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RENEE MONTAGNE, HOST:

It's MORNING EDITION, from NPR News. Good morning. I'm Renee Montagne.

STEVE INSKEEP, HOST:

And I'm Steve Inskeep. You can measure the past decade or so in Afghanistan in many ways. You could describe the number of bombings, the number of combat killings, or the amount of cash spirited out of the country.

MONTAGNE: But you could also focus on a different number - it's the life expectancy of the average Afghan. When the Taliban was still running the country in 2001, Afghanistan's life expectancy was an appalling 45 years.

INSKEEP: Today, life expectancy is up to 62 years, a profound change. The gain is almost entirely a function of reductions in child mortality. The spread of basic health services made a difference, though it will be hard to keep up the gains. NPR's Sean Carberry reports.

(SOUNDBITE OF BABY CRYING)

SEAN CARBERRY, BYLINE: Here at the Goldara clinic, a 2-month-old baby expresses her dissatisfaction with having a needle jabbed into her thigh.

(SOUNDBITE OF BABY CRYING)

CARBERRY: But this Penta vaccine will protect her from five different diseases that contribute to infant and child mortality. In 2001, 1 of every 4 children born in Afghanistan died by the age of 5. Today, 1 in 10 children die by age 5. It's a dramatic improvement. But children are still dying in large numbers from preventable conditions like diarrhea, pneumonia and hypothermia.

(SOUNDBITE OF CROWD CHATTER)

CARBERRY: The Goldara clinic sits in the center of a ring of destitute villages in the vast Shomali Plain north of Kabul. It's one of some 2,000 health facilities in the country today, up from only 400 a dozen years ago. According to the Afghan government, more than 60 percent of the population now has access to health services.

The clinic is part of a Health Services program run by Afghanistan's Ministry of Public Health, and administered entirely by non-governmental organizations. The clinic provides vaccinations, midwife services, and other basic medical education and treatment.

SAMIA: (Foreign language spoken)

CARBERRY: Samia, covered in a traditional blue burka, came to the Spartan, six-room clinic today to have one of her four children vaccinated.

SAMIA: (Foreign language spoken)

CARBERRY: Samia says she's been pregnant six times. The first ended in an abortion due to complications. The second time she gave birth at home, and the baby died within four days.

RACHEL MARANTO: Across Afghanistan, we're still looking at up to 80 percent of women giving birth at home.

CARBERRY: Rachel Maranto is director of program development for Save the Children, an international organization that's been doing health work in Afghanistan since the '70s. One of their programs is training volunteer community health workers who go out into the villages and raise awareness of the importance of things like prenatal care, and going to a clinic or a midwife for childbirth.

SAMIA: (Foreign language spoken)

CARBERRY: It was a community health worker who convinced Samia to seek medical services after her baby died. Since then, she's had four children - all born in clinics, and all vaccinated.

NOORZIA: (Foreign language spoken)

CARBERRY: Noorzia is one of the community health workers here at the clinic today. She says the biggest challenge is changing cultural practices.

NOORZIA: (Through translator) Once a mother-in-law threw me out of the house during a counseling and often, mothers-in-law won't even allow us into the house.

CARBERRY: Health workers struggle to convince older women to allow their daughters to deliver in clinics.

NOORZIA: (Through translator) They say: When I was younger, I gave birth to many children without going to a health facility. So my daughters can do the same.

CARBERRY: Mothers also pass along bad practices, like feeding their infants tea and biscuits instead of breast milk. Malnutrition is a major contributor to child mortality and actually, an even bigger challenge, says Maranto.

MARANTO: We're looking at around 60 percent of children that are stunted.

CARBERRY: Continuing the progress of the last decade also requires recruiting and training more female health workers - which is no small task, says Maranto.

MARANTO: In Uruzgan province, where we work, less than half a percent of women are literate.

CARBERRY: Save the Children ended its support for the community health workers here in Goldara several months ago, and part of the purpose of Maranto's visit is to see if the services are continuing.

UNIDENTIFIED WOMAN: (Foreign language spoken)

CARBERRY: A group of burka-clad women say they are carrying on as community health workers, but they miss the neonatal kits that Save the Children used to provide. They say that villagers are accusing them of stealing the kits.

This gets to the thorny issue of sustaining the gains that have been made so far. The World Bank, the European Union and the U.S. Agency for International Development are the primary funders of Afghanistan's basic health services. Continued support from USAID is most in doubt, as the international community draws down its support for Afghanistan, says Maranto.

NOORZIA: We hope very much that USAID will continue to commit for another three years.

CARBERRY: USAID says it intends to continue providing $100 million a year for health services in Afghanistan, but officials warn their funding is subject to congressional approval. And Congress just voted to cut Afghan aid almost in half. Sean Carberry, NPR News, Kabul.

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