Objective: The International Rescue Committee (IRC) strove to reduce maternal mortality among Afghan refugees in Hangu district of Pakistan by improving access to emergency obstetric care (EmOC), community knowledge of danger signs of pregnancy, and the use of health information. Methods: IRC established EmOC centers, trained community members on safe motherhood, linked primary health care with education on danger signs of pregnancy and the importance of skilled attendance, and improved the health information system. Results: The maternal mortality ratio among Afghan refugees in the area improved from 291 per 100 000 live births in 2000 to 102 per 100 000 live births in 2004. The proportion of refugee births attended by skilled staff increased from 5% in 1996 to 67% in 2007. Complete prenatal care coverage increased from 49% in 2000 to 90% in 2006, and postnatal coverage more than trebled from 27% in 2000 to 85% in 2006. Conclusion: Improved services, community involvement and education, good coordination, and effective systems succeeded in reducing maternal mortality in a traditionally conservative environment. © 2008 International Federation of Gynecology and Obstetrics.

Maternal mortality Emergency obstetric care Refugee reproductive health Pakistan Community participation

Pakistan female Afghanistan maternal mortality risk factor priority journal live birth maternal care refugee postnatal care prenatal care medical information Article health care personnel cesarean section human primary health care health education