In Afghanistan, women give birth to an average six children and the rate of maternal mortality remains high.
According to Save the Children, Afghanistan is the second-worst country in the world to be a mother. But midwives are working hard to change the lives of Afghan women for the better.
Mudassar Shah traveled to remote health facilities in Nangarhar province to find out more.
Each day in Jalabad city, Shah Zaman, 11, carts people’s luggage to earn a few cents.
His mother died during his birth and soon after, his father remarried.
“I wish my mother had been taken to the hospital,” he says, “I am so unlucky that my birth took my mother away from me. It would not have happened if she had been taken to see trained healthcare staff.”
In remote areas, war and internal conflicts have weakened the local economy and health system. And many health facilities lack trained staff.
In remote areas, health facilities can also be hours away, making it difficult for women to reach them in time.
The government is working hard to address the issue, training more than four thousand midwives since the fall of the Taliban in 2002.
According to a 2012 report from Save the Children, 1 woman in 11 dies in pregnancy or childbirth in Afghanistan.
But hundreds of midwives like Saliha say the rate of maternal mortality while dropping – remains high.
“It was my dream to be a doctor but I could not become a doctor due to financial constraints. So I completed a two-year midwifery course,” she explains, “There was no female health provider in our area and the roads were also in a terrible condition so many pregnant women died before reaching hospital.”
Saliha is a midwife in Kama district hospital in eastern Nangarhar province.
“We midwives, stay in the health facility and provide health services 24 hours because patients can come any time,” she says, “We wholeheartedly and regularly provide our services, which has reduced the maternal mortality rate.”
Government initiatives started in 2002 have seen the rate of maternal mortality drop significantly.
A survey by the Afghan Ministry of Health and its partners showed the maternal mortality rate dropped steeply – from 1,600 deaths per 100,000 live births in 2002 to 327 deaths per 100,0000 live births in 2010.
Medical practioners say women in rural areas have started to trust the local health services, and are traveling to hospitals to deliver their babies.
In the past, they would give birth at home.
Aasiya is Saliha’s colleague at the hospital, where she has been working for the past eight years.
“The child mortality ratio was extremely high in remote areas therefore a program focused on midwifery was started to reduce the death ratio,” says Aasiya, “Pregnant women used to give birth to their children in their homes and they have false perception about deliveries in health facilities. We organized health education and awareness sessions, which have helped to reduce the mother and child mortality rate in the area.”
Dr Mashal is in charge of the Kama district hospital. She says more midwives makes a huge difference.
“Local women have had several issues and problems and they confront worst health services, which were minimized when midwives were inducted into the health centers,” explains Dr Mashal, “Now, the local people are happy to have midwife support them during pregnancy.”
Nazia has traveled to the hospital with her sister, to deliver her first baby.
“We are very much grateful to health staff in the health facilities who provided us complete support and services for free to poor people like us who can’t afford at all,” says Nazia.
Huge progress has been made, but midwives in Afghanistan say there is still some way to go.