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Health care for children and women in remotest Afghanistan

Improving women’s access to medical care is helping reverse troubling trends in Afghanistan, one of the world’s most dangerous places to bear children.


By Rajat Madhok

Newborn deaths account for a staggering 44 per cent of total mortality among children under 5, and represent a larger proportion of under-5 deaths now than they did in 1990. These deaths tend to be among the poorest and most disadvantaged populations. According to a new series of papers released by The Lancet, the majority of children who die before they turn one month old – nearly 3 million each year – could be saved by better care around the time of birth.

In Afghanistan, mobile health teams are penetrating the remotest parts of the country in order to give mother and baby a fighting chance.

UNICEF mourns the loss of Dr. Nasreen Khan, an integral part of UNICEF Afghanistan’s staff who is quoted in this coverage, who died in the tragic attack on a restaurant in Kabul on 17 January 2014.

HERAT, Afghanistan, 12 March 2014 – Deep in Herat province, the children of Jaghatai village spot a cloud of dust rising in the distance. They begin to run around the village square, shouting and screaming.

The dust is kicked up by a coming vehicle. Bibi Gul Momand and her team of health workers are making their way toward the village in their small ambulance. The women quickly gather their children and collect at the village mosque. There, the team will set up camp for a few hours to check the children and women for health problems.

Bibi Gul Momand is a trained midwife. Her team, and others like it, visit villages that are more than 25 km from the nearest hospital or health centre. They bring care right to the doorstep of children and women like those in Jaghatai, who access life-saving interventions difficultly.

Bibi Gul Momand, who claims to have assisted women in the delivery of more than a thousand babies, says, “Health facilities are very far from here, and people cannot afford to travel. They have to cope with this. Sometimes, sick people die. So we come here to support them.”

UNICEF Image: A midwife takes blood pressure in Afghanistan.
© UNICEF Afghanistan/2014/Madhok
Bibi Gul Momand, a midwife who claims to have assisted in the delivery of more than a thousand babies, counsels women in Jaghatai village, Herat province. She is part of a UNICEF-funded mobile medical team reaching children and women in rural areas.

Dangerous place to give birth, dangerous place to be born

Afghanistan remains one of the world’s most dangerous places for women to have children. Per every 100,000 live births, 460 women will die in childbirth or during pregnancy. At least 1 in 10 children will die before their fifth birthday.

According to Dr. Nasreen Khan, Health Specialist with UNICEF in Afghanistan, there are health services available, but the majority of them are clustered in urban centres. Rural areas like Jaghatai village are therefore almost deprived of health services. “Health surveys in Afghanistan have revealed that more than 30 to 40 per cent of the population does not have access to health care,” says Dr. Khan.

“Another important thing is that, even if we provide the health services, there is inequity within the provision of these services,” she adds. “Even if the services are available, these are not accessible to women in rural areas, and those women who are poor.”

Bringing health care to children and women

UNICEF, along with the Ministry of Public Health and other partners, is working hard to ensure every last child and woman has access to health care. They are supporting mobile health teams like Bibi Gul Momand’s in Herat – and across the country.

The mobile teams include a midwife, two vaccinators, a community health supervisor and a community health worker. The team provide a variety of services for free. They check who has been vaccinated and give vaccinations. They screen for malnutrition and other health complications and provide basic medical treatment and give nutritional advice.

More serious cases are referred to the Khairia Rezaee maternity hospital in Herat city, the capital of Herat province.

© UNICEF Afghanistan/2014/Madhok
Women experiencing complications during childbirth can now be referred to larger facilities like Herat’s Khairia Rezaee maternity hospital, where a neonatal care unit also provides care for infants born prematurely.

Supporting rural mothers and their babies in hospital

Recently, Rukshana gave birth to a baby girl at Khairia Rezaee hospital. She traveled for five hours along a bumpy road to get there. Rukshana, who is 20, had already lost three children to miscarriage, and during unattended home delivery. So, this time, she decided to come to hospital.

“Children are sometimes born dead, and the mothers bleed a lot during deliveries at home,” Rukshana explains. “Children also suffer from health problems. They get sick after being born and sometimes die from illnesses like pneumonia.”

After she had her baby, Rukshana was admitted to the maternity waiting home. Supported by UNICEF, the home caters to women who come from remote communities without medical facilities. Pregnant women and new mothers can stay at the home with their families before and after delivering their babies, knowing that doctors are on hand in case of complications.

With the odds stacked against them, this service is a lifeline for many rural women.

UNICEF has also funded the construction of a special care neonatal unit, which provides medical care for babies who are born prematurely. The unit has qualified nurses and a doctor on standby around the clock.

Reaching remotest Afghanistan

UNICEF, its partners and teams of dedicated health workers like Bibi Gul Momand and her colleagues are reaching the areas of Afghanistan that are hardest to access.

Armed with trained workers, small ambulances, specially equipped hospitals and tenacity, they deliver the care, interventions and referrals that will save the lives of mother and baby and ensure that children survive – and thrive – one village at a time.



UNICEF Photography: Gender issues

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