Nosha Asiyan
In a remote district of Badakhshan province, the only companions to a woman in labor are usually her family and a local village midwife(Traditional midwife). When the searing pain of giving birth rises, no ambulance is on the way, no doctor is waiting behind the door.
It’s an experience Gulnisa knows well. In January, the 28-year-old gave birth to her fourth child, but her baby died in the process and she narrowly escaped death herself.
She lives in Kuran wa Munjan, a remote border district of Badakhshan, home to over 8,000 people and nestled in towering mountains about 160 kilometers from the provincial capital Faizabad. It’s renowned for its rich natural resources, especially the semiprecious gemstone lapis lazuli. Yet despite the wealth that lies in its mines, what reaches the people has been poverty and deprivation.
Its remoteness and poverty mean that for Kuran wa Munjan women, childbirth is not always the beginning of life, but often its end. With no hospital or doctor nearby, the potential joy of a child’s birth is instead riddled with fear and uncertainty, with their only trust the trembling hands of elderly midwives.
The roads leading to Kuran wa Munjan are in extremely poor condition, making it nearly impossible for women to access timely medical care during childbirth and contributing to the high infant and maternal mortality.
Kuran wa Munjan village in Badakhshana/ image: supplied
And the roads from the district center to where Gulnisa lives in Pas-Kuran area are just as bad.
Gulnisa’s sister Khujasta*, who lives in Faizabad, told Rukhshana Media her baby likely died from lack of oxygen.
“At night, when Gulnisa’s labor pains began, they called for a woman in the village who had spent her life helping women give birth and had delivered many babies there. But the baby died before it could be born,” Khujasta said.
“She endured a very difficult delivery, and by morning, they took her to the clinic on a donkey. The roads are in terrible condition, and there’s no regular transport.
“Even if a vehicle is available, the cost of traveling from Pas-Kuran to the district center is between 2,000 to 3,000 Afghanis (US$28-42) – an amount poor families cannot afford.”
According to Khujasta, Gulnisa had been warned her by doctors about the risks she might face after previously losing another child during labour. But her husband, a farmer who, like many in the district, is living hand to mouth, was unable to afford the critical medical care for his wife.
Gulnisa’s tragedy didn’t come as a shock to the district residents. It’s a reality many of the families know well with the loss of a mother or baby during childbirth devastatingly common.
Dying on the road to seek help
Mahgul, who was expecting her first child, died from severe bleeding in March 2024 on her way from Aywim area to the district health clinic. She was traveling by donkey to give birth, but she died along the route before reaching help, with her baby not surviving either.
“We have no clinic, no medicine, no treatment, no doctor, and the roads are destroyed,” Mahgul’s brother Ahmad Shah said.
“My sister is not the first – many women have lost their lives the same way.
“All we could do was pray over them and bury them. Neither during the previous nor under the Islamic Emirate (Taliban rule) has anyone paid attention to us poor people.”
Catastrophic number of deaths each year
Afghanistan has one of the highest maternal mortality rates in the world with 638 mothers dying for every 100,000 live births, according to a United Nations report.
However, the lack of access to basic healthcare in remote and mountainous regions claims more women’s lives than in urban areas.
Aywim area resident Mahbegum said that the situation in their village is catastrophic.
“Women here face many problems, especially pregnant women. For example, when they fall ill, they often self-medicate,” the 28-year-old teacher said.
“There’s no doctor to advise them on birth spacing. As a result, pregnant women face numerous challenges. Just this March, two women from our village lost their babies during childbirth because they had common ailments like headaches or body pain. They took whatever medicine was available at home or from neighbors, hoping it would help them recover.”
She said that in her area alone, she knows of more than ten newborns and as many as five mothers who died during childbirth last year.
“This is the number I’ve witnessed, and it could be even higher. Since the distance between villages is so vast – some are a day’s journey apart – we don’t always hear about it. But it’s become a norm for births to go wrong or for babies to die,” she said.
Nearly a month ago, Afghanistan’s Tolonews also reported, citing local sources, that in the year 1403 (2024), at least 20 women had died during childbirth in just one village of Kuran wa Munjan district.
Death toll in childbirth becoming normalized
Abdulhad, a 24-year-old member of the Pas-Kuran area council, said that due to the long distances and lack of access to healthcare, most women give birth at home.
“We don’t have any health center, and if someone gets sick, we’re forced to walk two to four hours just to reach the clinic at the district,” he said.
“People can’t afford to travel to the district center for childbirth, so most deliveries happen at home with traditional methods. The cost of traveling from our village to the district center is between 2,500 to 3,000 afghanis, and people here just don’t have that kind of money.”
Local resident Homaira said women are expected to rely on God.
“The death of a mother or child has become something normal here. Women rely only on God, hoping for the best,” the 32-year-old mother said.
“During childbirth, women often suffer heavy bleeding, and sometimes the placenta doesn’t come out until four or five days later, causing serious complications. Just last month, one of our relatives gave birth – her baby was born alive but died just a few minutes later.”
She said just the past two months she knew of a mother in Pas-Kuran and another in Shah-Pari village who died during childbirth.
Janki, 25, witnessed one of her neighbor’s go into labor and leave for a clinic as complications set in, but return as a corpse.
“Wazir Begum was 28 years old and one of our neighbors. Just a month ago, when her labor pains began, her condition quickly worsened and she started bleeding heavily,” Janki said.
“Her husband decided to take her to the clinic, but on the way, before they could even reach the clinic, both she and her baby passed away.”
A doctor at Badakhshan Provincial Hospital, who requested to remain anonymous, told Rukhshana Media that she has been working in the hospital’s maternity ward for more than eight years.
“We receive very few patients from Kuran wa Munjan. People in that district are extremely poor, and they don’t come to Faizabad unless the patient’s condition becomes critical,” the doctor said.
“Even then, they hesitate – only when they realize the patient might die do they consider making the journey. It’s understandable, though, because these people are struggling just to afford a piece of bread.”
This story published In partnership with More Her Story*
*Names have been changed to protect the identity of sources
