In Afghanistan, perhaps the only thing more dangerous than being a woman is being a pregnant woman in need of medical care. A 2002 survey counted 1,600 maternal deaths per 100,000 live births. The cause of death was most often hemorrhaging or obstructed delivery, both preventable if skilled health care is available.
The contrast is staggering: in 2005, maternal mortality in four Afghan provinces ranked 130 times higher than the United States, with a reported 50 to 70 mothers dying every day from complications at birth. Nearly half the deaths among Afghan women of child-bearing age have been pregnancy-related and preventable.
A Cultural Legacy
When the Taliban claimed the capital of Kabul in 1996, Afghan women confronted impossible odds to survive in a culture that limited their freedom, banned their education, forced them into marriage and provided only conditional access to health care. The Al-Qeada organization flourished, planning the September 11 terrorist attacks that provoked United States forces to join Afghan opposition and remove the Taliban from power in 2001.
Since then the country has slowly been rebuilding, but the decades of war, extremism and instability have been slow to fade, and Afghan women continue to suffer from the same types of oppression that took root under the Taliban. Today, forced marriages, lack of education, violence and high rates of maternal mortality persist.
Chain Reaction: A Cycle of Trauma
The crisis in reproductive health care is the leading cause of maternal mortality and reflects a destructive chain reaction that begins for Afghan women at a dangerously early age. A 2004 study showed that most Afghan women were forced into marriage before they were 16, with some as young as nine. The consequences are steep, impacting the young girl’s physical development and general health as well as her chances for education.
Pregnant women must cope with poor nutrition and scarcity of food in Afghanistan. Weakened by malnutrition, they are vulnerable to anemia while lactating, and this puts their bodies at higher risk for hemorrhaging. Vitamin deficiencies lead to scurvy, while iodine deficiencies cause goiters in mothers and a thyroid condition called cretinism in their babies.
Underlying these challenges is the fact that few Afghan women know how to recognize danger signs during pregnancy. For those who do, lack of money and transportation make getting to a hospital all but impossible. If she does manage to recognize the signs, acquire transportation, survive the broken roads and reach a hospital, the care and facilities a pregnant woman would find would almost certainly be inadequate, if not downright dangerous.
Access to skilled physicians who know about obstetrics and gynecology is no easy matter in Afghanistan. Under the Taliban, men were not allowed to treat women under any circumstances, and some men believed it was better to have their wives die than have a male doctor treat them. Unfortunately there was no alternative, as women were banned from learning medicine or working.
The problem persists, even though by 2000 the Taliban had begun to allow men to treat women. Meanwhile, a generation of Afghan women has fallen so far behind academically that it is difficult to find capable female candidates to learn medicine in the villages. One successful effort has been to offer a vaccination program through UNICEF that is administered by women who can enter houses, see mothers and children themselves, and provide vaccinations and care.
Path to Progress
There is no question that Afghanistan’s health care infrastructure lay in ruins after the Taliban was removed, and it has only incrementally been improving since. In 2002, of the few medical facilities that had toilets, most were hazardous pit latrines. A quarter of those facilities had electricity, half of which depended on generators. Patient transport systems relied on bicycles and horses or were nonexistent.
In 2002, two thirds of Afghanistan's clinics could not provide basic reproductive health services and only 10 percent were equipped to perform Caesarian sections. Of the 25 percent of children who died before turning five, nearly half died from preventable causes such as diarrhea or respiratory infections.
Prior to 2001 women were absent from Afghanistan’s public life and political scene. By 2004 a new Constitution stated that male and female citizens were equal before the law. As of 2006 Afghan women are represented in both houses of parliament, and more and more are voting, going to school and becoming involved in government policy.
But progress in those areas has not yet changed the daily reality that for many Afghan women, becoming pregnant is forced upon them at a young age through unwanted marriage, and that bearing children is too often a debilitating, if not fatal, consequence.
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