- Syed Anwar and Swaminathan Natarajan
- Title, BBC World Service
A woman named Ferhunde, who lives in the northern province of Badakhshan and is six months pregnant, says, “I am afraid that the birth of my second baby will lead to the death of me or my baby.”
Ferhunde had planned to give birth to her child in a 60-bed maternity hospital run by the World Health Organization (WHO). However, the hospital’s maternity unit has been closed since July.
“I gave birth to my first child by caesarean section. “I don’t know what will happen this time,” said Ferhunde, adding that she is very worried about the situation.
The BBC’s Afghan Service has heard many testimonies from young women like Farhunde, which show how difficult maternity services are in the country.
Incompetence in gynecological services
Badakhshan is widely known among people as the “worst place to be born” in the country. In this mountainous, rugged and hard-to-reach region, the WHO facility was a much-needed lifeline for women.
WHO officials in Afghanistan told the BBC that they had taken the difficult decision to close the hospital’s maternity unit due to a severe lack of funding.
A former worker in the maternity unit who was spoken to by the BBC said that “up to 15 caesarean sections were carried out every day in the hospital” before the ward was closed.
The hospital was often overcrowded.
“Other surgeries like hysterectomy and cystectomy were done in this hospital,” said the WHO official.
The only other operational maternity hospital in Badakhshan is funded by the Aga Khan charity. The hospital with 30 beds, where two specialists and four doctors work, is having trouble coping with the increasing demand.
The nearest hospital to the area is in Kunduz. It is also almost five hours away by car. Many people, like Ferhunde, are too poor to rent a car. Even if she finds the money, there is no guarantee that she will be admitted to the hospital in Kunduz to give birth, which is also overcrowded.
Death tolls are getting worse
According to data from the United Nations Children’s Fund (UNICEF), the last maternal mortality rate recorded in 2020 was 620 deaths per 100 thousand births. This rate is almost three times higher than the global average.
UNICEF said in its report, “Afghanistan remains one of the most dangerous places in the world to be a child, a child or a mother,” and noted the difficulty of accessing institutions Cheers.
In 2023, 37 infant deaths were reported for every 1000 births.
A doctor from Jalalabad, the fifth largest city in Afghanistan, said that infant deaths are increasing faster than maternal deaths.
The doctor from Jalalabad said, “We don’t have the resources to keep premature babies in public hospitals. “We have very poor conditions for dealing with problems at birth,” he continued.
lack of midwives
According to a recent UNICEF report, one third of women give birth in places without health care facilities.
Healthcare workers are reluctant to travel due to social restrictions imposed by the Taliban.
This means that many women rely on uneducated female relatives and neighbours.
“Due to the lack of maternity services in the area, some women give birth at home, and this method is completely inferior in terms of medical support and basic hygiene,” says a midwife who works in an area remote of Kandahar city.
“The villagers once brought a woman who gave birth at two in the morning, but the placenta had not come out,” continued the midwife.
The family waited until sunrise and then they took the woman to the hospital.
“He was in a lot of pain. “We did our best and the woman was relieved of her pain,” said the midwife, noting that even a few hours’ delay could be fatal.
Destruction of body and soul
Only a small percentage of women can afford hospital costs.
In the waiting room of the private Shefajo clinic in Kabul, we meet 35-year-old Musrsal, who has had seven miscarriages, and 20-year-old Hamida, who has had four miscarriages.
Their trauma is still fresh.
Looking physically exhausted and emotionally exhausted, Musrsal said, “Every time I lose a child, I feel like I’ve lost half of my memory. I lost half my hair. “I get mental problems every time I lose a child,” he says.
Musrsal remembers that doctors told her that the reason for the miscarriage was “not eating well and gaining weight. “
Unlike most Afghan women, Musrsal still has a government job, eats good nutritious food, and does not do hard physical work.
Hamide enters the clinic with a silk sheet and her fingers covered with henna. Her face is open.
“My last miscarriage was about six months ago. After that, I consulted doctors in Kandahar, Quetta and Chaman.
The last two cities are in Pakistan. Doctors in Kandahar discovered a bacterial infection and ordered a vaccine. Like Musrsal, Hamide is struggling to get pregnant.
Hamide, who was forced to marry at the age of 16, is the subject of ridicule from the people around her because she cannot have a child yet.
Hamide said, “Some people make fun of me and ask why I don’t have children. “These words are very hard for me to bear,” he says.
The two women have gone through many tests and are now waiting for their results.
Musrsal and Hamide, Dr. Dr., gynecologist and founder of Shefajo Hospital. Najmussama Shefajo patients.
Dr. Shejafo cites the reasons for the sharp decline in health care services as follows:
“The main factors are the lack of female doctors and nurses, specialized hospitals and medicines. “Illiteracy and lack of awareness among people are also other major reasons.”
After the Taliban seized power in 2021, many experienced female doctors fled the country.
The situation worsened when the new government refused to grant medical licenses to newly graduated female doctors.
“The shortage of female doctors is increasing and this situation will worsen,” said Dr. Shejafo says public hospitals cannot meet the demand and provide the necessary health services.
“I saw three or four mothers with blood sitting on the same bed in a public hospital. “In another place, they put five babies in an incubator.”
accuse each other
A spokesman for the Taliban government’s health ministry attributes the poor state of reproductive health to the previous administration.
Dr. Şerafet Zaman says that they are trying to find donors to finance a sustainable health project.
He said their goal is to work on long-term sustainable projects that will provide better health services to the Afghan people.
Dr. Amar also says that they are trying to find resources both from the main budget and from international funds to improve health services, and that this is a process that could take years.
