Doctoral Dissertation Improvement Grant: Society, Culture, and Maternal Death on the Peripheries of Afghanistan and Tajikistan

Stanford University, Stanford CA

Investigators

Abstract

Graduate student Kylea Liese, under the supervision of Dr. Melissa J. Brown, will in investiage the cultural and social contexts that produce and epxlain maternal mortality in remote peripheral societies. Liese will undertake the research on both sides of the Afghanistan and Tajikistan border. The Badakhshan region of Afghanistan has the highest reported maternal mortality ratio in the world (6507 deaths per 100,000 live births) . Meanwhile, the national maternal mortality ratio for Tajikistan is nearly one-hundred times less (65.5/100,000), with only two maternal deaths reported in Tajik Badakhshan between 2002 and 2004. Despite historical and geographic similarities, Tajiks and Afghans on the peripheries have felt the reverberations of starkly different macro-political changes in ways that distinguish them socially, religiously, politically and economically. When the international border officially closed in 1925, the people on the Tajik side and the Aghan sides of the border became part of quite different societies. Liese's research will investigate the relationship between these dramatic variations in rates of maternal mortality and how these social forces have taken shape over the past century. The comparative approach will elucidate how social and cultural factors affect health in otherwise similar populations. The researcher will employ both qualitative and quantitative methods to go beyond the existing maternal mortality data and understand how the suffering and survival of women are valuable indicators of the long-term and far-reaching affects of social upheaval. In two years of research on both sides of the border, she will collect ethnographic data using semistructured interviews, life-history interviews, observations of birth events, local leader interviews, verbal autopsies, participant observation, and fieldnotes. These data will be used to test three major hypotheses concerning the causes of maternal mortality, the effect of social upheaval on maternal mortality in terms of maternal risk, and local Islamic constructions of gender and health. The research is important because there are few anthropological studies of the cultural and social factors affecting maternal mortality in perhipheral communities. It also will contribute to improve health policy in regions with limited resources, particularly where the causes of increasing maternal mortality are still shrouded in mystery. The research also will contribute to the education of a social scientist.