Sangima watched her sister-in-law Mastbegeen die trying to give birth to her seventh child. The baby was born prematurely and there was excessive bleeding during labour. There were no doctors or trained midwives near her village in the northeastern Afghan province of Badakshan to help so her family had to watch her life ebb away; the child did not survive either.
Such is the reality in many remote villages of the Wakhan corridor in Badakshan, where there is little or no access to healthcare. In this rugged area in the Pamir Mountains it takes between four and six days on horse-back or by yak to reach the nearest medical facility, provided bad weather has not blocked the roads.
Abdul Haq, a resident of Big Pamir village, also endured his 29-year-old wife dying during delivery. "We don't have clinics, schools or [government] offices here. Who do we go to with our problems?" he asked.
"When women or children get sick there are two ways [here]. Either Allah makes them well or they die," he said.
Haq expects to remain a widower. The area is sparsely populated and there are not enough women to marry.
Ilyas Bai is another widower in the Small Pamir village. His 20-year-old wife died six years ago giving birth to their first child. "We do not have doctors and medicines. We cannot take the patients to other places. When it snows no one can move around," he said.
|Most Afghan women have at least seven children|
With 6,500 maternal deaths per every 100,000 live births, Badakshan province has the highest maternal mortality rate in the world, according to the United Nations Population Fund (UNFPA).
"Badakshan province has been identified as the worst anywhere in terms of maternal mortality," said Abdul Momin Jalali of the public health provincial department in Badakshan.
The reason, says Hajera Zia Baharestani, a gynaecologist with the Faizabad maternity hospital, is a combination of a "lack of awareness, lack of access to healthcare clinics and lack of doctors and midwives in the health centres".
According to a recent study by the UN Children’s Fund (UNICEF), only 3.3 percent of the women in the area had given birth in a medical facility. Many of the locals interviewed by IRIN said the women gave birth by the river bank during the summer and in the animal sheds during the winter.
As in many parts of the country, women are expected to do all domestic chores right up to childbirth. Even where there is access to health services, these are often inadequate or overburdened. "Building clinics is not enough," said Baharestani. "What is needed [more] are trained doctors and midwives."
Facts on maternal mortality
Women in the area are more likely to face problems arising from poor nutrition, lack of dietary supplements and a high fertility rate. The widespread practice of child marriage contributes to the high mortality. More than 40 percent of women in Badakshan are married before the age of 15, according to UNFPA.
While Badakshan fares the worst, the situation throughout Afghanistan remains dismal. UNICEF officials in Kabul say that Afghanistan has the second-highest maternal mortality rates in the world - 1,600 per 100,000 live births - after Sierra Leone.
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