March 1, 2005
Women dying to give birth in Afghanistan
By Angie Ramos
Wednesday February 23 2005
Contrary to perceptions, family planning is actually accepted in Afghanistan
GULNAMA Shamsali sips tea and tries to calm her screaming six-month-old son as her husband and his four siblings quietly nibble their lunch - a few pieces of stale wheat bread - in their cold, dark mud house.
In two months, Gulnama, still only 22, will give birth to her second child.
And she could die from doing so.
The nearest hospital is 100 km away, four to five days by donkey, the most common transport in rural Afghanistan. But Gulnama, whose youthful face is scarred by patches of frostbite from the bitter winter weather in her native Badakhshan province, says she is not worried. "I will give birth and their destiny belongs to God. He will save them," she said.
According to UN data, Afghanistan has among the world's highest rates of maternal mortality, and remote, impoverished, Badakhshan has the highest rates ever recorded anywhere in the world, with one mother dying in every 15 births.
It is not difficult to see why.
The province is spectacularly beautiful, with high mountains and deep valleys blanketed by green in spring and summer, red in autumn, and white in winter. But this beauty masks extreme poverty, an absence of physical infrastructure, a lack of skilled health workers, high illiteracy and social pressure on women to bear many children.
Poor facilities: Gynaecologist Dr Hajera Zia Baharestani runs Badakhshan's only maternity hospital, a 20-bed facility in the capital, Faizabad, inaccessible to most of the province's estimated 230,000 women of childbearing age.
"If Badakhshan had good roads, maybe a lot of doctors from other provinces would come here, but at the moment, no one's coming. We need help," Baharestani said.
Most women suffering from pregnancy complications who try to reach the hospital from remote areas die on the long trek through impossible mountain passes.
Those who make it get as much attention as Baharestani's staff of five doctors and a handful of nurses can give. But there is very little to offer.
"We don't have oxygen here, we don't have specialists for anaesthesia," said Baharestani, who with her overworked team, must carry out complex surgical procedures such as hysterectomies using emergency lights powered by a faltering generator.
"We need antibiotics because patients come in a very bad state."
Despite three years of increased foreign aid after the overthrow of the Taliban, and UN efforts to highlight the problem of maternal mortality, the situation remains dire.
Experts say that it could be decades before Afghan mothers get proper protection.
"It's the kind of thing we can't change overnight," said Dr Jeffrey Smith, who works with Johns Hopkins University affiliate USAID/REACH, one of many foreign aid organisations involved in women's health in Badakhshan.
"The issue of maternal mortality is an issue of infrastructure, we have to develop the right personnel ... and deploy them to the rural areas."
Smith's organisation has recently opened a midwifery school in Faizabad to train women who will go back to their villages to help pregnant women with complicated deliveries.
Family planning: A key priority is to try to steer women towards education and family planning, but this too will be a long battle as despite efforts to improve women's rights since the Taliban's overthrow, provinces like Badakhshan still suffer from rates of female literacy of just five percent.
Twenty-two-year-old Hossima is typical. Married off to a 30-year-old man when she was 11, she has since given birth to nine children - all but one of whom died, mainly from poor nutrition. As Hossima cuddles her surviving six-month-old son, who is recovering from a fever; she tells Dr Baharestani she wants to have two more children. "Well, she can have nine more if she wants," an exasperated Baharestani said, "She has a very healthy reproductive system."
Contrary to perceptions, Smith says, family planning is actually accepted in Afghanistan.
"People recognise that they need to space their births and limit their births," he said. "So I think family planning is part of the educational process for midwives and is something that we're working to strengthen throughout Afghanistan."
Despite the difficulties, Dr Baharestani is optimistic for a better future and hopes President Hamid Karzai's Western-backed government will make good its promise to build roads and clinics and provide better salaries to attract skilled staff.
"When Mr Karzai inaugurated this hospital, he promised us he would make Badakhshan one of the nicest cities in the world," she said. "I believe him."
This optimism is echoed by Gulnama's husband Rahman, who, despite the risks his wife faces, is already planning the future of their unborn children.
"I want them to be educated so they can have a better future," he said.
"Look at us now - we are not educated, look at the kind of life we have: living in a cold hut, no job, no money. But I know my children will be educated and they will have a better future."
reuters
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