Best of the BBC: Maternal mortality worldwide

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REPORTER: We're in Badakhshan in northeast Afghanistan, which is now ranked second worst in the world when it comes to maternal mortality. And just a few years ago in 2006, Badakhshan had the worst ever recorded incidence of maternal mortality ever recorded in history. And yet you visit here and there are so many NGOs working here. Why are the statistics so stubborn? Well, with me here, hopefully to give me some answers is John Tomaro. He is the director of the health programs for the Aga Khan Foundation, which is very active here in Badakhshan. I've seen some of your programs here. Why are the statistics still so bad, so grim?

JOHN TOMARO: Well, I mean we still haven't had a scientific survey following the survey that was taken in 2006. That's one factor. Second, it takes a long time to really have a change in the maternal mortality ratio. There are a couple of techniques that will indicate whether or not we're on the right course, that is that the maternal mortality ratio is going down. But it takes a significant amount of time to measure it. We do think, however, that we've begun to put in place some of the measures that will have an effect in reducing the ratio.

REPORTER: Give me one. Give me a top one that has to change.

TOMARO: The community midwife school, where we have recruited young women from the villages throughout Badakhshan province. They have come to a school where they are introduced to a course which lasts 18 months, and they're given basic midwifery training. At the end of that, they go back to their villages. They work in what are known as basic health centers. They're supervised very carefully by the staff there, and then they're supervised on a twice annual basis by staff who comes out from the school, to make certain that what they're doing is in compliance with the appropriate instruction. So we think it's measures like that, measures like health promotion. Also some of the work that we're doing in terms of introducing community

nursing, that these will have an effect both on maternal health and will have an effect also on infant health as well.
REPORTER: So you're starting to move things in the right direction, but with these midwives, are they coming up against some of the same problems that are causing so many women to die? That is, ignorance, cultural taboos, religious taboos.

TOMARO: Yes, I think it's more-- I think we can say more it has to do with culture and tradition than it has necessarily to do with religion. If it has anything to do with religion, it may be a misinterpretation of what Islam is really about. These are very traditional societies in which changing practices and changing beliefs takes an awful lot of time. But that's a part of what we're also trying to do by introducing a health promotion and disease prevention interventions. This is also what we're trying to do in terms of introducing safe water program and good sanitation programs, because these will have an effect on the status. We're also heavily involved in education, and that's education across the board. This is for boys, this is for girls, because we do need-- clearly, there's a clear correlation between the education of women, for example, and their health and the health of their children. So you have to proceed on multiple fronts and I think that's what we, that's what the government is interested in, and that's what a lot of NGOs are doing.

REPORTER: Is the government really interested in it?

TOMARO: Oh yes.

REPORTER: Because we talk about a government which is not that present outside of Kabul.

TOMARO: Well, I mean, I just came from a meeting with Dr. Momeen [PH]. Dr. Momeen is the provincial health authority. He's the man who represents the Ministry of Public Health here in

Badakhshan. I would say two things. One, he's very current on the issues and two, he's very committed to using the means at his disposal in order to improve the situation. So I would give him very high marks.

REPORTER: John Tomaro, thank you very, very much. As the cars start up, you can hear the generator in the background. Of course, this is a province without electricity as well. Thank you very much.

TOMARO: You're very welcome. Thank you very much.