In a small village surrounded by velvety white snow-capped mountains in Afghanistan’s Bamiyan province, Aziza Rahimi mourns the infant she lost last year after a horrific birth without medical care.
“It was very difficult for me when I lost my baby. As a mother, I nursed the baby in my womb for nine months, but then I lost him, it hurts so much,” said Rahimi, 35.
The rugged and remote village beauty of Bamyan’s Fooladi Valley comes with deadly barriers for expectant mothers. The narrow road to the village with few vehicles is sometimes cut off by snow, cutting off the lifeline to hospitals, clinics and trained health workers.
However, an improvement is on the way that could potentially save lives. Rahimi’s village is one of several around Bamiyan that has sent 40 young women to train for two years as midwives in the provincial capital, after which they will return home.
Isolation can become a death sentence in any difficult birth, doctors and aid workers say, contributing to Afghanistan’s high maternal and child mortality rates, which are among the worst in the world.
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The United Nations estimates that an Afghan woman dies every two hours during pregnancy and childbirth, making Afghanistan’s maternal mortality rate the highest in Asia.
The United Nations High Commissioner for Refugees (UNHCR) led the trainee midwife program in collaboration with Watan Society for Social and Technical Services, a local charity. They hope to expand the program, which is also being implemented in the neighboring province of Daikundi.
Since taking office in 2021, Taliban authorities have banned women from attending universities and most charitable jobs, but have granted exceptions in the healthcare sector and the UNHCR says local health authorities are supporting the project.
“When the roads are closed, of course, there is no transportation, people even use donkeys to take patients to clinic centers, but sometimes there is no chance for that,” said Mohammad Ashraf Niazi, head of the UNHCR office in Bamiyan. .
Rahimi, who has five other children, said riding a donkey was out of the question when pain during her ninth month of pregnancy hit her in the middle of the night four months ago. She was born there and stumbled, bleeding, two hours home to her parents after her husband was unable to find a car or ambulance to take them to hospital.
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The child died soon after. Too late, an ambulance arrived.
Women giving birth face a very different situation in the main Bamiyan City Hospital where trained midwives work alongside staff, and with the help of a trainer learn how to assess and guide pregnant women, deliver babies and provide postpartum care.
“We want to learn and serve the people of our village,” said a 23-year-old intern, who walks two hours every day to the hospital. UNHCR asked the trainees not to reveal their names for their own safety.
In one of the hospital’s small clinics, where dozens of women wait outside, a trained midwife guides a woman with the help of a book of pictures about what to expect to prepare for childbirth under the watchful eye of two trained health workers.
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Any woman at risk of complications is admitted to a maternity ward in a nearby building where another trained midwife takes the blood pressure of a pregnant patient with an infection. She regularly checks in on a woman who gave birth six hours ago, her infant daughter lurking beside her.
Many trained midwives, some with young children, faced logistical and financial challenges, often having to travel long distances, or live far from home to attend the programme.
said a 20-year-old intern and mother of an 18-month-old son who struggles to get care in her village. She said that many women and families in remote areas did not have the information and support they needed to prepare for a safe birth.
“We have to change this kind of thinking… I want to go to remote areas to treat women who have problems.”
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