A young mother in Afghanistan should not continue to die every 27 minutes

© UNICEF/HQ07-1446/Khemka

A swaddled newborn at Malalay Hospital in Kabul, Afghanistan, is his mother’s tenth child. The mother, now 30, delivered her first child at age 15. Four died within a day of birth.

Sixteen-year-old Ekleema is waiting to deliver her first baby. Her labour is progressing very slowly. After twenty-four hours there seems to be no end to her misery. She looks terrified and exhausted. She was married at 14 and has already had one miscarriage.

Ekleema lives in Afghanistan, where discovering you’re pregnant is akin to finding out you have a potentially fatal illness. She has a one in eight chance of dying during her lifetime – even though there’s nothing whatever wrong with her.

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 childbearing 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, if needed.

The building is old and poorly equipped, but conditions here have improved significantly since the days of the Taliban when operations were frequently conducted by oil lamp because there was no electricity. Malalai has become one of Afghanistan’s leading training hospitals, providing qualified doctors and midwives for the country’s nascent health care system.  

Six years ago, after decades of war, drought and civil unrest Afghanistan had nothing that could be described as a functioning medical system. A survey conducted by UNICEF and partners supported by the Ministry of Public Health shortly after the fall of the Taliban found that the maternal mortality rate in the country was among the worst in the world. In fact, with 1,600 women dying for every 100,000 live births, Afghanistan was second only to Sierra Leone which has the highest maternal mortality rate in the world. 

There are many reasons why so many women were, and still are, dying during and after pregnancy; poverty, traditional cultural practices and difficult terrain are among them. One problem the country faced was an acute shortage of female medical professionals. Although the Taliban officially allowed women to study medicine, in reality few did. In addition, many qualified women left the country. One Malalai midwife described how her colleague left Afghanistan the day after being beaten by the Taliban for not wearing socks with her burka. Her story is not an isolated one.

This shortage of female health workers is particularly crucial because in Afghanistan it is unacceptable for a woman to be treated by a man. Only if she is in a critical condition would a family consider allowing this to happen.

To address this shortage, in the last few years there has been a massive drive to recruit and train midwives. And special effort has been made to find women who are prepared to live in the most remote areas of the country where it is hard to keep staff. Today Afghanistan has more than 2,400 trained midwives, nowhere near the 8,000 needed but a big improvement on the 446 recorded in 2002. 

According to UNICEF’s Dr. Hemlal Sharma, Afghanistan’s health system has made great strides. A good policy structure has been established, more than 80 per cent of the country now has a basic health package (up from 9 per cent five years ago) and there’s been a reduction in the infant mortality rate.

But many problems remain. The lack of security in some parts of the country continues to hamper progress. Not only does the ongoing unrest make it difficult, sometimes impossible, to create functioning medical facilities but it is also a drain on resources.
Fauzia Kufi is the Member of Parliament for the north-eastern province of Badakhshan, a remote mountainous area, where women sometimes have to walk for days to reach the nearest medical facility. Badakhshan has the worst recorded maternal mortality rate in the world, an appalling 6,500 maternal deaths for every 100,000 live births. The province is in desperate need of roads, hospitals and trained staff, but Kufi says that often her relatively peaceful part of the country is overlooked as funds are needed to fight the insurgency in the south of the country.

Despite the progress made in the last five years Kufi, a vocal campaigner for women’s rights, believes that the authorities have been slow to make maternal health a priority. She points out that currently Afghanistan has the attention of the world and that donors are providing money and expertise. “If we can’t do it now, when can we do it?” she asks rhetorically. If this opportunity is missed, she fears it will never come again and a young mother in Afghanistan will continue to die every 27 minutes.

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