Ziba Balkhi
When Medina’s sister went into labour in November, her family took her to the main provincial hospital in Sar-e Pol. There, they were told she needed a caesarean section, but that no specialist was available to carry one out. Their only option was to drive her for 90 minutes to a private hospital in a neighbouring province, but by the time they got there, it was too late — the baby was dead. Doctors said that if they had got there any later, the mother could also have died.
“The doctors operated quickly, and my sister survived, but sadly her baby died,” Medina, who asked not to be identified by her real name, told Rukhshana Media in Sar-e Pol, which lies about 600 kilometres (400 miles) north of the Afghan capital Kabul.
It’s an all too familiar story in a country where giving birth has never been as safe as it should be – especially in mountainous rural areas like Sar-e Pol, where many women still have their babies at home.
Now, it’s getting worse.
Taliban restrictions on women’s employment, education and mobility, combined with shrinking health budgets resulting from the withdrawal of international aid, have exacerbated existing problems in a country battered by decades of war and instability.
Hundreds of health facilities have been forced to close since the US closed aid programmes in Afghanistan earlier this year, removing the only option for many women to give birth safely.
Even in hospitals that still operate, there’s a chronic shortage of trained health workers. One source at the Sar-e Pol provincial hospital told Rukhshana Media that an average of four mothers and eight children die every month due to the lack of health services and specialist doctors there.
“Unfortunately, at Sar-e Pol Hospital, there is only one specialist obstetrician–gynaecologist, and even that doctor works only from 8 til 12,” said the source, who spoke on condition of anonymity. “After that, if any emergency patient arrives, there is no doctor to attend to them… the situation in the maternity ward here is extremely critical.”
One local resident described how she recently suffered a miscarriage and went to the hospital but was turned away and had to travel to a neighbouring province to be seen. “It’s called a hospital, but they provide no services to people, especially to women,” she said.
Afghanistan has one of the highest maternal mortality rates in the world. UN Women said in September that the risk was increasing, citing the high rate of adolescent pregnancies due to child marriage as one factor.
This situation is particularly challenging in remote parts of the country, though no reliable data is available as the Taliban does not publish it.
One source working in Sar-e Pol’s health sector said authorities were trying to cover up the maternal death figures. “Even in morning reporting meetings, they say nothing about how many babies or mothers have died, because it would damage the hospital’s reputation,” said the source.
In more remote districts of the province, women still usually give birth at home. Rukhshana Media spoke to people in Kuhistanat district who said it could take between three and five hours to reach the provincial capital. In many high-risk cases, or for those requiring caesarean sections, the baby or the mother dies before reaching the hospital.
“Here, most births take place at home because there are no hospitals and no proper clinic,” said one resident. “The clinic is on top of a hill, and we have to use animals to transport people there. That’s why most women here give birth at home. From here to the centre of Sar-e Pol it is about four hours.”
One local man said his brother’s wife had died on the way to the provincial centre in October due to severe blood loss.
“Her condition was bad. She lost consciousness and had severe bleeding,” he said. “The village clinics can’t cope with cases like that, where the condition is critical, so they took her to the centre of Sar-e Pol. But on the way, both the baby and my brother’s wife died.
There’s a similar situation in many other districts of the province. Residents of Balkhab district said it was often just not possible to bring women in labour to the hospital, meaning they give birth at home, often with no formal medical help.
One Balkhab resident said the cost of transport was a significant barrier to going to hospital. Often, he said, all you could do was pray.
“Clinics can handle a normal delivery, but if the condition of the baby or mother is critical, they advise taking them to the hospital,” he said. “But the road is in poor condition and it’s a difficult and slow journey. As transport costs are extremely high, we cannot afford to take our women to the centre during childbirth.
“My own child—it was my fourth—died during birth. My uncle’s daughter-in-law died in the same way during the birth of her first child, though the baby survived. No official in our district pays the needed attention.”
Increasingly, even if they do make it to the hospital in the district headquarters, women aren’t getting the care they need. Medical staff at the hospital, speaking on condition of anonymity, described serious lapses due to the lack of specialist staff. One described the death of a young woman who came to the hospital in labour with her first child. When it became clear that she needed an emergency caesarean section, there was no trained surgeon available, so the midwifes performed the procedure. The child died, and the hospital ended up having to remove the woman’s uterus to save her life, leaving her unable to conceive again.
In Sar-e Pol, where tradition dictates that a woman’s value lies in her ability to bear children, that meant her life was ruined, said the health worker.
“She will face ridicule from her husband and in-laws for the rest of her life.”
