Midwives Take On the World’s Most Dangerous Country for Women
Dec 20th
Imagine that you are nine months pregnant and have to drive seven hours to reach the nearest hospital. You have never seen an obstetrician or midwife for prenatal care and emergency health services are miles out of reach. This is the situation in parts of Afghanistan, where the maternal mortality rate is the highest in the world.
As of 2008, it was estimated that 1 in 11 Afghan women die in childbirth. (In Greece, the country with the lowest maternal mortality rate, the statistic is 1 in 31,800.) With a fertility rate of 6.62 children per mother, the life expectancy for women in Afghanistan—recently ranked “the most dangerous country for women” by the Thomson Reuters Foundation—is less than 48 years.
Now, a national midwifery program is one of several initiatives to drastically improve women’s maternal safety, report Isobel Coleman and Gayle Tzemach Lemmon in Ms. Magazine. Funded by organizations like the U.S. Agency for International Development, the United Nations, and the European Union, the program has trained more than 2,500 midwives. Coleman and Lemmon write:
For women in the country’s most remote provinces, who face the greatest challenge accessing health care in this overwhelmingly rural country, the midwives serve as a lifeline. Of the approximately 500 birth complications that occur daily in Afghanistan, 320 happen in those rural areas. Midwives are also active in cities, making home visits to women too poor or limited in mobility to seek help at clinics or hospitals.
The midwives can affect more than just the maternal mortality rate, they continue:
Along with saving mothers’ lives, the midwives serve as homegrown role models whose economic strength and earning power are changing their families’—and their communities’—views on women’s roles. Midwives can earn around $350 each month, a substantial salary in one of the world’s poorest countries and where per capita GDP is less than $500 per year. The money matters and is playing a role in shifting male attitudes toward women’s work outside the home…. When women begin contributing economically to the family, they also have a greater say in what happens to them and to their children.
“Most people have a lot of respect for midwives because they need health care,” says Fatima, [a] student in the program. “Midwives save mothers’ lives and women’s lives.”
Source: Ms. Magazine (excerpt only available online)
Image by isafmedia, licensed under Creative Commons.
Birth a deadly challenge in Afghanistan
Oct 31st
A chronic shortage of midwives and basic health services makes having a baby one of the most dangerous things an Afghan woman can do.
A woman dies during childbirth every 29 minutes in Afghanistan, which is wracked by poverty, insecurity and deeply ingrained discrimination against women.
At a tiny ultrasound room at the Malalai maternity hospital in Kabul, 35-year-old Benafsha gives birth to a baby girl.
She already has five children; her family would have preferred another son, but she was dreaming of a daughter.
“When she grows up she should go to school and increase her knowledge,” she said.
It is one of the biggest maternity hospitals in Afghanistan, but most Afghan women never reach there.
Eighty-six per cent give birth without any trained help, and it can be a deadly scenario.
Benafsha’s first two babies died during the Taliban’s rule because her family would not let her go to the hospital.
She still remembers the tiny faces of her lost newborns.
“I feel sad and cry – what else can I do?” she said.
Even in hospital, childbirth is traumatic; the midwives abuse Benafsha, accusing her of being too slow.
More than 130 babies are born at the hospital everyday, with some women given only half an hour to deliver.
Midwives slap Benafsha on her pregnant belly to speed up the contractions. If Australian midwives did the same, they would be stood down and could even face criminal charges.
The baby looks deathly white and motionless when it emerges. The midwife cuts the cord and rushes down the corridor, carrying the newborn girl face down along her arm.
When the nurse reached the neo-natal ward, the doctors take over. They use a suction tube and a foot pump to try and open the baby’s airway.
The baby has swallowed faeces or meconium during the traumatic delivery and now has severe asphyxia.
It is many more minutes before the baby finally coughs out her first cry.
Her skin colour starts to change from white to blotchy pink. Her arms and legs begin to move. She weighs in at four kilograms, a big baby for Afghanistan. The doctors are relieved for now.
