

The bitter reality for Afghan women: an address by Malalai Joya.

By Tim Anderson

May 20, 2012 -- Stop the War Coalition, Sydney -- Amnesty International has muddied the waters over the occupation of Afghanistan with its latest campaign urging NATO to “keep the progress going” on women’s rights. The campaign was aimed at a NATO summit in Chicago and drew on one of the few remaining arguments for continued military occupation of that war-ravaged country.

The idea that a military occupation would somehow help Afghan women was promoted by Laura Bush, wife of the former US president who ordered the October 2001 invasion. It is an argument that been rejected by the Afghan women’s group, Revolutionary Association of the Women of Afghanistan (RAWA) and by activist and former Afghan MP Malalai Joya (see video above). They say that the NATO occupation has simply added a third enemy, on top of the Taliban and the NATO-backed warlords.

Amnesty International pleads: "NATO: Keep the progress going!"

Amnesty was forced onto the back foot almost immediately by protests over its posters, which read “NATO: keep the progress going”. Many thought this appeared an endorsement of the occupation.

Amnesty USA (as the US branch likes to be known) tried to redirect attention to what it said was its main aim: that the US and NATO should (in the words of Hillary Clinton) “not abandon women”. This was the theme of an article earlier in the year, when the group’s policy director Cristina Finch attacked NATO’s “peace talks” with the Taliban.

The Amnesty argument was that NATO should "defend and extend" the women’s rights that have been achieved under 10 years of occupation. Amnesty staffer Jungwon Kim referred to “significant but tenuous gains Afghan women have made over the past decade”.

This in turn linked back the Finch article, which suggested “modest advances in human rights for women and girls had been made in Afghanistan during the past ten years of US occupation”. These were said to be in the areas of girls in school, new laws against gender-based violence and a quota for women in parliament.

Another Amnesty official, Vienna Colucci, defending the group’s “NATO: keep the progress going” posters, claimed: “Today, three million girls go to school, compared to virtually none under the Taliban. Women make up 20% of university graduates. Maternal mortality and infant mortality have declined … this is what we mean by progress: the gains Afghan women have struggled to achieve over the past decade.”

Reference to the “struggle” does not hide the implication: that any gains were backed by a military occupation.

There was no source for these claims, but they appear to come almost word for word from an article by Khorshied Samad posted on a Fox News site. Samad is Afghan born, a Washington-based “strategic affairs analyst” and her husband has been an Afghan diplomat under the Hamid Karzai regime. It seems more likely that Colucci copied Samad, than the other way around.

Maternal mortality

I took a particular interest in Amnesty’s claim that maternal mortality has fallen under the occupation. I have studied maternal mortality and all the recent data put Afghanistan as the worst or equal worst on Earth. Was there any basis for the assertion that “maternal mortality and infant mortality have declined” under the occupation?

Maternal mortality is undoubtedly an important indicator. As a key human development measure it has been listed country-wise since 1990 in the UNDP’s Human Development Reports. It is also included as the fifth of eight goals in the UN’s Millennium Development Goals (MDGs). The first part of MDG 5 is to reduce maternal mortality, the second part addresses the principal means of doing this, such as improving ante-natal care and ensuring the presence of a skilled assistant at birth.

There is a “natural” rate of maternal mortality, suggested as about 1500 deaths per 100,000 pregnancies (one every 67 pregnancies). This is roughly the rate of deaths that occur when there is no skilled birth assistant, such as a midwife, doctor or a specialist nurse. These assistants can prevent most deaths that occur by bleeding, infection, shock and obstruction (Van Lerberghe and De Brouwere 2001).

The worst outcomes in the world, rates of more than 1000, have been in Afghanistan and in several Sub-Saharan African countries: Chad, Guinea-Bisseau, Sierra Leone and Somalia. The UNDP (2012) notes that all countries have made some progress since 1990, but remain extremely high. Afghanistan began the worst, got no better under the Taliban, and remains the worst.

Table 1: Maternal mortality – highest rates, 1990-2008

The Amnesty (Finch) article refers to UNICEF data which lists Afghanistan’s maternal mortality rate (adjusted) at 1400: the worst in the world. So where is the "decline"? On the consensus of latest data available (I will come to the exception posed by WHO-World Bank data), it seems that Afghanistan remains the worst in the world, despite some slight improvements.

