Maternity Hospitals Fail Afghan Mothers
April 5, 2002
Middle East Times
Farkhundah Khan

A few months ago, the director of the Malalai maternity hospital in Kabul was operating blind. Because the Taliban's strict regulations forbade him to look at a woman's flesh, he would stand in the hallway and give instructions through the operating theater door. Although the Taliban have gone and clinical procedures have relaxed, pregnant women continue to be denied basic care. Afghanistan has the world's
second highest rate of stillbirths and alarming levels of maternal mortality.

According to the World Health Organization (WHO), 1,700 out of every 100,000 babies delivered in the country are stillborn, while about 45 women die in childbirth every day. WHO is now helping to rebuild the health system in Afghanistan but says that huge financial input is needed, and has called for an initial package of $150 million.

Institutions such as Malalai have suffered from decades of under-spending and although the Taliban can be blamed for letting the health care network run to rack and ruin, the system they inherited was already rundown. Patients at Malalai, who come from the capital and neighboring provinces, all complain of the low level of care, the poor hygiene and the lack of qualified staff. They say that they often have to get hold of their own medicines and sometimes even have to secure basic medical equipment necessary for operations.

The lack of a blood bank in Kabul also causes terrible problems for patients. As if this wasn't bad enough, there are frequent power shortages. "Sometimes, when there is no electricity, we have to conduct deliveries by lantern light. It can be done ­ but when there are complications we'd prefer to have electricity," said one doctor. On visiting the hospital, it is clear that one of the overriding concerns is
the lack of qualified personnel. The wards echo with cries for help. On any given day, 80 to 100 pregnant women are admitted and doctors say they are just not able to cope.

One patient described how she had stumbled across a woman delivering her child in one of the hospital's filthy toilets. In Afghanistan as a whole, it is estimated that 90 percent of deliveries are
unattended by medical professionals. Since the fall of the Taliban, doctors, especially female ones, have been steadily returning to work. "Otherwise our hands are tied. We have limited
resources and just do the best we can," said Malalai's president Fahima Sekandary.

But the patients keep coming, as they cannot afford to go elsewhere. In an effort to improve medical care for pregnant women, the Afghan Red Crescent Society has been training Traditional Birth Attendants, who serve remote regions of the country, educating expectant mothers and providing them with safe delivery equipment. Just over 200 TBAs are working around the country ­ the goal is to
eventually have about 1,000.

The United Nations children's agency, UNICEF, has already begun a training program at Malalai, aimed at instructing female doctors from various parts of the country in emergency obstetrics. "They will then go back to their regions where they will in turn train more doctors," said a UNICEF official. Courtesy of Institute for War and Peace Reporting.