Afghanistan’s population is faced with major health challenges as shown by its high maternal mortality ratio (estimated at 1600/100,000 live births - one of the highest in the world and meaning that an average of one in nine Afghan women die in childbirth), low life expectancy of only 46 years, and high child mortality rate (under-five mortality rate is 191/1000 and infant (under-one year) mortality rate is 129/1000). A low contraceptive prevalence rate (6 %) contributes to a high fertility rate (average of 6.6 children per woman). 

The strategic objectives of the WHO program on Reproductive Health (RH) in Afghanistan are the reduction of the maternal and newborn morbidity and mortality by increasing availability of and equitable access to RH services with special emphasis on essential obstetric care. Use and quality of RH services are to be improved and knowledge and decision making at the community level increased. 

Experience of safe motherhood programs all over the world showed that maternal mortality has decreased where women have increasingly given birth with a professionally skilled attendant whether at home, in a primary health care facility or in a hospital. The improved functioning of essential and emergency obstetric care facilities for women with complications and an effective referral system are also important. Every pregnancy faces risks and care provision needs to be available to respond to all women and newborns, should complications develop. 

In order to improve service delivery and enable skilled attendants to provide quality maternal and newborn health services to women and infants, WHO introduced and technically supported the MoPH in adapting the evidence based WHO guidelines and tools on Making Pregnancy Safer and Family Planning (“Pregnancy, Childbirth, Postpartum and Newborn care – the essential practice guide”, “Decision Making Tool for Family Planning Clients and Providers”, and “Managing Complications in Pregnancy and Childbirth”). With WHO support, the adapted guidelines have been translated into Dari and Pashto and were printed and introduced to all stakeholders through the National Reproductive Health workshop. Moreover, 16 national trainers were trained by a WHO consultant from Geneva. The national trainers then trained 157 health care providers from Kabul and three other provinces in the use of the “Decision Making Tool”. 

In addition, WHO has supported the establishment of the newborn care unit in Malalai Hospital to improve and strengthen the maternal and newborn health care service delivery in Kabul. Support by WHO included training provided for 248 doctors and midwives who were taught about basic and comprehensive emergency obstetric care and basic newborn resuscitation.  

Furthermore, 63 community midwives in three provinces (22 in Baghlan, 19 in Bamyan, and 22 in Badakhshan) are trained in order to increase assess of women to skilled attendance at birth especially in rural areas, and to make essential obstetric care available as close to people’s homes as possible. 

The “WHO Strategic Approach to Improving the Quality of Care of Reproductive Health Services” was used as a model to improve the MoPH’s family planning/birth spacing program in Afghanistan. As the first phase of the strategic approach, a strategic assessment of birth spacing services had been carried out and the report has been disseminated to all stakeholders. Based on its findings a National Plan of Action for Family Planning has been prepared. 

To increase women's access to health information and services innovations are supported such as the WHO developed tool for working with individuals, families, and communities (IFC). A National IFC committee was formed which works on developing a strategy for IFC. 

After helping to build research capacity of the MoPH staff by sending five staff to Bangkok and Finland for training on research methodology, WHO is now supporting the Afghan Institute of Public Health and the Reproductive Health Department of MoPH in carrying out two studies. This research on the use of a Partograph to prevent prolonged labor and on the use of a Haemoglobin Color Scale to detect anemia in pregnant women will start this year.