Many Afghans Lost to Hazards Of Childbirth

Roshanak Wardak checks on a patient in Sheikhabad. She opened her clinic after the winter of 1996, when 40 area women died in childbirth.
Roshanak Wardak checks on a patient in Sheikhabad. She opened her clinic after the winter of 1996, when 40 area women died in childbirth. (Pam Constable - Twp)
By Pamela Constable
Washington Post Foreign Service
Tuesday, June 6, 2006

SHEIKHABAD, Afghanistan -- According to Afghan tradition, children are the fruit of heaven. The more each couple produces, the greater the blessing; hence the country has one of the world's highest birthrates. If an infant dies, village tradition says, another will come along soon. If a mother dies giving birth, it is the will of God.

But according to international studies, Afghanistan is also one of the most dangerous places in the world to be born or to deliver a child. In a recent report, the U.S. charity Save the Children found that Afghanistan has the world's second-highest rate of newborn deaths, 60 per 1,000 births, just below Liberia. It also found that one in six Afghan mothers -- 20,000 a year -- die during or after childbirth.

Safia, an illiterate villager of about 30, has survived several pregnancies, but just barely. Last month, she arrived at physician Roshanak Wardak's clinic in this town 50 miles west of the capital carrying a 3-week-old baby.

The child was thin and weak, because Safia could neither produce milk nor afford to buy formula.

Her previous child, a boy, had nearly died at birth. Safia was in labor for two days and nights, she said, with no way to travel from her village. By the time she finally reached a hospital two hours away, she had to have an emergency Caesarean section, and both she and the baby were hospitalized for a week.

"My husband was away working. I couldn't reach him, and no one else would help me," she said. "I was having terrible pains, but the baby would not come. Later the doctors told me it was because I worked so hard during my pregnancy, lifting water buckets and other heavy things. They told me not to have any more children for three years, but now I have this new one."

Although Afghanistan has had a stable, Western-backed government since late 2001 and foreign donors have since spent tens of millions of dollars to improve health care, conditions still conspire to sabotage the chances of healthy and normal births.

"It's really as bad as it can get and still sustain a population," said Linda Bartlett, a physician and maternal and child health officer for UNICEF in Kabul, the capital.

Many parts of Afghanistan are harsh and remote, with bad roads, few clinics and little ability to attract skilled health workers. Village girls are often married by 15 and urged to produce a child each year. About 85 percent of Afghan infants are born at home, without even a trained midwife in attendance.

If complications arise, families may not recognize the danger signals and end up wasting precious time deciding what to do. The mother, in protracted labor or losing blood, may have to be carried or put on a donkey for several hours to reach a road leading to a hospital. By then, it may be too late to save her or the child.

"The worst problem is lack of skilled staff. In some provinces, there are no female health workers at all," said Nadra Hayat, director of maternal and infant health at the Public Health Ministry in Kabul. Delivering babies is traditionally done in Afghanistan by women, and many families do not want male doctors to treat their wives or daughters.

Even when foreign donors offered to increase the government's monthly salary for doctors from $40 to $1,000 for those willing to work in arid, isolated southern provinces, Hayat said, "the living conditions were so bad that no one wanted to go."

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