Fatima with her husband and grandchildren. Married at 15 years to a man 40 years older than her, Fatima lost her son as she was highly Anaemic and suffered from eclampsia
From Sarah Crowe and Rajat Madhok
Daikundi Province, 3 August 2011 – Few roads lead to Daikundi, Afghanistan. It is the heartland of a hard land - So barren, so remote, not even the conflict reaches here. Ironically for a country at war, it is not violence that puts the lives of mothers and small children at risk but the simplest act of giving life and struggling to survive. Even in the warmest months, mothers must rely on the oldest and cheapest way of getting around and getting help. As it is Afghanistan is one of the worst countries in the world to be a mother and Daikundi is the worst of the worst. To be a child is tougher still. Those who make it here, to get rare medical help, are the fortunate few.
Habiba is heavily pregnant but for now her worry is for her third-born child Sakina. She is in the red danger zone of malnutrition; she’s been treated here for a week with her mother at her side. Sakina is given fortified nutritious biscuits and is released from hospital. Her mother now must start to think about her unborn child. Around her are reminders of what faces that child – more than half of Afghanistan’s children are chronically malnourished and nearly 200 out of every thousand children do not live to see their fifth birthday and most of those deaths, could easily have been avoided – with clean water, decent food, and basic treatment to prevent killers like diarrhoea.
Just to have a basic check-up is literally an uphill battle for Habiba – she has to walk across three hill tops in scorching heat to a different building some two kilometres away. No wonder nine out of 10 mothers do not to give birth in a health facility. The cost of transport is beyond their reach. 30 year old Tahira is part of a government health team that visits the remotest of these remote parts of Daikundi province only five or six times a year. Doctors are rare. For these women, Tahira is their doctor, their nurse, their carer, their lifeline. “Most of the women here are child brides, they live far from health facilities, they work the whole day in the fields, they are not educated at all and they all come from very poor economic conditions” says the midwife.
Training midwives and community health workers who go door to door and counsel pregnant women and mothers on reproductive health and hygiene, these volunteers also talk to women on broader issues that may affect their health as well as their children’s. Here they run all the standard tests - iron deficiency is an important one, but there are no major worries for her. If Habiba was dangerously anaemic she could lose her life or lose her baby – like 25 year old Fatima did four months ago. Fatima’s ill health and extreme poverty led to her baby boy dying during child birth. Her story is typical here – at 15 she had to marry a man 40 years older than her. All her daughters were born at home with no medical help.
Today Fatima is still weak. As she prepares her family’s daily meal – of bread and tea – she recounts her loss. “I lost my child because I could not go to the health facility as it was very far. If a hospital can be built nearby then we all would be very grateful. Even now I am so weak that I can barely do my daily chores or work in the field. I really miss my child, whenever I see babies from other houses I miss him so much, I feel so sad.”
Ironically for a country in conflict, the most dangerous thing a woman can do in Daikundi is give birth and for a child to be born. So the aim here is to get the international community to invest in this neglected province and see a peace dividend pay off so that the desperate won’t turn to growing poppies for Opium or move to volatile Kandahar or Kabul. UNICEF and other UN agencies and NGOs have ambitious plans for this forgotten province – a target province of the country. The aim is to provide a minimum package of care – health, nutrition and better water and sanitation – for most of the women and children here by 2013.
Adriana Zarrelli, UNICEF’s Health chief in Afghanistan feels that the international community can play an important role in helping reduce the numbers of infant and maternal mortality in Daikundi. “It’s important that the international community understands that it’s not only a health problem, it has to be solved with the engagement of all sectors, especially transportation and telecommunications and also sectors related to improving the economies of the families like food security and agriculture. And we should not forget education because the girls who are attending the schools today will be the mothers of tomorrow and they need to be empowered to take decisions when it comes to their health and lives and the health and lives of their children.”
In Daikundi today’s parents know that they won’t be able to boost tomorrow’s generation without a helping hand and in this forgotten province of Afghanistan that - is what is needed.