Today, when we think of Afghanistan, a cauldron of chaos comes to mind: massive international counterinsurgency and counternarcotics operations, countless NGOs struggling to maintain neutrality and operational integrity amidst the militarization of aid and development, and the sheer deprivation of dignity suffered by the overly-occupied Afghan people, among other such indictments of the international community's historic and present-day involvement. While these issues continually make above-the-fold headlines, today is International Women's Day (IWD), and I wish to highlight yet another travesty in Afghanistan: maternal mortality.
With more than half a million women dying each year from largely preventable complications related to pregnancy and childbirth, Afghanistan is now ranked second worst in the world when it comes to maternal mortality behind Sierra Leone. In fact, in 2006, Badakhshan province in northeast Afghanistan had the worst incidence of maternal mortality ever recorded in history. According to UNICEF, Afghanistan's maternal death rate is 1,800 per 100,000 live births, compared to the U.S. rate, which is 11 per 100,000. While those of us living in free and open societies would agree that the rights of women in Afghanistan are in dire straits, we must also agree that this particular situation demands special attention. Indeed, with regard to these statistics, President of CARE USA Dr. Helene Gayle famously stated, “We have to stop being polite about this issue – we need to start marching in the streets. Post-partum hemorrhage is a nice way of saying we let women bleed to death.”
Addressing this challenge is compounded in difficulty when we begin to understand the landscape of the geography, culture, history, and politics of Afghan society. Intermittent access to basic healthcare and education; religious influence, tribal lines, customs and tradition; and living in perpetual states of war and occupation make it particularly difficult to approach the problem of maternal mortality. But there is hope on the horizon.
In a previous piece I wrote on the Aga Khan Development Network (AKDN), which focused on their efforts with regard to women and girls in Afghanistan and Pakistan, I made note of their 18-month midwifery training program. Developed in Badakhshan province, the program is showing signs of success in both health promotion and education, in addition to their community nursing initiatives. Efforts of this sort will have an effect on both maternal and infant health explained John Tomaro, Director of Health Programs for the Aga Khan Foundation (AKF), to the BBC. Intensive training of this nature is not the only method to achieving lasting and positive health outcomes; educating the populace on the use and benefits of contraception can also make an enormous difference.
With Afghanistan averaging more than six babies per woman and UNICEF estimating that a mere 10 percent use some form of birth control, improving such damning statistics may not be as hard as it seems. Just last week, the World Health Organization's journal, Bulletin, published a study conducted in 2005-2006, which involved 3,700 families in three rural areas with different ethnic groups, including both Sunni and Shia Muslims. In this case, the Health Ministry collaborated with nonprofit organizations to spread the word that using contraception was 300 times safer than giving birth in Afghanistan. The results of the study indicated that over the course of eight months, the use of the pill, condoms and injected forms of birth control rose to 27 percent in all three areas — and up to half of the women in one area — once the benefits were explained one-on-one by health workers. “The fastest, cheapest, easiest way to reduce maternal deaths in Afghanistan is with contraception,” said lead author Dr. Douglas Huber to the Associated Press.
Funded by the William and Flora Hewlett Foundation and conducted for the U.S.-based nonprofit Management Sciences for Health, the report noted that the key to such societal shifts rested largely in the hands of the mullahs — local religious leaders. Quotes were used from the Quran to promote breast-feeding for two years, while mullahs joined community and health leaders to explain the importance of spacing out births to give mothers and babies the best chance at good health. “All the mullahs at the community level knew of these things that the Prophet Muhammad himself advised his followers,” Huber continued. “This was not a hard sell.”
But it is certainly a long process. Great strides have been made in bringing the plight of women to the forefront of societal awareness and policy debates around the world since IWD first began in 1911, and one upcoming forum in particular vows to carry the baton even further. Positioning women's maternal and reproductive health as a global priority, the Women Deliver 2010 conference is being held June 7-9 in Washington, D.C. It expects a lineup of government officials, experts and advocates destined to attract national and international headlines, including Hillary Clinton, Ban Ki-moon, Sarah Brown, and Melinda Gates, among many others. In an interview with Jill Sheffield, the founder of Women Deliver, she said, “Women are an asset to their families, to their communities, and to their economies. On the eve of the G8 summit, the Women Deliver conference will seek to reinforce the idea that investing in women makes economic sense as well as good common sense, mobilizing historic action on this issue and bringing it directly to policymakers.”
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On Tuesday, a drama will unfold in Washington that will be unlike anything we've seen in the first year of the Obama administration.
I will join dozens of leaders of unions and other public interest organizations and thousands of others to protest the major lobby that is blocking real health care reform in Congress. We will hold a rally and then march to a Washington hotel where America's Health Insurance Plans (AHIP), which represents all the corporate heavies in the health industry, will be plotting their next steps.
The demonstration is being organized by Health Care for America NOW!, a national grassroots campaign for quality, affordable health care. This coalition asked the directors of about 100 groups to risk arrest at the event. I will be joined by Institute for Policy Studies board member Barbara Ehrenreich, AFL-CIO President Richard Trumka, and other allied group leaders.
That dozens of leaders would risk arrest in confronting the corporations that stand squarely in the way of fundamental change represents a new moment for our social movements. There is a growing realization that giant health care, fossil fuel and financial firms will stop at nothing to block fundamental change. In this case, the leaders of the giant health insurance companies have joined with CEOs of the largest pharmaceutical firms to buy the votes in Congress to block fundamental health care reform.
Hence, we must up the ante if we are to create the change this country so desperately needs.
One thing that must change is the executive pay system. Chief executives of the top five health insurance companies raked in a combined total of more than $113 million in 2007 and 2008, according to executive pay experts at my organization, the Institute for Policy Studies. All five of these firms — WellPoint, UnitedHealth Group, Cigna, Aetna, and Humana — are represented on the board of directors of the AHIP lobby group.
The highest-paid health insurance exec was Ronald Williams of Aetna, who made $35.6 million over the past two years. It would take an American worker with average pay more than 1,000 years to make that much.
Soon to be released pay data for 2009 are likely to show continued executive excess, since these firms maintained high profit levels last year, while at the same time ordinary Americans were reeling from rising health care costs and soaring unemployment.
We know now that the out of control executive pay system was a cause of the financial crisis. But it's not just in the high finance world that outrageously high rewards encourage executives to take actions that put the rest of us at risk. The greater the potential reward, the greater the temptation to grab that reward by any means necessary. In the health insurance industry, that has meant denying coverage to people with health problems that might cut too much into the corporate bottom line.
A health crisis for the rest of us just means a bigger paycheck for the executives.
Throughout the economy, executives seeking massive personal rewards behave in ways that are bad for the economy in the long term — reckless investing, shortchanging worker training and slashing R&D, hammering consumers, or, should all else fail, simply cooking the books.
UnitedHealth Group, the nation's largest health insurance company, was nabbed a few years ago for backdating stock options in order to jack up payouts for top executives. The firm had to oust their CEO and pay $895 million to settle a class action lawsuit over the scandal — just one example of the kind of risks executives are willing to take in order to line their own pockets.
And, these firms have reaped enough profits from an increasingly unhealthy America that in addition to outrageous CEO pay, they have plenty left over to block most meaningful change in the “best Congress that money can buy.”
The stakes are undeniably high: Just listen to the stories of people in your own communities who were denied coverage by their insurers. Just as the Biblical David faced down Goliath, one hundred of us are willing to go to jail tomorrow if it will send a clear message to the CEOs of our nation's health insurance plans: They cannot grow rich while the rest of us grow sick and tired.
Alexander Melton