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February 2007 – Kabul District: Women in Distress February 17, 2007

Posted by Linda Barnes in Afghanistan, Maternal Mortality Afghanistan, MCH in Community, Midwifery, Rabia Balkhi Hospital, Terres des Hommes.

District 10

In this ever-expanding urban sprawl in Kabul women are disadvantaged. No dependable supply of potable water, shallow or non-existent latrines, no public transport, poorly staff and distant basic health facilities, and dangerous neighborhoods all contribute to abject vulnerability. Family affairs are tightly regulated by custom and ultra-conservative law. Women are exposed to additional cruelties: forced teen marriages, squalid households dominated by female relatives-by-marriage, virtual imprisonment and physical/sexual abuse. Winter in District 7

My current work in Afghanistan has again put me in contact with a cadre of community midwives working for Terres des Hommes (TDH), a Swiss non-government organization with a wide range of activities in Afghanistan. These midwives have been working in Kabul District communities since 1997. They are professionally trained midwives, many of whom started their career in one of the two major maternity hospitals in Kabul, Rabia Balkhi Hospital and Malalai Hospital. Some moved back to the community during the Taliban years when leaving home was dangerous; others were drawn back to their communities to provide basic care to pregnant women and newborns. These are unusual women who, for reasons of practicality and/or compassion, are dedicated to the unrelenting plight of women who live on the soft underbelly of this society.

With a small grant from the Gates Foundation a pilot intervention in two of the poorest districts in Kabul is being started; it will provide additional support to households with low birth weight newborns (newborns weighing less than 2,500 gms at birth). There is scant data in Kabul regarding low birth weight in the ever-expanding urban sprawl, however the contributoWeighing a Newbornry factors associated with low birth weight are endemic. Last week a midwife from District 7 in Kabul reported delivering both twins and triplets within 36 hours…all five newborns were premature. In both cases the mother had no antenatal care or diagnosis of multiple pregnancy; in both households the women were forbade from going to a clinic. The midwife had been summonsed to the births in the middle of the night because she is known in the community.

It is estimated that only 20% of births in Afghanistan are attended by “skilled” midwives. Additionally only a fraction of births occur in a health care facility. Most babies born in the major maternity facilities in Kabul are discharged within 2-3 hours of birth and therefore are at high risk from the onset of their fragile existence. It has been reported that between 18 and 25 percent of infants die before their first birthday. All these appalling figures only illustrate the vulnerability of children in Afghanistan.

Birth Demonstration

When the midwives arrived at this household the two wives and mother-in-law were the only occupants of the family space, a room about 12 x 12 feet and shared by first of the two wives, the husband and six children. By the time the midwives began the visit another 20 women and children had crowded into the room; they are eager for information and contact with the midwives. Despite their lack of control over matters of reproduction they are keen to participate in the communal antenatal visit and the midwives’ demonstration of how to help a woman deliver at home. Each client of the TDH midwives keeps her own copy of the  home-based maternal record and the women scrupulously observe all the information the midwives enter in it even though they cannot read. The home-based maternal record is an empowerment tool.

Women being in charge of information; insignificant it may seem, but in this setting the home-based medical record is a symbol of support for these vulnerable women of remarkable resilience.

“Motherhood Afghanistan” was recently aired by PBS. The film graphically illustrates the plight of women and infants in Afghanistan and exposes the duplicity of the US government response since 2001.