Over half a million women die every year from the complications of pregnancy, delivery or shortly after that. Most maternal deaths are avoidable. Maternal mortality in the United Kingdom was reduced significantly only in the earlier part of the 20 th century with the advent of widely available blood transfusion services and antibiotics. The other major advance was in the 1970s with the better care for new born which allowed babies to be delivered at a earlier gestation. This allowed mothers with pre eclampsia to have their babies delivered at a earlier stage, stopping the deadly condition.

Pregnant women are vulnerable to many disorders some associated with pregnancy and some intercurrent with the pregnancy. They are vulnerable to changes in the environment , both physical, economic and emotional. When these conditions change for the worse, maternal mortality rises correspondingly. When health services improve, maternal mortality goes down. Just as the DOW index can be used as a measure of economic health, maternal mortality can be used as a measure of the efficacy of health care delivery.

Just as some countries have had conditions deteriorate recently, the maternal mortality has also increased lately. Afghanistan has had some of the worst maternal mortality statistics since data was available. This could be interpreted as a representation of the plight of women in Afghanistan. The reasons for this deterioration parallels the fortunes of the country as a whole since the Russian involvement and the rise and fall of the Taliban. Malnutrition, deconstruction of the health care system , physical overwork have been instrumental in increasing maternal mortality in the past few decades.

One of the United Nations Population Fund goals is to reduce maternal mortality by 75 % by 2015. It would appear at first glance that in Afghanistan it would be as elementary as improving blood transfusion services and supplying antibiotics. It is unfortunately not that simple. Deep seated cultural attitudes regarding the role of women in Afghani culture dictate the access that Afghani women have to health care. Changing attitudes is as crucial as changing the healthcare system. NGOs have been addressing this by training midwives in rural areas who will hopefully get access to womenfolk in the communities from which they are from.

Basic measures such as immunization, routine iron and folate supplementation and two blood pressure measurements for all pregnant women is a realistic and effective goal. It is said ante partum hemorrhage weakens and post partum hemorrhage kills. Risk stratification in a rural setting where medical records are rudimentary calls for unequivocal signs which caregivers can share with patients. Hemorrhage, at whatever stage of pregnancy is a good red flag for high risk and any woman with this needs to be monitored. Again, to monitor the woman without removing her from her other children, husband and family calls for cultural finesse which is best left to members of the community from which the woman hails.

Emotional health has taken a back seat in the battle to reduce maternal mortality. It would appear commonsense at first glance but there is good evidence to show mental health impacts measurably on emotional health. Depressed persons have been shown to have abnormal activity of T lymphocytes, Natural Killer cells and platelets, instrumental in protecting a woman from infection during and after pregnancy. Emotional health is deeply rooted in most cultures with interpersonal relationships and culture and in order to address this health care givers need to be uniquely culturally sensitive.

One of the more effective economic strategies in development has been to award mocro loans, usually to women entreprenurs. It would not be difficult to adapt this concept to reducing maternal mortality, by setting up micro cells of health care givers embedded in the communities from which they hail from.