ROBERT SIEGEL, HOST:
From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.
AUDIE CORNISH, HOST:
I'm Audie Cornish. And we begin this hour in Afghanistan. A U.S.-sponsored mortality survey released late last year announced huge improvements in health across the country. Among the headlines, life expectancy in Afghanistan has increased by 20 years, just since 2004. USAID funded the study with a contribution from the United Nations Children's Fund. Officials say it provides the most accurate snapshot ever of health in Afghanistan.
But the scale of improvement is so remarkable that experts, including several involved in the survey, worry the results are too good to be true. NPR's Quil Lawrence reports on the debate about the data.
QUIL LAWRENCE, BYLINE: During three decades of war, Afghanistan remained a black hole of health information. A few studies looked at a small slice of the population and then extrapolated. The numbers horrified the world. Life expectancy in 2004 was measured at just 42 years, 25 percent of children did not survive until the age of 5. For every 100,000 deliveries, a staggering 1,600 women died in childbirth, the second-worst rate in the world.
But last year's survey delivered shockingly good news. Afghan surveyors in all 34 provinces brought back data suggesting that life expectancy at birth is now 62 years. Child mortality under 5 dropped to 10 percent. Of 100,000 live births, the maternal mortality rate was down to 327.
SUSAN BROCK: We were all surprised. That's what led to additional review and much more analysis.
LAWRENCE: Susan Brock, health adviser with USAID in Kabul, says it was such an improvement that they delayed the release to crunch the numbers again. Last November, USAID confirmed the findings. But some experts who worked on the survey still think the data is too good to be true, like Dr. Kenneth Hill, a Harvard University demographer.
KENNETH HILL: Because there are question marks still hanging over the estimates, I'm not sure that there is an enormous value in the data.
LAWRENCE: Hill says many Afghans simply don't discuss family matters with strangers.
HILL: Conditions for data collection in Afghanistan is desperately difficult. Knocking on someone's door and asking them details about their children and their household is not something most people would want to do.
LAWRENCE: USAID says their statisticians adjusted the findings for many anomalies which are all explained honestly in the survey. But three of the six experts on the survey's technical advisory group told NPR they still have doubts, like Julia Hussein of Aberdeen University, who has worked on maternal mortality in Afghanistan since the 1990s.
JULIA HUSSEIN: You've got to match what you know in terms of evidence with what you see with your eyes, virtually. And I suppose - so my instinctive reaction to figures like this, that have been reported in the survey, is that I just find them unbelievable, knowing what sort of care is available in Afghanistan.
LAWRENCE: But defenders of the study say people can't believe the numbers because they've gotten used to thinking that Afghanistan is hopeless. Dr. Mohammad Rasooly says health is improving in many different ways. He was lead technician from the Afghan side on the survey.
MOHAMMAD RASOOLY: For instance, if we consider only the example of midwife, 10 years back we had only 400 midwife at the national level. So today, we have more than 3,000. So this is very important for maternal care.
LAWRENCE: Also, new paved roads mean a journey to the clinic takes hours instead of days, says Rasooly. Widespread mobile phones help people call for assistance. Dr. Rasooly says the survey's margin of error is pretty big, but he has no doubt health is much better now than 10 years ago. It's not about knowing the exact number, says Ken Yamashita, USAID mission director in Afghanistan.
KEN YAMASHITA: We're quite confident of the numbers. In the end, it's a survey, and so, any survey has an error margin.
LAWRENCE: Yamashita says the new mortality survey is the best ever done here, but it will take more studies like this one some years down the road to do a comparison and establish a trend.
YAMASHITA: What it represents is a more representative survey on the one hand, and two, a very real improvement in health.
LAWRENCE: So while the experts debate whether life expectancy could have really jumped 20 years since 2004, doctors now have a better baseline. And even the most optimistic numbers still show that Afghanistan will need help for many years to improve the health of its people. On that, at least, all the experts agree.
Quil Lawrence, NPR News.