“She is very beautiful,” Benafsha said.
Fathers are not allowed inside the hospital so the guard at the front gate announces that Benafsha’s baby has arrived.
In the baby’s first minute of life, she was given only two out of 10 on what is known as the APGAR score of newborn health.
In Australia, a baby in this condition could be sent to intensive care.
But only three-and-a-half hours after she is born, her father orders the baby and Benafsha to be discharged because he does not want to wait anymore.
‘No-one cares about them’
Neonatal doctor Noor Zia Sharifi is worried the baby could die of infection or have some brain damage from the asphyxia.
“If the newborn is a girl, they don’t pay much attention to her,” he said.
“They won’t let the mother and baby stay in hospital for a few days so we can take care of them.
“But if the newborn is a boy the relatives touch the feet and hands of the doctors, begging for us to keep the baby boy in hospital. They want us to give him the best treatment.”
Despite the gains made since the fall of the Taliban, Afghanistan remains one of the most dangerous places on the planet to be born female.
The average Afghan woman is dead by the age of only 44.
Dr Sharifi is struck by the loss of opportunities and talent that Afghanistan so desperately needs.
“The baby girls born here, many have potential, they are intelligent and alert,” he said.
“But no-one cares about them. Even if they try to go ahead in the future, their talents are strangled by the situation in this country.”
Girl Scout Wins Gold Award for AMP Project!
Jul 19th
It always amazes me the power people have to change something and how big people’s hearts are. Being involved with the AMP over the past two years has been one of the most rewarding experiences of my life. Not only because we are helping women and children in Afghanistan but also because so many people have given their time and their money to making a change in the world. I have always liked the quote from Mahatma Gandhi, “Be the change you wish to see in the world,” It has always inspired me to take action when I see something that needs to be fixed instead of waiting for others to change things. I was reminded of how people can change what they don’t like the other day when a young woman in New Jersey sent the AMP 3 boxes full of supplies. She took the AMP on as her Girl Scout project. She was nominated for The Girl Scout Gold Award which is achieved by girls who complete rigorous leadership projects that involve a minimum of 65 hours of planning, implementation and completion. A big thank you to her for supporting the AMP!
AMP Featured as “Stuff We Love” in SQUAT Birth Journal
Apr 20th
SQUAT Birth Journal Selects AMP in "Stuff We Love"
”In the arena of human life the honors and rewards fall to those who show their good qualities in action.” ~ Aristotle
That’s a wonderful sentiment, and one that we’d like to think applies to us here at Afghan Midwifery Project. And just recently, we were given an honor that we’d like to share with all of you!
The authors of SQUAT birth journal, a web and print publication, have selected AMP as part of their Stuff We Love: Organizations Edition! We couldn’t be prouder!
The SQUAT Stuff We Love: Organizations Edition, includes mention of several other birthing organizations including; National Advocates for Pregnant Women, 123 Hi Baby, Best for Babes, Sistersong, The International Center for Traditional Childbearing, and Mama Baby Haiti). While each of these organizations have a different mission, they all have have a healthy mother and baby focus, and we are very proud to have been selected alongside them.
Download the article here or check out a thumbnail of the article online here (AMP on page 22-23).
About SQUAT Birth Journal
SQUAT is quarterly publication that is put together by a just a few people who dedicate their time to create a magazine to support healthy and empowering birthing practices. Find out more at the SQUAT Birth Journal blog.
National Geographic Article
Mar 15th
Veiled Rebellion
Afghan women suffer under the constraints of tribalism, poverty, and war. Now they are starting to fight for a just life.
By Elizabeth Rubin
Photograph by Lynsey Addario
Twenty-five years ago an Afghan girl with green eyes haunted the cover of National Geographic. She became the iconic image of Afghanistan’s plight, a young refugee fleeing the war between the Soviet-backed communists and the American-backed mujahideen. Today the iconic image of Afghanistan is again a young woman—Bibi Aisha, whose husband slashed off her nose and ears as punishment for running away from him and his family. Aisha fled to escape beatings and other abuse.
