You would think there would be more of an uproar in a country with the highest maternal death rates. No other country in the world loses more women in childbirth than Afghanistan. None. Rarely has being first at something meant so much loss.
It’s not just the women either, lest you callously chalk it up to the inevitable argument over women’s oppression in a country like Afghanistan where women set themselves on fire to escape arranged marriages, rapist go free, victims go to jail, and women die in childbirth when a male doctor lives just 10 minutes down the road, because he is unable to view her naked or worse yet, touch her.
The children too are dying at alarming rates. Skirting at the top of the heap, currently in the second position when I last checked, of the highest infant death rates in the world. Babies die from suffocation when they a nasal suction would clear out their mouth and nose post delivery. Babies die of dehydration when they are given dirty water instead of breast milk. Babies die common colds due to harsh winters with little to keep them warm.
All three causes are easily rectified. As are many of the major causes of the mother’s deaths. Dirty knives that cut the umbilical cord and cause infection. Inability to deliver the placenta causes the woman to bleed out.
Lack of a few simple medicines, lack of pre or post natal care, lack of female doctors equal death on a large-scale in a country already suffering from something akin to country-wide post traumatic stress disorder due to nearly four decades of war and incredible loss of life that has affected every family. In short, many of these deaths are preventable, and families crave midwives even areas that they won’t yet education girls.
Midwife training schools exist in nearly every province to address this situation and the Afghan Minister of Public Health touts its success. Successful for cities and larger communities, yes. But this 2 year program rarely spreads far.
Lack of education makes a trickle down effect nearly impossible. A unique village-to-village approach is needed to save lives in rural communities. The reason? Girls must have a 9th grade education to attend midwife training. Those that have the education, must then have the permission from their father or husband to leave their community for 2 years to attend training. In the rare case that education, permission and scholarship is available, and the girl attends school, she will return to her community to live. A wonderful solution for THAT village and she will do much for her community’s welfare, but what about the communities that do have educated girls to send?
It is extremely rare that a girl would return from school to a village other than her own. So the villages that don’t have girls educated to 9th grade, a rarity in many regions, have no hope to train girls from within their own village.
So, the solution? Train women and girls with low levels of education, to be skilled birth attendants. Teach them the simple solutions that save lives that you or I could learn in 4 short weeks. Teach them basic sanitation and have them educate their village. Teach them how to administer basic medicines and vaccinations. Pay them a small stipend to work in their village. As the village thrives, and the women earn money for their family, the value of women increases and deaths decrease.
A great example of this cultural shift occurred in a remote mountain village in the Panjshir. We had ongoing discussions about building a girls primary school, and the elders were reticent. When we shared our other program, rural midwife training, their eyes lit up and questions and stories flew around the room as I struggled to keep up with their pace. Upon realizing that we couldn’t train illiterate women, and the knowledge that there wasn’t one single literate woman or girl in the village, we ended the discussion. The next morning, fifteen men met me with green tea and said they would like to pursue the original discussion of a girls school.
Often it’s illustrating the way girls and women can contribute to the general welfare of the community that makes the rational argument for their health, worth, and their education.
Our first training begins with women from two Taliban-controlled provinces. Where women have long suffered under oppression, but where even there, the lives of women and their offspring have value enough to save, but no one to save them.