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Afghan Women Face Childbirth Risks

By Christopher Torchia

Associated Press Writer

Tuesday, September 10, 2002; 8:51 PM

MAZAR-E-SHARIF, Afghanistan –– Makai gave birth before dawn Tuesday for the 14th time and gazed a few hours later at her swaddled boy, his face red and puckered, lying in a hospital cot beside her.

"This is the last one. That's enough for me," said the 40-year-old farmer's wife, who has seen nine children die of malnutrition and disease. After undergoing a Caesarean section, Makai was expected to recover for 10 days in the main public hospital in northern Afghanistan.

Makai, who has only one name, was fortunate to be treated at Barat Hospital. Afghan women are as vulnerable during childbirth as their children in a country with only rudimentary health facilities after decades of war – one woman in seven dies giving birth.

Women also face more risks during childbirth because they lack basic rights in a traditional society where unskilled midwives assist the vast majority of births, human rights activists say.

For example, a study released Tuesday by the Boston-based Physicians for Human Rights says the maternal mortality rate in the northwestern province of Herat ranks among the highest outside Africa, with 593 mothers dying during every 100,000 births.

The group said 92 percent of those deaths were reported from rural areas.

Afghanistan as a whole has a higher maternal mortality rate – 1,700 mothers die per 100,000 births – than any country except Sierra Leone. And Afghan women take that risk frequently: The average woman has seven children.

By comparison, the maternal mortality rate in the United States is 12 deaths for every 100,000 births, Physicians for Human Rights says.

Complications from pregnancy or child delivery are the No. 1 killer of Afghan women between 15 and 45 years old, said Dr. Marie Claire Mutanda of the UNICEF operation in Mazar-e-Sharif, the biggest city in northern Afghanistan.

Mutanda said 42 percent of Afghan women dying in that age category are victims of maternal mortality. Many women give birth at home, she said, and village midwives are unable to stem internal bleeding and other complications that can be treated easily at a clinic.

"They cannot solve medical problems," Mutanda said. "The idea is to get them to recognize the danger signs and be able to refer them" to professional health care in time.

The ouster of the hardline Taliban in a U.S.-led war last year brought a measure of peace, as well as an inflow of international aid, to many parts of Afghanistan. Some non-governmental organ birth.

Years of war shattered the infrastructure of Afghanistan, with many roads and buildings destroyed or crumbling. The population is impoverished.

Dr. Zahra Amnawa, a gynecologist at Barat Hospital, said some pregnant women ride to clinics on donkeys or horses because they do not have any other means of transportation.

Hospital staff often make house calls if women are unable to travel, but they do not have enough vehicles, Amnawa said.

Also, occasional showdowns between rival military forces sometimes make it unsafe for doctors to visit rural areas.

Makai, who had an intravenous drip containing a dextrose solution attached to her arm, lives only a few miles from Mazar-e-Sharif and traveled easily to the hospital for her operation.

But many Afghan women are unfamiliar with Caesarean sections, or do not have enough money for professional care during childbirth.

Some husbands in this traditional Islamic society prefer that their wives give birth in the privacy of their homes and believe it shameful for them to be treated by strangers in a public setting such as a hospital.

Dr. Lynn Amowitz, a medical researcher who conducted the Physicians for Human Rights survey, said other factors that may contribute to the high maternal mortality rate include forced marriages, lack of access to birth control and lack of control over the number and spacing of one's children.

"What appears to be simply a public health catastrophe in Herat Province also speaks to the many years of denial and deprivation of women's rights in Afghanistan," she said in a statement.

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