Estimating maternal mortality: what have we learned from 16 years of surveys in Afghanistan?

Summary box ‘Particularly hard hit by Afghanistan's 23 years of war, civil strife and Taliban misrule are Afghan women, who are experiencing what health officials call ''catastrophic'' death rates associated with pregnancy and childbirth’.1 The opening paragraph of this 2002 New York Times article captures how women’s health became, and still is, a cornerstone of development aid in Afghanistan. As a result, maternal health measurements have become an important tool for ‘evidence-based advocacy’,2 as in many other countries grappling with poor maternal health. Maternal mortality estimates in particular, have played a major role in justifying external assistance to the Afghan healthcare system1 and in documenting maternal health improvements as a legacy of the 2001 intervention and successive foreign involvement in the country.3 Sixteen years later, we …