Why do husbands, fathers, brothers-in-law, even mothers-in-law brutalize the women in their families? Are these violent acts the consequence of a traditional society suddenly, after years of isolation and so much war, being hurled into the 21st century? And which Afghans in this society are committing the violence? There are significant differences between the Hazaras, Tajiks, Uzbeks, and Pashtuns, the most populous and conservative group and the one that has dominated political life since the 1880s.
In the Pashtun crescent, from Farah Province in the west to Kunar in the northeast, life was—and in many ways still is—organized around the code known as Pashtunwali, the “way of the Pashtun.” The foundation of Pashtunwali is a man’s honor, judged by three possessions—zar (gold), zamin (land), and zan (women). The principles on which the honorable life is built are melmastia (hospitality), nanawati (shelter or asylum), and badal (justice or revenge).
The greater a Pashtun man’s hospitality, the more honor he accrues. If a stranger or an enemy turns up on his doorstep and asks for shelter, his honor depends on taking that person in. If any injury is done to a man’s land, women, or gold, it is a matter of honor for him to exact revenge. A man without honor is a man without a shadow, without assets, without dignity.
But it is not generally acceptable for Pashtun women to extend hospitality or exact revenge. They are rarely agents. They’re assets to be traded and fought over—until they can stand it no longer.
At a shelter in Kabul for women who have escaped domestic abuse, I heard about a girl from one of the richest Pashtun families in a province bordering Pakistan. She fell in love with a boy from the wrong tribe. Her father killed the boy and four of his brothers, and when he discovered that his own mother had helped his daughter escape her father’s wrath, he killed his mother too. Now he is offering a $100,000 reward for his daughter’s dead body.
These are extreme actions by an extreme man. But many Pashtun men perceive that their manhood and very way of life are under assault—by a foreign military, foreign religious leaders, foreign television, international human rights groups—and they hold fast to traditions that for so long have defined what it means to be a Pashtun man.
One day in a Kabul bookstore I found a collection of landays—”short ones”—the two-line poems the Pashtuns recite to each other at the village well or at wedding celebrations. The book, originally published as Suicide and Song, was compiled by Sayd Bahodine Majrouh, a celebrated Afghan poet and writer assassinated while in exile in Pakistan in 1988. He first collected women’s landays in his native Kunar River Valley. Majrouh, a humanist, found glory in these cries from the heart, which defy convention and in many ways mock male honor. From cradle to grave, the Pashtun woman’s lot is one of shame and sadness. She is taught that she is undeserving of love. This is why, Majrouh wrote, landays are “a cry of separation” from the idea of love and a revelation of the misery of misalliance.
A woman’s husband is often either a child or an old man forced on her through tribal bonds:
Have you with your white beard no shame? You caress my hair and inside myself I laugh.
Tauntingly, a woman lances a man’s virility:
In battle today my lover turned his back to the enemy. / I am ashamed of having kissed him last night.
Or voices her frustrated desire:
Come, my beloved, come quickly and be close to me! / The “little horror” lies in slumber and you may kiss me now.
The “little horror” is the man a woman is forced to marry, a kind of dupe. Only without his knowledge will she find true love. As Majrouh understood them, Pashtun women, for all their submissiveness, have always lived in a state of deep craving for rebellion and for the pleasures of earthly life. He called his book Suicide and Song because these two acts are how they protest their anguish. In Majrouh’s time the two methods of suicide were poison and drowning. Now they are poison and self-immolation.
The Afghan Parliament recently drafted a law intended to eliminate violence against women, who are beginning to reject old cultural practices and assert themselves in public and in private. I went to the Kabul home of Sahera Sharif, a Pashtun and the first female member of parliament from Khost. “No one knew a woman could put up campaign photos and posters on the walls in Khost—men didn’t allow women to even have jobs in Khost,” she said.
