James Palmer
Mohammed Hatem stands proudly but anxiously over his 28-year-old wife Saily Nisa as she rests on a narrow bed with a pink veil covering her face at a rural health facility. She is about to deliver the couple's fifth child.
While the 38-year-old food vendor is looking forward to the newest addition to the family, he is apprehensive about the financial implications.
Faizabad: A father digging a grave to bury his dead newborn child.
"We want as many children as possible, but we just don't have enough money for more now," said Hatem, who earns about $40 a month. "If I can get more money, then we'll surely try to have more."
Today, many Afghan couples are torn between adhering to the tradition of large families and the financial reality of caring for many children. Afghanistan has the highest fertility rate in Asia at more than seven children per woman. About 800,000 people annually are added to the nation's population of 32 million, according to the United Nations Development Fund.
The dilemma is particularly significant in rural areas where parents depend on children to tend crops and livestock, but where war and drought have pushed many Afghans into poverty. Aid groups warn that the current population growth rate will exacerbate rising poverty; some 42 percent already live below the poverty line while another 20 percent linger just above it, according to U.N. statistics.
The village of Dharaim sits deep in the Hindu Kush mountain range in the northeast province of Badakhshan along the border with Tajikstan. While security in this small farming community is far better than in most regions, the area's 25,000 residents lead hard-scrabble lives with constant shortages of water and electricity, and just one rutted dirt road linking it with the rest of the country.
"People are poor here," said Samiulllah Majid, 38 who earns a high salary for the area - between $300 and $400 monthly - selling construction materials. "Families are leaving, and many younger men go outside the country to find work."
Indeed, a faltering economy has caused many villagers to reduce the size of their families and turn to family planning services that offer birth control pills and injections and condoms.
"People in this community had 10 or 12 children before, but now it's down to four or five," said Parinaz Shakari, 35, a doctor at the lone health facility in Dharaim. "Money is a big problem."
The construction by the federal government of health facilities throughout Badakhshan - 38 since 2002 - has brought family-planning services to Afghans. According to the health ministry in the provincial capital of Faizabad, 21,183 women visited family-planning clinics throughout Badakhshan in first six months of 2008. The province has a population of 521,000.
"People here had no idea about family planning before we started the program," said Shakari.
Afghanistan is a predominately agrarian society, and families often require a large household to maintain crops and livestock. "Everyone has a job to do," said Haji Abdul Sabut, a 76-year-old farmer.
Across the rugged countryside of Badakhshan, there are many young children toiling in the furrowed soil of sprawling fields or herding sheep, goats and cows along muddy paths and rocky outcrops of weathered mountainsides.
On a bright and cool afternoon, 12-year-old Habibullah, who like many Afghans uses only one name, was trudging through a wheat field in rubber boots gathering roots as his cousin Abdul Malik, 20, plowed the soil by hand with two cows and a wooden stake.
"This is good for fire," said Habibullah as he held up a handful of dried roots, which his family will burn for warmth during the coming months.
With few government-run welfare services, children are considered insurance for aging Afghan parents.
"I supported my father when he was old, and I hope my children will do the same for me," said Amanullah, a 32-year-old farmer who has four children.
Still, some in this remote farming village also hold lofty ambitions for their children. Education for boys is available through middle school, while girls typically receive only an elementary school education. Few parents in Dharaim can afford to send their children to Faizabad to continue their studies.
Aid groups warn that the current population growth rate will exacerbate rising poverty; some 42 percent already live below the poverty line while another 20 percent linger just above it, according to U.N. statistics.
"I want them to work for society and help improve our country," said the merchant Majid, who hopes his four children will attend college.
In the end, conservative views in this deeply religious community may decide family size.
"Most of the people here believe the number of children they have is dependent on God's will," said Roohullah Muqiq, 32, a Dharaim physician. "They don't believe they have any control over the matter."
But failure to rein in population growth could result in critical consequences for Afghanistan, experts say.
A U.N. Population Fund report released in July warned that Afghanistan's current population growth rate will more than double the demand for water and land, stress the country's inadequate infrastructure and damage the environment.
Experts say increasing population has already contributed to astounding levels of maternal and infant mortality, which are among the highest in the world. In Afghanistan, there are 1,600 maternal deaths per 100,000 births, a rate 123 times higher than in the United States. The infant mortality rate is 154 deaths per 1,000 live births. In contrast, the U.S. rate is 6.3 per 1,000 live births, according to CIA data.
The U.N. report also said that easing population growth would allow the Afghan government to direct more attention to reducing maternal and infant deaths, while improving services for children's health and education, and developing the country's roads and energy sources.
Ironically, modest improvements to family planning services has contributed to sustaining the country's high population growth, according to UNICEF.
Afghanistan annually reports some of the lowest health indicators worldwide but an increased number of medical facilities and physicians in rural areas in recent years has prolonged the lives of Afghans, even though the life expectancy is just 47 years.
"More people here are living longer because there are more health services available to them," said Zahir Fazil, the director of UNICEF in Faizabad. The number of doctors in Badakhshan province, for example has increased from 12 in 2002 to 40 in 2008.
That is welcoming news to many parents in Dharaim who yearn for a traditionally large family.
"They're expensive," said wheat farmer Amanullah in reference to his four children. "But I still want more."
More people
-- The Afghan fertility rate is 7.5 children per woman, the highest in Asia. In contrast, the rate in the United States is 2.1.
-- Afghanistan is the world's 47th most populated country, with an estimated 32 million people.
-- At the current growth rate, Afghanistan's population will grow to more than 56 million by 2050.
-- Afghan officials estimate the urban population will double by 2015.
-- In Afghanistan, there are 1,600 maternal deaths per 100,000 births, a rate 123 times higher than in the United States.
-- The Afghan infant mortality rate is 154 deaths per 1,000 live births. The U.S. rate is 6.3 per 1,000 live births.
-- Researchers say continued population growth poses a greater obstacle to reducing poverty than HIV/AIDS.
Sources: U.N. Population Fund, U.N. Development Program, National Center for Statistics, CIA World Factbook.