At 4am, Abdul Malek and his pregnant wife were in a rented car heading to Boost Hospital in Lashkargah, capital of southern Helmand Province.
Afghanistan has some of the worst maternal health indicators in the world as 1,600 out of every 100,000 women die during childbirth (about 48,000 deaths annually), according to aid agencies. (Photo: Kate Holt/IRIN)
The couple decided to leave their home in the Sangeen District as early as possible to avoid roadblocks by pro-government forces or being seen by anti-government forces.
“When foreign forces block a road, people have to wait for hours and sometimes even a whole day,” said Malek, referring to the occasional road closures by NATO forces for de-mining and military investigations. “And if we’re frequently seen by the Taliban on the way to Lashkargah they would get suspicious and may accuse us of spying for the foreigners or working for the government.”
The Taliban execute people accused of espionage without a fair trial and usually do not allow for meaningful self-defence. They also punish people who work for the government even in civilian posts, according to locals and government officials.
In volatile Helmand Province, roads and footpaths are, meanwhile, notorious for improvised explosive devices (IEDs), which often kill and maim combatants and civilians indiscriminately.
Hundreds of civilians have been killed and wounded by IEDs over the past year, according to human rights organizations.
Preventable deaths
Afghanistan has some of the worst maternal health indicators in the world as 1,600 out of every 100,000 women die during childbirth (about 48,000 deaths annually), according to aid agencies.
Most of the deaths could be prevented if women reached a healthcare centre on time, health specialists say.
“We receive women in critical condition with complications almost on a daily basis,” Sarah Wacheke, a midwife at Boost Hospital, where Médecins Sans Frontières (MSF) has been working since November 2009, told IRIN.
Many women arrive at hospital very late, making it very difficult to save their lives. More than 24 percent of the women brought to the maternity ward of Boost Hospital in April had obstetrical complications, according to MSF figures.
Every day up to 20 deliveries, including at least three caesarean sections, are performed in the maternity ward where Wacheke and her seven Afghan colleagues work more than 60 hours per week.
“Most of our patients are poor and cannot afford private clinics and we see malnourished mothers and children among them,” said Wacheke.
Gender-related restrictions
The Boost Hospital also serves people wounded in the conflict. It attracts patients from all over the province, particularly from the rural areas which lack clinics and health workers due to insecurity.
In addition, women’s ability to seek healthcare services is restricted by tradition. Women usually do not go to a doctor alone and must be accompanied by a male relative.
“Due to insecurity in general, people may be unwilling to permit their women to travel to an area even if the clinic itself is not under direct attack,” said Aanchal Khurana, a spokesman for the UN World Health Organization (WHO).
These restrictions undermine women’s access to antenatal, postnatal and family planning services, which are considered critical for their wellbeing.
“They should take two doses of tetanus vaccine during pregnancy but most women hardly get even one,” said MSF’s Wacheke.
“After delivery we want to keep women for at least 24 hours to observe any post-delivery complications but it’s very difficult to keep them even for two hours,” she said.
A shortage of female health workers is another major problem in the insecure south of the country where more than half of girls reportedly do not have access to education. “The lack of schooling equates to a lack of trained health workers,” said WHO’s Khurana.
Citing figures from a UN briefing paper, 29 Afghan and foreign aid agencies wrote to heads of NATO-member states in a report on 19 November that maternal mortality rates were triple the national average in Helmand Province and 53 percent of health clinics in the south of the country were closed.
WHO, however, said maternal mortality was a nationwide problem but particularly severe in the northern Badakhan Province.
More ambulances, more health facilities and more health workers are urgently needed, experts say.
“Communities also need to invest in the health of their women,” said Khurana, adding that more professional training institutions had to be established near rural areas to increase demand and facilitate attendance.