Afghan maternal mortality rate high

FAIZABAD, Afghanistan | When Azada went into labor high in the Hindu Kush mountains, it started an odyssey that lasted 72 hours and covered 60 miles of forbidding terrain.

The journey for the 20-year-old mother of two, who like many Afghans uses only one name, included a trek atop a mule and a bone-crushing drive in a battered rental car over winding paths, through deep gorges and around craggy peaks.

Stops at a clinic near her home and at another poorly equipped health facility offered insufficient help, forcing Azada and her family to trudge on to Faizabad, a provincial capital in Afghanistan’s remote northeast corner.

Azada’s ordeal ended in a hospital. After three days of intense labor, her child was stillborn, she suffered a ruptured uterus and underwent a hysterectomy.

Yet she was fortunate for an Afghan woman: She survived her pregnancy.

“We see patients like this all the time,” said Dr. Waquili Kareem, a physician at the Faizabad hospital. “Many die on the way here.”

Afghanistan’s struggle to provide basic human services underscores the fragility of a government also facing terrorism, drug trafficking and insurgency.

Afghanistan has the second-highest maternal mortality rate in the world, after Sierra Leone, according to the United Nations Children’s Fund (UNICEF). For about every 62 infants born here, one mother dies during pregnancy, in labor or during the postpartum period. The resulting rate of 1,600 maternal deaths per 100,000 live births is five times higher than in neighboring India and 123 times the rate in the United States.

The province of Badakhshan where Azada lives is one of the worst areas.

The province’s Ragh district had the highest rate of maternal mortality recorded, according to a 2002 U.N. survey, with a staggering 6,500 maternal deaths per 100,000 live births.

Medical professionals point to several reasons, notably the lack of facilities, impassable roads that can isolate pockets of the population for months and the dearth of medical professionals to treat and educate citizens.

“They don’t recognize the danger signs and there are no doctors where they live to help,” said Dr. Hajera Zia Bahrastan, 53, chief of the maternity ward at the Faizabad hospital.

“Many of those women who know they are in trouble either can’t afford to travel to a hospital in a city or are unable to reach one because the roads are closed,” she said.

Further complicating matters, the Islamist values of many prohibit male doctors and health workers from examining women or assisting during childbirth. To deal with this complication, all six physicians in the maternity ward of the Faizabad hospital are women.

“Women would never come to this hospital if there were no female doctors,” Dr. Bahrastan said. “They will die before they see a male doctor.”

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