As a girl, Sharif stood up to her father, a conservative mullah, locking herself in a closet until he allowed her to go to school. She lived through the civil war between competing mujahideen groups, who ravaged Kabul before the Taliban conquest in 1996. She witnessed unimaginable cruelty and many deaths. “Much of the violence and cruelty you see now,” Sharif said, “is because people are crazy from all these wars.”
After the Taliban fell in December 2001, Sharif started a radio station to educate women about hygiene and basic health. More radically, she volunteered to teach at the university in Khost (a first there). She took off her burka (another first) and stood before the male students teaching them psychology. They blushed. And so she began to reeducate them.
As we talked, I could see what an inspiration Sahera Sharif has been to her 15-year-old daughter, Shkola, who interrupted her mother to show me a photograph of a woman in a magazine. The woman was lying with her throat cut, murdered by her husband’s family. The woman’s mother, mad with grief, had begged the magazine to publish the photograph. “I became crazy from this picture,” Shkola said. “I saw it over and over like a film.”
Shkola is studying Islamic history and law. She intends to become a lawyer in order to help women defend themselves against violence and injustice. In the meantime, she is scouring books from Iran to find stories for children “like you have,” she said. “We have almost none here. So I’m translating them into Pashtu, and I’m also writing a novel.”
In various corners of the country—in Khost and Kandahar, in Herat and Kabul—I’ve met young women like Shkola. They’re writing not the old landays but poems and novels, and they’re making documentaries and feature films. These are the new stories women are telling about their lives in Afghanistan.
Inchu Clinic Update
Jan 22nd
I thought everyone would love to see the pictures of the Inchu Clinic. As you may recall, members of the AMP traveled to Afghanistan and had the honor of touring a clinic that was in need of assistance in the Parawan province. This clinic servers 15,000 women and was without the basic necessities to assist these women. Our first project at the Inchu Clinic was to purchase a generator and a pump so that the clinic will now have access to electricity and water. Two things that will greatly affect the type of care that they can give. Through the generous donations of our supporters, and the women of Alpha Gamma Delta, in Normal, Illinois, we were able to purchase items for the clinic. Your help ensured that they had the items they needed to continue to serve the women of the Parwan province.
The Spirit of Charitable Gift Giving
Dec 9th
Not sure what to give the person who already seems to have everything? Instead of giving conventional gifts this holiday season (does Dad really need another tie?) why not make a donation in his name to a worthy cause? Making a donation to the Afghanistan Midwifery Project in the name of another person as a tribute or gift is a wonderful way to both support a charity and solve gift-giving dilemmas. If you make a donation in someone else’s name you’ll get a greeting card with the announcement of the gift. We’ll mail or email a full-color card — or send you a downloadable PDF file — that explains your gift and the donation you’ve made in their name. Your donation will be used where it’s most needed to help supply medical training and medical supplies to the women and children in Afghanistan. What a better way to honor that special someone than by truly giving the gift that keeps on giving.
The Afghanistan Midwifery Project is a registered 501(c)3 charitable organization. All donations are tax deductible.
Inchu Clinic, Parwan Province
Oct 19th
The Afghanistan Midwifery Project is proud to announce that we will be sponsoring a the Inchu Clinic in the Parwan province of Afghanistan. On our last trip to Afghanistan, we toured the clinic in Parwan province that was in desperate need of help.
Inchu Clinic, Parwan Province
The clinic operates in a remote area of Parwan and like most clinics in remote Afghanistan, it is badly equipped, understaffed, and offers slim chances of survival for both mother and child. The Inchu Clinic was established in 2006 in the Sayed Khail village of Parwan province. The clinic is working to provide health services for the people of Parwan as they have fewer opportunities to health care and they also provide training for midwives.
