A Global Perinatal Health Indicator Falters in Afghanistan

ABSTRACT

Through the life of a global health project in a maternity hospital in Kabul, Afghanistan one indicator—intrapartum mortality—was taken to represent the quality of emergency obstetric care and was at the center of a struggle over project management. The indicator was also contested by Afghan clinicians, and so was adapted, in which process the relationship between the indicator and women’s lives outside the hospital was made clear. As the indicator faltered, new possibilities for intervention emerged, although these were not fully realized. Global health governance and financing must be flexible enough to respond when indicators falter.

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KEYWORDS:

• Afghanistan
• agencements
• global health
• metrics
• perinatal
• quality

Acknowledgments

I am grateful to all project personnel who agreed to share their experiences with me, especially those in Kabul, Afghanistan. Among those in Kabul, M. S. S. helped arrange my schedule, provided me with an excellent translator, and generally made me very welcome. I am grateful to Susan Erikson, who commented on an early version of this article, the Medical Anthropology reviewers of this article, and Editor Lenore Manderson. Their insightful comments led to important revisions; the deficiencies which remain are my own. Northern Arizona University Institutional Review Board approved the research under the title Donor ethics in global health: the case of Rabia Balkhi Hospital in Kabul, Afghanistan on October 26, 2015 (789052-1). The IRB also approved an amendment on April 15, 2016 (789052-2), and a renewal on October 25, 2016.

Additional information

Funding

Northern Arizona University supported part of this research through faculty development funds.

Notes on contributors

Michelle Anne Parsons

Michelle Anne Parsons is assistant professor in the Department of Anthropology at Northern Arizona University and author of Dying Unneeded: The Cultural Context of the Russian Mortality Crisis (2014). In her work, she examines global health practices and applies ethnography to issues of population health in Russia and the USA.