Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles.
In their informative paper Jai Das and colleagues cite the WHO Trends in maternal mortality: 1990 to 2015, which gives an estimate (in Annex 7) of maternal mortality ratio of 396 per 100,000 live births. 1 Many have regarded such low estimates as too good to be true. Surprisingly Das and colleagues nowhere mention the Demographic and Health Survey 2015, which gives an estimate of MMR of 1,292 per 100,000 live births. 2
This paper, like a number of others on healthcare in Afghanistan, also fails to mention that data in that country are often corrupted. The massive inflow of funds for aid and development, with insufficient monitoring and audit, has fostered corruption, and that extends to data. It is no surprise that some recipient organisations aim to please their international donors with high achievements. A report by the Afghan government in 2016 said “fraud, falsification, fakes, and forgeries have become a routine aspect of documentation in the Public Health sector. This has had dire consequences for the integrity and reliability of each of the main elements of the health system”, including health services delivery and management information systems.