BBC News, October 4, 2008

The struggle to save Afghan mothers

Badakshan has had the worst rates of maternal mortality ever recorded, the UN says. For almost 16 babies born, one woman will die in labour

By Martin Patience

Badakhshan, poverty
Badakhshan: The nearest hospital was 60km (37miles) away and they had no car.

Badakshan, northern Afghanistan: When the heavily pregnant woman had complications during labour, the villagers of Shattak faced a problem. The nearest hospital was 60km (37miles) away and they had no car.

"We got a ladder," says Abdul-Majid, the head of the village's health shura (council) recalling the incident over four years ago.

The villagers then laid the woman on the ladder and 20 men took turns to carry the make-shift stretcher along a rutted, windy track that rarely sees vehicles. The pace was agonisingly slow.

"We didn't make it to the hospital," says Mr Abdul-Majid. "The mother died on the way."


In valleys and villages across Badakshan, a province located in the Hindu Kush mountain range, such stories are common.

Maternal mortality, when a woman dies during or shortly after pregnancy, is believed to be the highest in the world here.

According to statistics published by the UN in 2002, the province had the highest rate of mortal maternity ever recorded.

For almost 16 babies born, one woman will die in labour. As a country, Afghanistan is ranked second in the world for maternal mortality rates after Sierra Leone.

But health professionals in the province are optimistic that a new project is reducing the numbers of deaths.

Run by the Aga Khan Health Services, a midwife trainee programme selects bright young women from districts across the province.

The students take an 18 month course in the provincial capital, Fayzabad, before returning to their villages as trained midwives.

About 50 women have graduated from the programme since it started in 2005.

Maternal mortality is traditionally high in Badakshan for a number of reasons. The difficulty of travelling large distances to health facilities means the vast majority of births are at home.

In the past, even if a pregnant woman experiencing complications did reach the few hospitals or clinics in the province, the facilities were almost always under-equipped.

"When I first started there was just one bed for expectant mothers in the entire hospital," says Dr Bahrastan, a female doctor, who has worked in Fayzabad's main hospital for 14 years.

There was also a problem of staffing. All the doctors and midwives, apart from a handful of exceptions, were male.

'Health education'

Every 28 minutes a woman dies in Afghanistan during childbirth
54 percent of Afghan children are born stunted
The Afghan fertility rate is second highest in the world at 7.5 children per woman
UN Development Programme Afghanistan

In Afghanistan, where the separation of the sexes is strictly enforced, this often had devastating consequences.

"Women in the past have died rather than see a male doctor," says Dr Bahrastan.

The midwife-training programme tackles all these problems head-on, providing female health professionals for expectant mothers.

Dostorgall is one of about 25 students enrolled in the current programme. Her village is located in an area called the Wakhan corridor, a five-day journey from the provincial capital.

"When I graduate the first thing I'll do is provide health education for women," she says, at the programme's training centre.

"I'll tell them they should consider family planning and if they have any complications during their pregnancy they should get help immediately."

One of the villages to benefit dramatically from this initiative is Shattak.

At the village, pregnant women totter across the lunar landscape on donkeys making their way to its new single-storey health clinic.

They are coming to see Ferangee Sultani, a recent graduate of the midwife programme.

Ms Sultani says that she's delivered over 60 healthy babies in her time here without any maternal deaths.

Mr Abdul-Majid is happy too. He says that mothers are healthier than they have ever been before, thanks to the clinic and its midwife.

The only problem now, he says, "is that the clinic doesn't have enough medicine to give the patients."

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