What explains the enormous more than 50 fold difference in maternal mortality rates across this river? Both areas of Tajikistan and Afghanistan are "in geographically contiguous poor, post-conflict, highly conservative, mountainous countries." How can the obstetric risks for women be so different? To continue our review of this fascinating study, we take a closer look at the differences between the Tajik and Afghan sides of the river as reported in the study by Kylea Liese.
The Tajik side has a large Soviet era hospital, some basic equipment and some medical personnel. And the Tajik women have a maternal mortality rate 50 times lower than the Afghan women, who have little to no medical care. So it stands to reason that the presence of the emergency obstetric care and medical facility explains the difference, right? Not so fast says our anthropologist/nurse/midwife Kylea Liese. Instead, her observations reveal that the Tajik hospital is large, but poorly equipped. Even the physicians who may be working there do not actually have training in emergency obstetric care. The author says "Expecting a physician to provide emergency obstetric care was like starting to bake a cake with all the right bowls and pans but none of the right ingredients."
Liese makes a bold argument saying:
" I will argue that advanced obstetric care to treat complications is an insufficient strategy to reduce high levels of maternal mortality because it does not address what is causing women to have such a high level of pathological pregnancies. Instead I will argue that certain social structures and practices influence women over the course of their lifetimes, irrespective of access to EOC [emergency obstetric care]. These chronic risk factors result in higher rates of life-threatening complications in some countries and lower complication rates in others."
Interestingly, she argues that on the Tajikistan side, the appearance of a nice facility and some technology makes it seem as though these factors are contributing to the much-lower maternal mortality rate. However, in reality, the women have lower rates of obstetric complications because of lifelong differences in the status of women in their culture.
What are some of these differences that cause lifelong risks to women? Liese sees long-term, chronic, social and physiological stresses are present on both sides of the river: gender inequality, poverty, poor nutrition, religious conservativeness and violence. But certain factors PROTECT the Tajik women--factors including the Soviet emphasis on girls education, emphasis on reproductive health care and marriage laws.
The takeaway point: One can not look at the moment of birth to explain the differences in maternal mortality.