Parwan province has a population of 590,000. It is situated on the Salang Road, the main route from Kabul to the northern provinces. The province sits at the base of the Hindu Kush mountains and the Parwan river plain. The clinic is far away from the nearest hospital, and many times, the doctors are forced to provide immediate care there, or the woman will die. Many of the women reach the clinic on donkeys and horses and they can not make it to the hospital to receive the medical services
The doctors of Inchu Clinic
fast enough.
The consequences of poor health services and infrastructure are devastating. The clinic is currently without running water and electricity.They are also understaffed and have very few supplies and medicines to work with. The AMP’s first project with the Inchu Clinic will be to provide them with the means to get electricity and running water. Water supply and electricity are one of the most basic needs of the clinic and can help in greatly improving the performance.
The delivery room
We are very excited about the project with the Inchu clinic and look forward to sharing their success stories with you. Thanks for your continued support!
Our Own People Have Destroyed Our Country
Aug 17th
Another beautiful day in Afghanistan! We started this morning with a trip to the palace ruins that was the residency of the former king 96 years ago.
The ruins of the palace were enormous. It’s a shame that years of war and unrest have caused it to be in it’s current state. There are walls that are missing, bullet holes all over the building, and areas that appear to be the result of a bomb
. We got out of the car and met with some of the soldiers who were guarding the ruins. Their interpreter, Zamir, spoke great English and a little boy, probably around 5 or 6, came out to greet us as well. Zamir told us the history of the building and then exclaimed, “Our own people have destroyed our country.” It’s sad to see a piece of history completely destroyed but what else can be expected from years of war from the Russians, the Taliban, the warlords, and the most recent conflict?
After the palace we headed to visit the model center, another AWEC school, as well as the famed Chicken Street. We begin by heading to one of the older AWEC schools. There are two classrooms and since the area is less conservative, the boys and girls share a classroom, unlike the school we saw the previous day. We met with Massouda the social worker of the school. She has been at the school for 8 years and she gave us a history of the school and some of the children that were there. There were 4 special needs children that we received information on. All of these children needed more care than the AWEC doctor could provide. One of the children needs surgery. 
The story we were told is that when he was a baby his mother had to make money by doing laundry. She use to leave the boy laying on his side while she did all the laundry. From laying on one side for so long, his neck developed wrong. He doesn’t have the ability to turn his head completely to the right, it almost appears as one of his tendons / muscles is to tight to allow it to turn. The surgery costs $800-$1000. It seems so cheap compared to how much surgeries cost in the US but here it is a fortune, one in which many family’s simply do not have. Another one of the girls that saw us had bleeding gums. The doctor said she needed vitamins which AWEC doesn’t provide and which her family could not afford. Danielle and I will be giving her some of the vitamins that we brought from donations that people sent in. Hopefully they help her.
After visiting with some of the special needs children we went outside for their recess. 
The children were all playing either outside or playing games inside. The dirt playground consisted of a slide and two swings. The girls were jumping rope and the boys were rough housing on the slide. It was nice to see the children socializing and playing together because they usually don’t get this interaction once they hit a certain age. We got a great picture with all the children and of Danielle jumping rope, or attempting to anyway!
After the center, Danielle and I walked down the famous Chicken Street. Chicken street is a street full of shops that most foreigners go to. It is way over priced but it’s fun to go for the experience. We had two girls that were begging for money that kept grabbing Mine and Danielle’s hands. You felt so bad for the girls that they were out there begging, they couldn’t have been older than 8 or 9. No matter how much we said Go or No they followed us relentlessly for our whole time.
Later that night we were meeting with one of Anna’s friends, Qaseem. He is working with a business partner to build fiberglass domes. He thinks it could be a great solution to the housing problems (people living in tents) or could be used for schools / clinics. The domes are easy to put up and take down and last over 15 years. We have plans to go and see his domes and it might be a viable option for setting up some of these remote clinics, especially when the cost is around $7,000 / dome. We could set up a dome in a few days, stock the dome with medical supplies, and ta-da you’ve got a mobile clinic! I can’t wait to hear more about them and see them in person.
