ABC News, July 27, 2011
Birth a deadly challenge in Afghanistan
Eighty-six per cent give birth without any trained help, and it can be a deadly scenario
By Sally Sara
A chronic shortage of midwives and basic health services makes having a baby one of the most dangerous things an Afghan woman can do.
A woman dies during childbirth every 29 minutes in Afghanistan, which is wracked by poverty, insecurity and deeply ingrained discrimination against women.
At a tiny ultrasound room at the Malalai maternity hospital in Kabul, 35-year-old Benafsha gives birth to a baby girl.
She already has five children; her family would have preferred another son, but she was dreaming of a daughter.
"When she grows up she should go to school and increase her knowledge," she said.
Benafsha with her grandmother and her newborn girl. (Photo: ABC)
It is one of the biggest maternity hospitals in Afghanistan, but most Afghan women never reach there.
Eighty-six per cent give birth without any trained help, and it can be a deadly scenario.
Benafsha's first two babies died during the Taliban's rule because her family would not let her go to the hospital.
She still remembers the tiny faces of her lost newborns.
"I feel sad and cry - what else can I do?" she said.
Even in hospital, childbirth is traumatic; the midwives abuse Benafsha, accusing her of being too slow.
More than 130 babies are born at the hospital everyday, with some women given only half an hour to deliver.
Midwives slap Benafsha on her pregnant belly to speed up the contractions. If Australian midwives did the same, they would be stood down and could even face criminal charges.
The baby looks deathly white and motionless when it emerges. The midwife cuts the cord and rushes down the corridor, carrying the newborn girl face down along her arm.
When the nurse reached the neo-natal ward, the doctors take over. They use a suction tube and a foot pump to try and open the baby's airway.
The baby has swallowed faeces or meconium during the traumatic delivery and now has severe asphyxia.
It is many more minutes before the baby finally coughs out her first cry.
Her skin colour starts to change from white to blotchy pink. Her arms and legs begin to move. She weighs in at four kilograms, a big baby for Afghanistan. The doctors are relieved for now.
"She is very beautiful," Benafsha said.
Fathers are not allowed inside the hospital so the guard at the front gate announces that Benafsha's baby has arrived.
In the baby's first minute of life, she was given only two out of 10 on what is known as the APGAR score of newborn health.
In Australia, a baby in this condition could be sent to intensive care.
But only three-and-a-half hours after she is born, her father orders the baby and Benafsha to be discharged because he does not want to wait anymore.
'No-one cares about them'
Neonatal doctor Noor Zia Sharifi is worried the baby could die of infection or have some brain damage from the asphyxia.
"If the newborn is a girl, they don't pay much attention to her," he said.
"They won't let the mother and baby stay in hospital for a few days so we can take care of them.
"But if the newborn is a boy the relatives touch the feet and hands of the doctors, begging for us to keep the baby boy in hospital. They want us to give him the best treatment."
Despite the gains made since the fall of the Taliban, Afghanistan remains one of the most dangerous places on the planet to be born female.
The average Afghan woman is dead by the age of only 44.
Dr Sharifi is struck by the loss of opportunities and talent that Afghanistan so desperately needs.
"The baby girls born here, many have potential, they are intelligent and alert," he said.
"But no-one cares about them. Even if they try to go ahead in the future, their talents are strangled by the situation in this country."
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