Afghan Women
Saving Mothers' Lives But the determined young woman has no doubts about the importance of her work
in a small clinic in rural northern Afghanistan, a country with one of the
world's highest maternal mortality rates.
Fatema's elder sister bled to death in childbirth when she was 16, having
been married at 15. Her baby's shoulder became stuck in her small pelvis and two
traditional birth attendants broke its neck trying to pull it out.
It was a complicated breech delivery, with the child positioned bottom first,
and the untrained birth attendants -- who help 80 percent of Afghan women have
their babies -- did not know how else to handle the problem.
"Look, if someone had known something at that time, we could have referred
them to go to hospital," says Fatema, which is not her real name because like
many Afghan women interviewed for this story she did not want her name to be
used.
Lack of knowledge and superstition amongst the rural community in Takhar
Province spawned rumors afterwards that the dead teenager must have been "bad"
to deserve such a fate.
When the British medical charity Merlin came to Takhar in 2004 to look for
women to train as midwives, Fatema jumped at the chance.
In February she and 20 other women became the first graduates from an
18-month course at the Community Midwife Education center in the provincial
capital Taloqan, returning to their districts with internationally recognized
diplomas to improve the chances of women surviving birth.
War-shattered Afghanistan is behind only Sierra Leone for the highest number
of women to die in childbirth.
The maternal mortality rate here is around 1,600 out of 100,000 live births,
according to a recent UNICEF survey. This means that one in six women between
the ages of 15 and 49 die giving birth. This compares with a rate of about 13
out of 100,000 in Britain, where one in 3,800 women die in childbirth, according
to 2000 UN statistics.
There are many grim stories to illustrate the problem in Afghanistan: of
traditional birth attendants, called dayee, cutting a baby's limbs off with a
kitchen knife in a desperate attempt to save a woman's life when something went
wrong in delivery; of pregnant women bleeding to death on a days-long donkey
ride to find help at a far-away health facility; of husbands beating their
pregnant wives' bellies because they can't afford another child.
"It is the worst I have ever seen," says Addie Koster, who heads the Taloqan
center and has worked in Afghanistan for the past five years after stints in
Africa, Asia and Central America.
There are many reasons so many women die, says Koster, most linking back to
the 25 years of war that destroyed the country's infrastructure and entrenched a
social system that denied women basic rights.
Often mothers' pelvises are too small for birth, she says. This can be
because they are young -- with nearly two-thirds of girls married before age 16,
according to statistics cited by the United Nations -- or malnourished as about
two-thirds of pregnant Afghan women are.
When complications arise the difficult terrain and lack of infrastructure can
mean clinics are days away although some women are too poor to even afford the
donkey ride.
Dayees sometimes rely on folkloric techniques -- such has biting on hair to
dislodge the placenta -- that may appear to work in simple births but are of
little use when things go wrong.
More dangerously, they make liberal use of oxytocin –- an injectable hormone
that can be bought in the smallest bazaar without a prescription -- to induce
labor even when the baby just cannot fit through the pelvis.
In a custom entrenched during the 1996-2001 rule of the ultra-conservative
Taliban who forced women under the all-covering burqa that most still wear, some
men still refuse to allow their wives to go to clinics where only a male nurse
or doctor is present.
Taloqan's Community Midwife Education center is a key part of a strategy
taking on all these problems. One of its main aims is to boost the number of
women in the province giving birth with the help of a skilled attendant from the
current eight percent.
Another of the center's fresh graduates, 22-year-old Lailuma, is installed in
a clinic far from the provincial capital. Since arriving in April, she has
helped with 15 deliveries -- up from zero before she arrived because women would
not see the then male-only staff. "The area where I live is very remote. There
were no midwives," the stylish woman says softly, a black scarf framing her
face. "I wanted to become a midwife because I wanted to do something for women."
Twenty-two new students have been in place since April, learning to suture on
chunks of raw meat and delivering the same dummy baby over and over again before
getting down to the real thing.
They are not shy about describing the difficulties facing Afghan women.
"There are no cars, no road, no transport. And security is not good," says
one explaining why most rural women give birth at home.
"The dayees know nothing. After 20 years of war, no one knows anything. We
have been left behind because of the war," says another.
"During the Taliban it was worse," adds one more, recalling the government
that refused to let women work which meant there were few female doctors for
them to see.
The situation is improving in provinces like Takhar which see little of the
current Taliban insurgency, which is focused on the south and east of the
country. When the hardline regime fell, Takhar had only five female medical
staff, says provincial health chief Hakim Aziz. Today the number is well on the
way to the goal of putting at least two women into each of its 52 clinics.
And whereas a community health clinic once saw on average five deliveries a
month, there are now about 25, Aziz says.
The new students at Merlin's center were selected by their communities for
the program and are obliged to return after graduation to work for at least five
years.
They will go a long way towards filling the 32 vacancies for midwives in
Takhar, says Nezamuddin Jalil from the Social and Health Development Program.
"We started from zero," the doctor says. "There was no staff, no access. Now
we have enough health facilities and enough equipment. But there is a lack of
female staff." Despite the challenges, "day by day it will be ok," he says. ___________________________________________________________________________
TALOQAN, Afghanistan (AFP) -- In a white coat and
with a dark scarf covering her hair, newly graduated midwife Fatema, 20, is just
months on the job and still a little nervous.