Afghan maternal mortality rate high

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By James Palmer

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.