One of the most dramatic changes in Afghanistan since the fall of the Taliban is the increase in average life expectancy from 45 to 62 years. That gain is almost entirely a function of reductions in child mortality due to the spread of basic health services.
Yet Afghanistan still has one of the highest child mortality rates in the world, and there could be significant backsliding as the international community reduces aid after NATO troops withdraw at the end of this year.
At the Goldara clinic on a recent day, a two-month-old baby cries loudly, expressing her dissatisfaction with having a needle jabbed into her thigh. But this Penta vaccine will protect her from five different diseases that contribute to infant and child mortality.
In 2001, one of every four children born in Afghanistan died by the age of five. Today, one in 10 children dies by age 5. It's a dramatic improvement — although children are still dying in large numbers from preventable conditions like diarrhea, pneumonia and hypothermia.
Creating Access
The Goldara clinic sits in the center of a ring of destitute villages in the vast Shomali Plain north of Kabul. It's one of some 2,000 health facilities in the country today, up from only 400 a dozen years ago. According to the Afghan government, more than 60 percent of the population now has access to health services.
The clinic is part of a program run by Afghanistan's Ministry of Public Health and administered entirely by non-governmental organizations. The clinic provides vaccinations, midwife services and other basic medical education and treatment.
Samia, covered in a traditional blue burka, has come to the spartan six-room clinic to have one of her four children vaccinated.
She says she's been pregnant six times; the first ended in an abortion due to complications, the second time she gave birth at home and the baby died within four days.
"Across Afghanistan, we're still looking at up to 80 percent of women giving birth at home," says Rachel Maranto, director of program development for Save the Children, an international organization that's been doing health work in Afghanistan since the 1970s.
One of the group's programs is training volunteer community health workers who go out into the villages and raise awareness of the importance of things like prenatal care and going to a clinic or midwife for childbirth.
It was a community health worker who convinced Samia to seek medical services after her baby died. Since then, she's had four children, all born in clinics and all vaccinated.
Noorzia, one of the community health workers at the clinic, says the biggest challenge is changing cultural practices.
"Once a mother-in-law threw me out of the house during a counseling, and often mothers-in-law won't even allow us into the house," she says.
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