When Marzia Qasemi found out she was having twins, she couldn’t have been happier. Already a mother of three, she and her family began preparing for the new arrivals.
“I was so happy for those nine months,” she said. “I was full of hope, and counting the days until delivery. I went to a female doctor because I had high blood pressure during the pregnancy, and she gave me some medicine that did not harm my babies.”
Mariza’s first ultrasound determined that at least one of the twins was a girl; the other was not clear. Her husband was overjoyed, and her oldest daughter began shopping with her aunts for clothes and supplies for the newborns.
Finally the time came, and Marzia’s husband and sister took her to the hospital. The doctor checked her at 8:00 a.m. and said that Marzia was not yet in labor. But the anxious mother was worried.
“Today is the start of the tenth month of pregnancy,” she told her physician. “This is not good. Please help me, I don’t want to lose my babies.”
The doctor insisted that they wait until contractions began. As the hours passed, Marzia became more and more agitated. By 2:00 p.m. , when a nurse came to check on her, one of the babies was in distress. The heartbeat was very faint, and the doctors decided to induce labor.
The first child was born; it was a boy. He was healthy and crying. But the little girl was dead.
“I held her in my arms and did not want to give her back to the nurse,” said Marzia. “I was crying as I examined my little angel. She was so perfect, but I would never see her face again. I cannot forget this, ever.”
Marzia’s case is, unfortunately, far from unique.
According to the CIA World Fact book, Afghanistan has the highest infant mortality rate in the world, coming in at 115 deaths per 1,000 live births, or more than 10 percent.
This tragic truth is seen time and time again in the faces of women who have lost children, or whose babies struggle to survive.
Kamila, a 32-year-old from Balkh province, gave birth to her first child, a girl, last year.
“I hope my daughter gets better soon,” she said hugging the child while tears welled up in her eyes.
Kamila tried hard to give her baby a good start; she listened to all the advice that her doctor gave, while waiting anxiously for her child to be born.
But during the delivery something went wrong.
“My baby was under a lot of pressure,” she said. “The doctors did not take care of me or my child properly. After she was born she had breathing issues; the doctors in Mazar-e-Sharif told me to take her to Kabul or to Pakistan because they did not have the facilities to help her. Her father and I were shocked. We brought her to Kabul, but here as well the doctors were helpless. We were so scared. Here she is facing death and we can do nothing.”
Eventually Kamila and her husband took the child to Pakistan, where she was finally able to get some treatment.
“The doctors said we should have brought her earlier,” said the anxious mother. “Now my daughter is doing well and breathing normally. But every six months I need to take her to Pakistan to be checked.”
Kamila complained about he quality of health care for mothers in Afghanistan.
“It is a big risk for mothers to give birth in this country,” she said. “Doctors and nurses should have better training, and hospitals should be clean. The sheets at least need to be changed.”
Afghanistan is indeed a dangerous place to give birth. A UN survey in 2005 pegged the maternal mortality rate at 1600 per 100,000 live births, one of the highest in the world. More recent surveys show a marked decline,
but experts say that there is reason to be skeptical about the lower figures — now showing about 400 maternal deaths per 100,000 live births.
The under-five mortality rate is also quite high: it is estimated at roughly 102-105 deaths per 1,000 live births, or more than one in ten.
The reasons are many: lack of money, distance to health care facilities, socio-cultural barriers, poor roads and lack of security are among the most common reasons cited that prevent women from accessing care for themselves and their children.
Article 52 of the Afghan Constitution promises free medical care for all, and mandates the development of adequate resources. (Article 52). But the reality is quite different, as health care professionals know well.
“I am a human being and a woman, and I know that Afghan women are suffering,” said Mahdia, a medical student. “They are living under pressure an violence. Society should treat them properly, especially female doctors.”
Mahdia would like to travel to rural areas to help poor women with no access to medical care, but the security situation is worrisome.
“I hope the government takes some serious actions to provide facilities for Afghan women,” she said. “I would like to study abroad and learn more, to provide more professional care for our patients.”
Raziya Hamidi is a midwife who studied and later taught at Balkh University. She also dreamed of helping women in remote districts, and actually went to Jaghori, in Ghazni province. There she became a trainer for midwives and students.
“Women in rural areas are so far from health services, and during pregnancy they cannot see a female doctor,” she said. “Some men will not let their wives see a male doctor, so they don’t take them to the clinics. They also work hard, and women who are pregnant during Ramadan and do not break their fasts sometimes get so weak they die during birth.”
Raziya would like to go to other remote areas, once the security situation improves.
Fatima, another midwife student, is determined to continue no matter how difficult things get.
“I know that we have many problems,” she said. “There is insecurity, inequality, lack of respect for women and other issues that we are face in this country. Nevertheless, my goal is to help other women. I am still hopeful.”