things, especially when money is tight (and let’s face it, in Afghanistan, resources are incredibly constrained).

The idea was to project the impact if coverage of essential, proven interventions for mothers and newborns could reach 90% of everyone who needs them by 2030. Think about that – 90% coverage. That’s a big leap, but the model helps us see the payoff.

Scenario 1: Focusing on Quality

One scenario they looked at was improving the *quality* of care, meaning making sure that facilities are ready to deliver these interventions effectively, even if the *number* of women reaching those facilities doesn’t change drastically. If 90% of facilities were ready by 2030, the model projects something amazing: over 5,200 maternal lives saved *each year* compared to keeping quality levels as they are. For newborns, the impact is even larger, with over 22,000 additional neonatal lives saved yearly.

What interventions make the biggest difference in this quality-focused scenario? For mothers, it’s things like Cesarean delivery (when needed!), blood transfusions, and managing complications after birth. For newborns, it’s treating infections like sepsis and pneumonia, nutritional support, and yes, Cesarean delivery again (because sometimes it’s life-saving for the baby too). It’s clear that improving the *readiness* of facilities – having the right staff, equipment, and drugs – is absolutely critical.

Scenario 2: High Quality AND High Utilization

Now, the really powerful picture emerges when you combine high quality with high *utilization* – meaning more women not only have facilities ready to help but are also *able* to get to them and use the services. The scenario projected what happens if 95% of facilities are ready *and* 95% of pregnant women attend antenatal care and give birth in facilities, leading to that 90% overall coverage of interventions.

In this scenario, the numbers jump even higher. We’re talking about over 5,700 additional maternal lives saved yearly by 2030. The top interventions here shift slightly, highlighting the importance of things like uterotonics to prevent severe bleeding after birth, alongside blood transfusions and C-sections. For newborns, the projection is over 27,800 additional lives saved yearly! Key interventions include nutritional support during pregnancy, managing newborn infections, and C-sections.

What’s striking is that interventions during childbirth account for a huge chunk of the lives saved in both scenarios, for both mothers and newborns. This really emphasizes how crucial that moment of birth is and how much difference skilled care and emergency readiness can make.

Hitting the Targets: Getting Closer to the SDGs

So, what do these saved lives mean for the big picture, like the Sustainable Development Goals (SDGs)? The SDGs aim for fewer than 70 maternal deaths per 100,000 live births and 12 or fewer neonatal deaths per 1,000 live births globally by 2030. Afghanistan is currently far from that, with rates around 638 maternal deaths and 36 neonatal deaths per 1,000 live births.

But if that 90% coverage scenario plays out? The model projects the maternal mortality ratio dropping dramatically to 237 per 100,000 and the neonatal mortality rate falling to 16 per 1,000. While still above the SDG targets, these reductions are *massive*. They represent a huge leap forward and show that getting closer to those goals *is* possible with focused effort and resources. It’s a powerful argument for investment.

The Roadblocks and the Way Forward

Of course, none of this is easy. The report highlights the significant challenges. Funding is a major one. Afghanistan’s health system relies heavily on donors, and that funding has decreased. Domestic revenue is limited, and people are paying a huge amount out-of-pocket for healthcare (77%!). This isn’t sustainable. Without consistent, increased funding, the fear is that maternal mortality could actually *rise*, potentially by 50% by 2025 according to one estimate. That’s a terrifying thought.

Beyond funding, there are issues with the *quality* of care provided, even when services are available. We need more competent providers, better training, supervision, and support for healthcare workers. The private sector is also involved, and leveraging and regulating it is important for things like medicine supply and service quality.

And let’s not forget the factors outside the clinic walls. Things like poverty, education, food security, and safety nets – the social determinants of health – play a massive role. Addressing maternal and newborn health effectively requires working across different sectors: water, sanitation, nutrition, gender, education. It’s a team effort.

Building trust and getting buy-in from communities is also key. Engaging local leaders – tribal elders, religious figures – and aligning programs with cultural norms is essential for acceptance and success. Partnerships with NGOs, civil society, and local actors are vital.

Despite the political changes and humanitarian crisis, it’s important to note that health facilities *are* still operating, and female health workers continue their crucial work. Access to care seems to have stabilized somewhat since early 2022, and women are generally allowed to seek maternal and childbirth care. Staff retention is good, though specialist shortages exist. Equipment is mostly available, but medicine shortages are a concern.

The Call to Action

So, what’s the takeaway from all this modeling and analysis? It’s a message of *potential* and a clear call to action. Saving these lives is possible. The interventions exist. We know what works. But getting them to everyone who needs them in Afghanistan by 2030 requires serious commitment.

It needs *tenacity* – a refusal to give up in the face of immense challenges. It needs *innovation* to find new ways to reach vulnerable women and newborns. It needs *reinvigorated commitment* from both the Afghan government and the international community. And crucially, it needs *continued financial resources*.

The study points out that a major limitation was the lack of super-current, accurate data, especially after the 2021 political shift. More recent surveys are needed to get an even clearer picture. But even with the current data, the message is loud and clear: investing in quality maternal and newborn health services in Afghanistan offers incredibly high returns in terms of lives saved.

It’s about more than just numbers on a chart. It’s about mothers surviving to raise their children, about babies getting a healthy start in life, about building stronger families and communities. It’s an unfinished agenda globally, and in Afghanistan, the stakes are incredibly high. Let’s hope this kind of evidence can help guide those tough decisions about where limited resources go and keep the focus firmly on saving those precious lives.

Source: Springer