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Thursday, 7 November, 2002, 15:08 GMT
Afghanistan's childbirth challenge
Afghan women (AP)
Afghan women face high pregnancy deaths

A new study by the United Nations has confirmed Afghanistan's status as a world leader in maternal mortality.


Without ante-natal care, many women are unprepared for complications that occur during pregnancies

Complications in childbirth are responsible for nearly half the deaths of Afghan women of childbearing age.

There are many barriers to healthy childbirth for Afghan women.

Male family members often refuse permission for treatment.

Health services are lacking; there are problems of transportation and ignorance in the community about what can and does go wrong.

Lack of medical help

One-year-old Zaki will never know his mother.

She died within days of giving birth to him.

She had had two other children but as her delivery time approached became feverish and was shaking all over.

Afghan women at a vaccination centre
Better awareness is needed for safe motherhood
Her sisters-in-law were able to persuade the men of their family that she should go to hospital.

Despite resistance, that worked and Zaki was born.

But her illness persisted and she died at home, her father-in-law reluctant to allow her out for more medical treatment.

Her son is now cared for by her sister-in-law, who says she's against giving birth without medical care.

Family rules

"We shouldn't give birth at home. What if something goes wrong - there's no-one to monitor you?

"But we have to accept the situation because it's the rules of the family," she says.

But why do these rules persist?

Unicef project officer Shairose Mawji believes the role played by men is one of the factors that plays into why women are not able to access care.

Afghan child
There are many barriers to healthy childbirth
"In some communities, and especially more of the conservative communities, this is a factor, in fact," she says.

"The men do not allow the women to come to the facility, or the women have to wait for the decision-making to be made by a male member, whether it's a husband or brother, to be allowed."

But ignorance also plays a part.

Without ante-natal care, many women are unprepared for complications that occur during pregnancies and do not recognise them when they happen.

"Many times they think bleeding after delivery is normal. Or being in labour for three to four days is normal,"says Shairose Mawji.

"And therefore they don't come to seek help because they don't recognise that it's a problem."

Challenge

Sixteen-year-old Layla gave birth in the country's biggest and best resourced maternity hospital in the capital, Kabul.

Thankfully she arrived on time and so did her baby son, who is lying next to her, swaddled tight in layers of cloth.


One-year-old- Zaki will never know his mother

She said she came to hospital because she was in pain and she thought it is only right that women do get care when they are giving birth.

The reality is, though, that Layla is one of the lucky ones.

About half the women in Kabul have medical help when they deliver their babies, but in provinces like Kandahar and Badakhshan, skilled help is rare.

For the situation to improve, the country needs better resources and better training and more doctors like Dr Nivifar.

She is one of the hundred or so women doctors who, together with an all-female staff of nurses and midwives, deliver 80 babies a day in Kabul.

The women stay in the hospital for three to four hours, she says, before they are discharged and go home.

They usually come with their mother-in-law or mother or sister as the local culture does not allow men into the hospital.

The barriers to healthy childbirth for Afghan women are many - male family members who refuse permission for treatment, the lack of health services, problems with transportation and ignorance in the community about what can and does go wrong.

Childbirth has already cost countless numbers of Afghan women their lives.

Now it is a question of whether the new Afghanistan can save this generation and the next from the same fate.

See also:

31 Oct 02 | Health
17 Oct 02 | South Asia
26 Oct 02 | From Our Own Correspondent
18 Jul 01 | Business
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