The Other Necessary Health Intervention: Roads

In Afghanistan, it's a tale of two provinces. The first is the northeastern region of Badakhshan, a relatively peaceful province that boasts a comparatively high number of maternal health resources: 106 midwives and 73 health centers. The second is southern Helmand province, where — thanks to the ongoing violence — there are just 29 midwives and only 40 health centers to support over 450,000 women: a female population nearly 30% larger than that of Badakhshan.

And yet it's Badakhshan, not the conflict-ridden Helmand, which ranks as the world's worst place to be a mother. Nowhere else on earth are there are many mothers who die from pregnancy and related birth complications as Badakshan, where for every 100,000 children born, 6,500 mothers will die.

So what accounts for this discrepancy?

The answer, IRIN suggests, is roads. The terrain in Badakhshan is rugged, with roads that are poor and often nonexistent. So while the province might be better-equipped with medical facilities than some, unfortunately, they can be physically out of reach — especially in the wintertime, when floods and avalanches make it difficult to access clinics even by horse or donkey.

According to the U.K. nonprofit Save the Children, across the globe, Afghanistan is the most dangerous place to be pregnant (as well as to be born). But as Saadia Fayeq Ayubi, director of reproductive health at the Ministry of Public Health, puts it, high rates of maternal mortality has many roots — including lack of transportation.

"It'snot just a health problem and it cannot be tackled only through health intervention,” she says. "We need to build roads and eliminate illiteracy, poverty, gender violence and prevent child marriage and also raise public awareness about the risks of multiple and short-term pregnancies."

Globally, access to health centers is frequently undercut by geography, in which available health clinics tend to overwhelmingly cluster in urban regions inaccessible to many (for reasons of time, expense and weak public transport). In some areas of Niger, for example, fully 70% of villages are over nine miles from health centers, while others are 30 miles away. That might not sound far, but as Save the Children’s head of Niger programs says, "It can take three days to walk there [to the center] and three days to walk back, so by that time they have to leave again,."

As we've often written, when it comes to global health, more health workers are key, as is better investment in issues like water and sanitation. But sometimes as well, what you need is a working bus system — and roads.

Photo Credit: afghanistanmatters