Risks for Women Giving Birth at a Hospital in Kabul Afghanistan
Female Members of Parliament Fauzia Kofi. Fights Maternal Mortality
Sixteen–year–old Ekleema is waiting to give birth to her first baby. Her labor is progressing very slowly. After 24 hours there seems to be no end to her misery. She looks terrified and exhausted. Married at 14, she has already had one miscarriage.
Ekleema lives in war–torn Afghanistan, where discovering you’re pregnant is akin to finding out you have a potentially fatal illness. An Afghan woman has a one in eight lifetime chance of dying in pregnancy or childbirth. Indeed, with one of the highest maternal mortality rates in the world, Afghanistan is one of only a handful of countries where women have a shorter life expectancy than men.
Luckily she doesn’t know these statistics. Like the vast majority of Afghan women, she cannot read or write. But you don’t need an education to know that child-bearing in Afghanistan is a risky business. Every family has stories of lost mothers, daughters or sisters.
Ekleema’s chances of survival are good. She has been admitted to Kabul’s Malalai Hospital where her baby will be delivered by a trained doctor or midwife and emergency care is available.
In the main delivery ward beds stand in a line against the wall. There’s a woman lying on each one, the women scream in turn but none is quite ready to give birth. Lying on the floor at the far end of the ward is 22–year–old Parvana. With the help of a midwife who’s kneeling at her feet, she delivers her baby right there on the ground.
Looking at the delivery table that has been in use since the Soviets invaded in the 1970s, it is hard to believe that conditions at Malalai Hospital have improved since the days of the Taliban, when operations were frequently conducted by oil lamp because there was no electricity. Yet six years ago, after decades of war, drought and civil unrest, Afghanistan had no functioning medical system. While this affected all its citizens, the health of women was particularly neglected.
In a few short years, Afghanistan has made major strides towards creating a health system, with great improvements in the under–five mortality rate. Malalai has become one of Afghanistan’s leading training hospitals, running courses in infection prevention and emergency obstetric care.
Yet many problems continue to plague the country’s efforts to slash maternal mortality — one major obstacle being the shortage of female health workers. Since it is still unacceptable for a woman to be treated by a man., this shortage contributes to Afghanistan’s maternal death toll.
To address the gap, Afghanistan has launched a drive to recruit and train midwives, particularly in remote regions where the shortages are so acute. Today Afghanistan has more than 2,400 trained midwives, up from only 446 in 2002, but a far cry from the 8,000 the country needs for adequate health coverage.
Other obstacles to boosting maternal health include ongoing violence in some parts of the country and an appalling scarcity of hospitals and trained staff in others. Yet another culprit, says Fauzia Kofi, a rising star in Afghan politics, is the gender bias against women.
A Member of Parliament, Ms. Kofi recently traveled by car and on horseback to reach some of the most remote parts of her constituency. When she asked one woman how she would reach a hospital if she became pregnant, the woman replied that her life was not a priority for the family. It would be better, she said, for her to die than for her family to lose an animal.
This is an attitude which shocks even those like Ms. Kofi who’ve lived with it all their lives. The time has come for change, she says.