Voices of Change: Notes from Afghanistan
My colleagues who work in Afghanistan have an up-close perspective on one of the most dangerous places in the world to give birth. In a country where maternal mortality is at an estimated 1800 women per 100,000 live births, Micah and his wife Amy have seen it all. They work alongside Afghan doctors and nurses to save mothers everyday. During a recent conversation, Amy relayed her observations that many girls in Afghanistan marry very young and have little knowledge of pregnancy and delivery. And, she explained, since the girls live with their in-laws after marriage, they are often too afraid or intimidated to ask questions. Most of these girls have no idea what to expect from pregnancy or how to take care of themselves, especially when things go wrong.
While Amy and Micah and their co-workers treat obstetric emergencies everyday, Amy is quick to point out that some of the most important work they do is in the community before a woman ever gets pregnant or presents to the hospital in labor. They support trained Afghan nurses to go into rural communities and give seminars to young women, teaching them to recognize danger signs in pregnancy. The women who attend also learn to prepare basic things for their delivery and they get training on helping other women in labor or after the baby is born. The information is simple, the strategies straightforward, but the impact is life-changing for these girls, most of whom are illiterate. I asked Amy to share with me some of the attendees’ revelations after these training sessions. Here is what the women said (roughly translated by the nurses):
Nadira commented, “My uncle’s wife was pregnant with her first baby. When the time for her came to deliver she didn’t tell anyone in the family that she had pain and then she gave birth in the latrine outside of the house! Her mother in law found her there and took her to the house but the baby got very sick. After this course, I understand now, that her baby got an infection during this time as it wasn’t a clean place to deliver a baby!”
Ghazal was in her 6th month of pregnancy when she attended one of the courses on pregnancy and delivery. She shared this: “I felt pain in my womb and went to the doctor because I learned in this course that pain is not a good sign for pregnant women. The doctor said to me I should rest and avoid doing heavy work for a few days because the baby is low which isn’t good for this month of pregnancy.” Amy didn’t have any more information about Ghazal’s pregnancy, but chances are she was able to recognize signs of preterm labor and get to the hospital in time.
“I had been newly married and I didn’t know anything about pregnancy,” said Hadiya. “For two months I had no monthly bleeding. One day I felt pain in my womb and asked my sister-in-law about this kind of pain. She said to me it is ok you are newly married and it is possible you got some kind of infection. At that time my husband wasn’t there as he worked far away from home. After a few hours the pain and bleeding got worse and when I went to the toilet something came out but the pain and bleeding still continued. I went home and took some tablets for the pain and the stomach. That night I had a lot of pain and in the morning my father in law noticed that I was not fine and took me to the doctor. I had been pregnant and I didn’t know anything about pregnancy and I also took a lot of medicine by myself. Now I understand.”
Another woman named Safa shared an interesting observation about accompanying her daughter-in-law to the hospital. “I saw a woman who just had delivered her baby but she didn’t bring any clothes for after having her baby. Her husband came and took her to the taxi without pants. Her other clothes were also stained with blood. When I heard from your teaching about preparing for birth I new it is an important lesson and my daughter-in-law had everything for delivery. We are so happy to participate this lesson as we learned so many things!”
Teaching women the signs of miscarriage or what to bring to the hospital isn’t groundbreaking news in the discussion of maternal mortality, but even the simplest tools are giving these women, and hundreds just like them, a path to knowledge and empowering them to change their lives and their world.
Kate Celauro is an obstetrician based in Nashville, Tennessee. Her passion for maternal health, however, extends far beyond the hospital where she works. She has been an advocate for women’s health for many years, beginning in college when she saw first hand the differences between healthcare for women in the U.S. and in rural South America where she was working on a thesis. Since that time she has traveled all over the world with her husband, a World Vision Artist, and has become more involved in championing the causes of women.