WUNRN
April
30, 2008
By Tan Ee Lyn
FAIZABAD,
Afghanistan (Reuters) - A woman hemorrhages to death as she lies screaming in
agony in a Spartan hut in a remote region of Afghanistan. There is no doctor or
midwife to help and the hospital is several days journey away.
Women die this
way every day in Afghanistan, a country with one of the world's highest
maternal mortality rates.
About 1,600
Afghan women die in childbirth out of every 100,000 live births. In some of the
most remote areas, the death rate is as high as 6,500. In comparison, the
average rate in developing countries is 450 and in developed countries it is 9.
Photo: Afghan children who lost their
mother due the complications of pregnancy have lunch in their home on the
outskirts of Faizabad capital of Badakhshan province, northeast of Kabul, April
25, 2008. Women die in childbirth every day in Afghanistan, a country with one
of the world's highest maternal mortality rates. About 1,600 Afghan women die
in childbirth out of every 100,000 live births. In some of the most remote
areas, the death rate is as high as 6,500.
Virtually
everyone in Afghanistan can recount a story about a relative dying in
childbirth, often from minor complications that can be easily treated with
proper medical care.
Sharifa's
sister, a mother of six, bled to death after giving birth at home.
"There is
no clinic, no cars, no proper roads. It is a remote village, we could not take
her to hospital. She remained at home for one day and one night, then she
died," recalled Sharifa, who identified herself only by her first name.
Afghanistan's
government aims to reduce maternal mortality by 20 percent by 2020 but there
are many obstacles to overcome such as a reluctance by women to be examined by
male doctors and a lack of female doctors, nurses and midwives.
Then there are
the vast distances in this war-torn country where hospitals are generally
poorly equipped and medical help is inaccessible to those living in remote
locations.
HOME BIRTHS
It is an age
old practice for Afghan women in rural areas to deliver babies at home. Trained
midwives are rarely in attendance. If there are complications, it might take
hours, even days to reach the nearest clinic.
Even when
women with labor complications get to hospital alive, there are often no
doctors or medical equipment to perform caesarean sections and other life saving
procedures.
"In some
places, there aren't even operating theatres and women just wait for their
death," said Rona Azamyan, who coordinates the Midwifery Education
Programme in Faizabad.
Among the
prime complications of childbirth in Afghanistan are bleeding, infection,
hypertension and obstructed labour.
It is not
uncommon for girls as young as 13 to marry in Afghanistan and there are often
complications when they give birth.
"The
mothers are very young, so their (pelvic) bone development is immature,"
said Karima Mayar, a family planning team leader at the Ministry of Public
Health.
Poor and
malnourished, many pregnant women in Afghanistan are severely anemic.
"If they
get post-partum hemorrhage, they will die 100 percent of the time," said
Mayar.
Women's access
to healthcare has generally been poor in deeply conservative Afghanistan.
Afghan men
prefer their women to consult only women doctors, but that is easier said than
done in a society where there are few female doctors and nurses and little
emphasis is placed on educating girls.
The problem
got worse during the Taliban regime, when girls were banned from schools and
there were severe restrictions placed on women leaving their homes.
During those
years, from 1996 to 2001, there were only around 1,000 female healthcare
workers in the whole country, staffing female-only hospitals.
But the
situation is still far from ideal now, more than six years after the fall of
the Taliban, even in places such as the northeastern province of Badakhshan
where the town of Faizaban is located. The area is far from fighting with
Taliban insurgents.
Only 66
percent of basic healthcare centers have at least one female health worker.
Women make up only 23.5 percent of the country's healthcare workforce and 27
percent of its nursing staff.
MATERNAL DEATH
"One
woman dies every 27 minutes in Afghanistan due to complications in childbirth …
and the tragedy doesn't stop with the mother's death," said Mayar.
"When the
mother of a newborn dies, 75 percent of these babies die. Who will feed them,
keep them warm? There's an Afghan saying: 'When the mother dies, the child is
sure to die'."
The government
plans to distribute the drug misoprostol to pregnant women in 13 provinces this
year.
"We will
distribute this to women in their seventh month of pregnancy and they must take
it right after delivery. It will remove the placenta and prevent
hemorrhage," Mayar said.
In the
pipeline are plans to set up more midwifery schools and assign more female
students to medical and nursing schools.
"To
reduce maternal mortality, we need 8,000 midwives by 2010 to cover needs of all
pregnant women," said Mayar. There are 2,143 midwives in the country of 26
million people.
But years of
neglecting girls' education is taking its toll.
"In the
provinces, the maximum level of education is the 10th grade, but the minimum
requirement for entry into nursing school is 12th grade," said Fatima
Mohbat Ali of the Aga Khan Foundation, an aid group in Afghanistan.
Some progress
has been made in recent years, owing to government and NGO efforts to improve
rural healthcare.
In
Badakhshan's Eshkashem district, which borders Tajikistan, Afghan women have
been frequenting the health clinic, the most modern looking facility in a town
where most of the 13,000 residents live in mud houses.
From headaches
to prenatal checkups, childbirth and advice on contraception, women have been
bringing their complaints to the clinic's female doctor for the last three
years.
"Ever
since we got an ambulance, a lady doctor, two midwives and an operating theatre
three years ago, we have not had a single case of maternal mortality,"
said Abdi Mohammad, head of the Eshkashem health clinic and an obstetric
surgeon.
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