Table 2: Maternal mortality – highest rates, latest available data

The reasons for this are not too hard to see. The WHO reports Afghanistan as having the lowest levels of births attended by skilled assistants, among those five worst performing countries. Table 3 shows that only about one in seven Afghan women get such assistance, and that ante-natal care could not be calculated. None of the African countries had such poor levels of birth care.

Table 3: Maternal health care

However a distinct data set, produced by the WHO along with the Washington-based World Bank and some US academics has challenged all that. If we are to believe these figures, Afghanistan has made the 25th best progress in reducing maternal mortality over 1990-2010, a period which covers both the Taliban administration and the US-NATO occupation. The rate is said to have fallen by 65%, from 1300 to 460. The most dramatic improvements are suggested as in the pre-Taliban (Northern Alliance period) and under the occupation. Afghanistan, according this data, has raced ahead of the African countries.

Table 4: Maternal mortality rates revised – WHO-World Bank et al, 2012

But how credible is this WHO-World Bank report?

So far, all the key UN agencies (UNDP, WHO and UNICEF) maintain Afghanistan’s rate at 1400, rather than 460. The WHO-World Bank team say they “consulted” with government teams from each country to adjust their data. They say that in many countries (including Afghanistan) where there was no good civil registry data, they had resort to “other” national data. There is no other specific explanation of how the Afghan data came to be revised down this far.

The direct US government links (the US dominates the World Bank) are reason for concern over this study, as the legitimacy of the US military occupation in Afghanistan now depends significantly on claims (such as those made by Amnesty USA) that it is delivering benefits to Afghan women.

Given this conflict of interest and the lack of particular explanation for the “fall”, I suggest that, until and unless the key UN agencies (WHO, UNDP, UNICEF) adopt this revised data, it should be treated with suspicion and set aside in favour of the UN-published data.

That means that, despite some limited progress over the past two decades, the best data tells us that Afghanistan maintains the worst maternal mortality rate in the world (1400 per 100,000 pregnancies), a rate not very far from the “natural” rate.

This data is corroborated by the extremely low levels of skilled assistance available to mothers at birth. The billions of dollars spent on a military occupation (and many thousands of deaths of person other than mothers) do not seem to have increased Afghanistan’s rural midwives and doctors.

Sources

Amnesty USA (2012), "Shadow Summit for Afghan Women’s Rights", May 20, online at http://www.amnestyusa.org/ events/shadow-summit-for- afghan-women-s-rights

Colucci, Vienna (2012), "We Get It", May 19, Amnesty USA, online at http://blog.amnestyusa.org/ asia/we-get-it/

Finch, Cristina (2012), "US: Don’t Abandon Afghan Women", March 8, Amnesty USA, online at http://blog.amnestyusa.org/ asia/u-s-dont-abandon-afghan- women/

Kim, Jungwon (2012), "Afghan Women to NATO: Don’t Bargain Our Rights Away", Amnesty USA, May 15, online at http://blog.amnestyusa.org/ asia/afghan-women-to-nato- dont-bargain-our-rights-away/

Samad, Khorshied (2012), "What the NATO Summit could mean for Afghanistan’s women", Fox News, May 19, online http://www.foxnews.com/ opinion/2012/05/19/what-nato- summit-could-mean-for- afghanistan-women/

UNDP (2011), Human Development Report, online http://hdr.undp.org/en/ reports/global/hdr2011/ download/

UNDP (2012), "International Human Development Indicators: maternal mortality ratio", online: http://hdrstats.undp.org/en/ indicators/89006.html

UNICEF (2012), Afghanistan: statistics, online: http://www.unicef.org/ infobycountry/afghanistan_ statistics.html

Van Lerberghe, Wim and Vincent De Brouwere (2001), "Of blind alleys and things that have worked: history’s lessons on reducing maternal mortality", Studies in Health Services Organisation & Policy, 17, 2001, online: http://seriousgiving.org/ files/DWDA%202009/ Interventions/Maternal% 20Mortality/ SafeMotherhoodStrategies.pdf

WHO, World Bank, UNFPA, UNICEF (2012), "Trends in maternal mortality: 1990 to 2010’, WHO, UNICEF, UNFPA and The World Bank estimates", online: http://whqlibdoc.who.int/ publications/2012/ 9789241503631_eng.pdf

WHO (2012), "Afghanistan: health profile", online at: http://www.who.int/gho/ countries/afg.pdf