Page last updated at 11:00 GMT, Saturday, 9 April 2011 12:00 UK

Afghan midwives deliver life-saving birth education

By Nadene Ghouri
Kabul, Afghanistan

Afghanistan is one of the most dangerous places in the world to have a child. Women face a one-in-11 risk of dying during pregnancy and childbirth, while one in five children dies during or after birth or before the age of five. One initiative is under way to try to make giving birth safer.

Rogul, Afghan midwife and mother
Training and education is helping Rogul to save babies' lives

Rogul wraps a grimy blue scarf around her face and uses the cleanest corner of it to wipe her tears.

She has just told me how nine of her babies died after she gave birth to them at home.

Her firstborn, a little boy, was premature. Her mother asked a village mullah for advice. He suggested prayer and a type of holy water. The baby died.

Her second child died from an infection a few hours after birth. And so it went on - nine dead babies in total.

I am sitting in an Afghan neonatal clinic in Guldara district, just 20 minutes drive from the capital city Kabul.

Women, some in traditional blue burka, others wearing the brightly coloured scarves and loose pantaloons more typical of the nomadic Kuchi tribe, are here.

Some are clutching roundly pregnant bellies, others are here to have their babies vaccinated.

Few would be here at all, if they had not been persuaded to come by a local midwife.

Evil spirits

A young girl called Pashtu, with a dirty face and scared eyes, agrees to talk.

She does not know how old she is but looks no more than 15. She is eight months pregnant with her second child.

Newborn Afghan baby
Afghanistan has one of the highest infant mortality rates

Next month she will give birth in the safety of the clinic. She gave birth to her first child in a filthy hole-in-the-ground toilet at home with only her elderly mother-in-law for help. Her son was born blue and barely breathing. He survived for just under an hour.

I ask her why the baby died? She gives me a nonchalant shrug. Her aunt, a large woman with long braided dark hair is sitting next to her.

"Pashtu is too skinny and doesn't eat enough," she asserts loudly. "This is why her child died."

Another woman tells me it is because Pashtu's husband is an opium addict.

Many babies in Afghanistan also die because of traditional cultural practices.

It is common for babies to be washed in freezing cold water immediately after birth - which can cause pneumonia - umbilical cords are cut with unsterile knives, or babies are placed on a dirty floor to ward off evil spirits, which can cause infection.

Few women breastfeed for the first few days because colostrum, the nutritious fluid in early breast milk - something which is vital for a baby's immune system - is seen here as "dirty". Instead newborns are often fed melted butter.

No sex education

Istiqlal Hospital in central Kabul houses the city's largest maternity ward. Here stories of ignorance prevail.

Map of Afghanistan

Two teenage girls giggle as they tell me they had no idea how pregnancies happened, even after they were married.

One of them is here because she miscarried at five months. She had not known she was pregnant, because she was not aware of any of the symptoms of pregnancy.

"If we ask any questions about these things, we will be called bad girls," they explain as their faces flush red with embarrassment.

The doctor tells me that their mothers often assume they will work it out for themselves after they marry. But they often do not.

"I see many young girls who have married and still don't realise sex with their husband equals babies," he tells me.

But change is beginning to happen.

The ministry of public health has launched a programme to train and deploy 400 new midwives a year.

File photo (2009) Afghan midwifery students
Some 2,400 midwives have been trained in Afghanistan since 2002

What is key is that the women are not outsiders forced on a mistrustful local population, but are local women from the communities they serve. This means religious leaders and conservative husbands do not prevent them from working.

Largely as a result of this, the number of women giving birth who were helped by a trained midwife has more than tripled since 2003.

Rogul, who learned the hard way just what giving birth alone can mean has now been given midwifery training by the British charity Save the Children.

This woman who lost nine of her own babies has now saved lives of many others.

She tells me how, the week before, she had locked an angry mother-in-law out of a room where a young woman gave birth, because the mother-in-law had tuberculosis and could have passed the infection to the newborn.

She chuckles with glee as she recounts the tale of the mother-in-law banging on the door trying to get in.

It is clear what Rogul, with a combination of personal tragedy and a solid new education, can achieve in her community. But as yet, there are not enough Roguls to go around.

And for her the story has a happy ending. After her training she realised why her first nine babies had died.

When she fell pregnant again, she knew what to do and now has a son and two daughters. "They are living proof of my work," she says with a big smile.

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