She was 16 years old, she was going into labour for the very first time, and things started to go wrong.

Somewhere in the birth canal, the fetus got stuck.

It's called an obstructed delivery, and in most places on Earth, it is 99.9 per cent preventable.

But this is Afghanistan – to be precise, a remote northern province called Badakhshan, a part of the world where women die in childbirth with almost unimaginable frequency.

"When I found out how the women die every day, I cried," says an Afghan physician named Nafiza Qani, who was working in Badakhshan in 2003, at the time this drama took place.

She recounts the tale now, a chronicle of pain that has likely been repeated thousands of times in Badakhshan or other parts of the country. Some version of these events is likely playing itself out somewhere in this land right now. In Afghanistan, on average, a woman dies in childbirth every 27 minutes.

For two days and nights, the girl strained and suffered, until finally her desperate husband set out on foot through the winter-bound countryside in search of help.

In all, he spent six days clambering through the snow – three days to find a nurse and three days for the pair to return to the man's distant rural home.

They arrived too late.

By the time he reached her side, the man's young wife was dead. After eight days and nights of excruciating labour, she had finally succumbed without delivering her child. The infant died as well.

Qani tells the story in a low, uninflected voice, but it is evident the narrative haunts her still.

Nowadays, she works as a program officer for the United Nations Children's Fund, or UNICEF, and is based here in Kabul, capital of a country with some of the highest rates of maternal death ever recorded anywhere on this lopsided orb.

"If you go to the most remote villages," says Dr. Linda Bartlett, the Canadian who heads the UN agency's maternal and child health program in Afghanistan, "and if you ask people what are the problems, they will tell you, `Our women are dying.'"

The numbers are staggering.

One in every nine Afghan women dies while giving birth. For women of childbearing age, pregnancy and childbirth are the leading causes of death. Mostly as a result, the country is one of the few lands on the planet where the life expectancy of women (45 years) is lower than that of men (47 years).

In parts of Badakhshan, more than 6,500 mothers die for every 100,000 live births, the highest such mortality rate ever recorded anywhere on the planet.

The comparable figure here in Kabul is far lower – 400 deaths for every 100,000 live births – and conditions for expectant mothers seem to be improving. But it was not long ago that the capital was a treacherous place for anyone and perhaps especially for women about to deliver.

This country is not for the squeamish – and neither are the next few paragraphs.

The speaker is Mehrafzwan Mehrneswar, chief on-call doctor at the Malalai Maternity Hospital, by far the largest maternity-care facility in the land. Standing in one of the hospital's three operating rooms, she is recalling the early 1990s, when a civil war was consuming much of Afghanistan.

"We had to do a caesarean section," she says, "and the rockets were flying."

Some link in the electrical power grid may have taken a hit because, suddenly, the lights went out. In those grim days, the hospital lacked the diesel generator that nowadays kicks in whenever the electricity fails. The surgeon called for an oil lantern, there being no other light source.

Still unable to see properly, the surgeon demanded that the lamp be brought closer.

It was then that somebody fumbled the light.

"Some oil spilled into the patient's abdomen," remembers Mehrneswar, a high-spirited woman able to recount such grotesqueries in an animated, upbeat voice. She raises her hands to the ceiling in a theatrical gesture, as if to address an assembly of imaginary gods.

"And I thought: `In what textbook does it explain how to get oil out of a woman's abdomen?'"

Somehow, disaster was averted and both mother and child survived their ordeal.

But the accident with the oil lamp provided a measure of the perils that expectant women faced not long ago even in Afghanistan's largest, most sophisticated city, perils that they continue to encounter in many parts of the country.

"A lot has been done, but there's a lot that still needs to be done," says Bartlett. "The geographic distances are huge. There are places in Badakhshan where it's a 10- or 15-day donkey ride to the nearest health-care facility. If women get sick, they just die."

A guided tour of the Malalai hospital showcases the best that the Afghan medical system can currently offer in obstetrics and gynecology. It's a dramatic improvement over even the recent past – something that no one knows better than Mehrneswar.

"Before, we would say, `Oh – the patient's blood is dark. We must do something.'"

Now, thanks to international donations, one of the operating rooms here has machinery that monitors the level of oxygen in a patient's blood and also her heart rate. For complicated deliveries, doctors now have access to vacuum extractors in place of forceps.

There's an electrocardiograph as well and, two years ago, the hospital finally got an ultra-sound machine.

"The total hospital stay of our patients has decreased," says Mehrneswar, noting that many steps have been taken to improve hygiene.

"The number of repeated operations has decreased. The infections have decreased. The return of patients with infections – that's down, too."

The use of wood-burning stoves to provide wintertime heat lends the building a rustic and impoverished air. There are few wheelchairs or gurneys, and there is only a single gauge in the entire facility to control the release pressure of oxygen tanks.

In most respects, however, the 240-bed hospital is a thriving, successful affair, delivering approximately 80 babies each day with a mortality rate lower than 1 per cent.

But what happens here at Malalai is a far infant's wail from what goes on in the rest of the land.

In Afghanistan as a whole, a trained medical practitioner – whether a nurse, doctor or midwife – attends no more than 10 per cent of delivering mothers, and mortality rates remain shockingly high.

Bartlett conducted a thorough study of maternal death in Afghanistan prior to 2002 – its results were published in British medical journal The Lancet in 2005 – and she is convinced that progress is being made.

"We believe maternal mortality and fetal death have declined because of increased access to care," she says.

"We can't document it in actual numbers, but women are coming into hospital in larger numbers and having nice, safe deliveries."

But Afghanistan is a very poor country – among the planet's poorest – and suffers a chronic lack of resources in almost every area, including health care.

What's more, there's a war on now, another in a tangled succession of conflicts that have tormented the country for more than a quarter-century.

Inevitably, advances are gradual and tenuous, and the pace of progress may even be slowing.

"Funding is not at the level that it was," says Bartlett.

Born in Montreal, Bartlett graduated from medical school at Memorial University in St. John's and earned a graduate degree in public health at the University of British Columbia.

The trajectory of her career eventually led her to a job as an epidemiologist at the Centers for Disease Control in Atlanta. From there, the whims of fate and fascination somehow guided her to Central Asia.

"It's part of my destiny," she says. "It's my vocation to work in maternal health in international settings."

Bartlett will be departing soon, but many others, both Afghans and expatriates, will continue the uphill struggle to keep this country's women from dying while in the very act of giving life.

"Once, there was a time we had just one incubator," says Mehrneswar at the Malalai hospital. "Now, we have five. When they brought them in, I wanted to dance."

And you can almost see her start to sway.