KHOST: Zubaida travelled from the rural outskirts of Khost in eastern Afghanistan to give birth at a maternity hospital specialising in complicated cases, fearing a fate all too common among pregnant Afghan women — her death or her child’s.

She lay dazed, surrounded by the unfamiliar bustle of the Doctors Without Borders (MSF)-run hospital, exhausted from delivery the day before, but relieved. Her still-weak newborn slept nearby in an iron crib with peeling paint, the child’s eyes lined with khol to ward off evil.

“If I had given birth at home, there could have been complications for the baby and for me,” said the woman, who doesn’t know her age. Not all of the women who make it to the hospital are so lucky.

“Sometimes we receive patients who come too late to save their lives” after delivering at home, said Therese Tuyisabingere, the head of midwifery at MSF in Khost, capital of Khost province.

The facility delivers 20,000 babies a year, nearly half those born in the province, and it only takes on high-risk and complicated pregnancies, many involving mothers who haven’t had any check-ups. “This is a big challenge for us to save lives,” said Tuyisabingere. She and the some 100 midwives at the clinic are on the front lines of a battle to reduce the maternal mortality rate in Afghanistan, where having many children is a source of pride, but where every birth carries heavy risks — with odds against women mounting.

Afghanistan is among the worst countries in the world for deaths in childbirth, “with one woman dying every two hours”, UN spokesman Stephane Dujarric said earlier this month. The Afghan health ministry did not respond to repeated requests for comment on this story.

According to the latest World Health Organisation figures, from 2017, 638 women die in Afghanistan for every 100,000 viable births, compared with 19 in the United States. That figure, moreover, conceals the huge disparities between rural and urban areas.

Terje Watterdal, country director for the non-profit Norwegian Afghanistan Committee (NAC), said they saw 5,000 maternal deaths per 100,000 births in remote parts of Afghanistan. “Men carry the women over their shoulders, and the women die over the mountain trying to reach a hospital,” he said.

‘Brain drain’

Before the return to power of the Taliban in August 2021 and the end of their insurgency, women would sometimes have to brave the frontlines to reach help, but now there are new challenges — including a “brain drain” of expertise. “A lot of gynaecologists have left the country,” Watterdal said.

Moreover, Taliban authorities want to get rid of the mobile medical teams visiting women because “they cannot control the health messages they were giving”, he said.

Under the Taliban government, women have been squeezed from public life and had access to education restricted, threatening the future of the female medical field in a country where many families avoid sending women to male doctors.

“Access to antenatal and postnatal care for a woman was (always) extremely complicated. It’s even more complicated today,” said

Filipe Rib­eiro, MSF director in Afghanistan.

Published in Dawn, December 22nd, 2023