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Last Updated: Sunday, 10 September 2006, 01:40 GMT 02:40 UK
The risks of childbirth in Afghanistan
By Jane Elliott
Health reporter, BBC News

Rabia and family with Jacqui Hill
Rabia gave birth to a healthy boy
For women like Rabia, giving birth is a very risky business.

Not only did she discover she had a heart and lung condition, she was also living in Afghanistan - one of the world's poorest countries for maternity care.

Rabia, who has a heart valve complaint and high blood pressure in the arteries that supply her lungs, was given just a 50/50 chance of pulling through her birth.

Against the odds she survived and had a healthy baby - but she is one of the lucky ones.


Recent reports show that only 11 of Afghanistan's 32 provinces have the capacity to provide comprehensive emergency maternity care, and only 17 of the country's 174 hospitals can carry out Caesarean sections.

Afghanistan has one of the highest mortality ratios in the world - 1,600 maternal deaths per 100,000 live births.

We get many young women who very nearly die during pregnancy or childbirth
Jacqui Hill

When Jacqui Hill qualified in obstetrics and gynaecology, she wanted to make a difference to women like Rabia.

"For many years my desire has been to practise obstetrics in countries where obstetric skills and knowledge are sparse.

"I chose Afghanistan, with its terrible history of oppression of women and after obtaining my certificate of completion of specialist training, I started working in Badakhshan province in the northeast of the country.

"It is in this province that the world's highest maternal mortality rate was recorded."


And Jacqui explained that cases like Rabia's, where pregnant women are found to have heart conditions, are not uncommon in Afghanistan.

But because the lack of expertise available, Jacqui and her team at the Cure International Hospital in Kabul sometimes have to call on specialists abroad, through charities like the Swinfen Charitable Trust.

This links doctors in developing countries with others worldwide, via email and phone.

The Cure International Hospital in Kabul
Patients can travel long distances for treatment

"Heart disease is a big problem here," said Jacqui.

"In the UK all these women with congenital or valvular heart disease would have been diagnosed, and valves replaced or surgery undertaken.

"But this hasn't happened here and we get many young women who very nearly die during pregnancy or childbirth."

Because many of the women come to the hospital late on in their pregnancies, they often have extra complications, such obstructed labour and a ruptured uterus, as well as eclampsia.

Long travels

Jacqui said: "I recently delivered twins using forceps.

"The mother had travelled for two days to reach the hospital. She was feeling unwell and had swelling in her face and a severe headache.

"She travelled for the first day by horse and spent the second day on a bus.

Jacqui Hill
Jacqui is angry about funding shortages

"By the time she reached us she had started labour, but then had a fit. We had to give her magnesium sulphate to stop her fitting and I delivered the twins.

"She then went on to develop a condition called HELLP syndrome (where women can develop bleeding, liver and blood pressure problems), but fortunately she pulled through all that and was able to travel home with two healthy babies."

One of the major problems facing Jacqui's team is a lack of funds.

Money to train specialists in obstetrics and gynaecology has been guaranteed for this year by the charity Cure International, but the future looks uncertain.

Jacqui said: "Here we have a programme that has huge potential to really make a difference in this country and nobody seems interested in funding it."

An e-mail saved this boy's life
05 Dec 04 |  Health
Burns victim treated by e-mail
02 Oct 02 |  Health


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