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Institute for International Programs

Reproductive Age Mortality Study (RAMOS II)

Repeat Reproductive Age Mortality Study (RAMOS II) (Afghanistan)

In 2011, a reproductive age mortality study (RAMOS) was implemented in three districts to measure changes in maternal and child mortality, maternal causes of death, and risk factors. It was designed to replicate the methods used in RAMOS I conducted in 2002 by the MoPH, the US Centers for Disease Control and Prevention and UNICEF. This 2002 study found that all indicators of mortality risk were among the highest recorded globally, increasing substantially with remoteness. These study findings initiated a strong response from the Afghan MoPH and the international humanitarian aid community. Enhancement of maternal and child health services became a major priority area and the focus of nearly a decade of health strategies and policies

In an effort to identify changes in mortality rates in the same geographic areas over time the MoPH and stakeholders approved a repeat of the RAMOS I study using the same two-stage survey methodology, as well as qualitative data collection to assess contextual influences affecting maternal mortality decline. The survey was completed among 27,000 households in Kabul City and Ragh district in Badakshan province – a sample size calculated to measure a decline of up to 25% in maternal mortality. Kabul and Ragh represent extremes of urban and rural contexts. . 

The results have shown significant improvements in maternal and newborn mortality risk, but also evidence of great disparity between urban and rural settings. Results have been submitted to the Lancet Global Health, and are being used by the MoPH and international partners to guide further action to save mothers lives.