The School Walls Protected Afghanistan’s Future From the Trash Laden Streets
Jul 22nd
Wednesday June 23, 2010
An early day for Danielle and I, as the call to prayer sounded over the loud speakers at 3:30 am. Followed shortly by the sun peeking in our window. It’s 4 am and I am wide awake and excited for the day. We have a packed day of events. We are headed out to see one of AWEC’s schools, register with the minister of interior as a foreign visitor, and meet the Hassina, the director of AWEC. At 9:00 we met our new driver Jamal. Jamal is 24 years old and speaks English very well. He loves American music and we drove around all day listening to his favorite artist Shakira along with other’s like Ricky Martin and T-Pain.
Michelle ready for the day
After registering with the Ministry of Interior, we drive across town to meet with the executive director of the Afghanistan Woman’s Education Center (AWEC). AWEC is an organization that Anna Hacker (the woman we are staying with) has worked with for many years and has been in the process of building their model center over the past 5 years. Hassina was an amazing woman. She spoke so passionately about the work that AWEC was doing as well as the hardships they are facing with funding. AWEC has some amazing programs that focus on the street working children and widows of Afghanistan and they also provide a doctor medicine to all the children that go to their centers.
One of the main reasons that we wanted to meet with AWEC is because they do work in the Paktika province (which is where I was stationed at) and have health education programs there. After some discussion about what we were hoping to accomplish in a health program, Hassina said that AWEC was willing to put together a proposal for a program that would focus on pre and post natal care for women and would have social workers that would to women’s houses to check up on them. I plan on meeting with a few more NGO’s over the next few days to decide which ones seem like the best fit for the AMP. AWEC has been in existence since 1991 and they are audited regularly so I know that their books are kept in order.
After our meeting with AWEC, we headed over to visit on of their centers.
As usual, the drive to the center was exciting. We weaved in and out of cars and I even got to see a woman driving! This is not very common as women just got the right to drive again after the fall of the Taliban.
The school is located on the other size of this trash filled lot
It still amazes me the vast contradictions you see when driving through Kabul. You see poverty, wealth, destruction, rebuilding, old, and new all on the same street. Not to mention the oddities such as KFC Mexican Pizza. As we got closer to the children’s center it was clear that we were entering into a very poor area. There was garbage that littered the road and small streams of waste water that tricked down the sides of the road. The flies were terrible and as we approached the center we drove over a massive trash pile in which children were playing. The smell of rotting trash and sewage stung my nose as we exited the car.
The center was a very small unassuming hole in the wall. We entered through a gate into a reception area. We were greeted by a male and a female social worker whose job it is to go out into the villages and recruit children for AWEC, check up on the children at their houses, and over look their medical care. We spoke to the male social worker for a while about the center and what exactly they were accomplishing there. AWEC takes in street working children and teaches them grades 1-4 in a matter of two years. Once they complete this training, they are transitioned to government schooling. Most of these children would not be allowed to go to government school as they are too old. If it wasn’t for AWEC taking them in, most would never get an education. The children come in shifts and while we were there, grade 1 was there. Grade 1 ranged in age from 8-16 year old and they were divided in boys and girls classrooms.
Ramatullah
We were introduced us to some of their special needs children. Many of these children need medicine and AWEC pays for the majority of it. One boy had polio and has to take medicine that costs 150 Afghani’s a month (roughly around $3.00). AWEC is running out of money to provide this medicine for him and may not be able to support his medical needs much longer. Another boy , Ramatullah, that we met was 16 and in the first grade. He was a little slow mentally and had epilepsy. To make matters worse he had shrapnel in his brain and in his leg from the war. The shrapnel had affected his ability to use the left side of his body. Ramatullah was the oldest out of 11 kids and was from a very poor family. The doctors told him that if he wanted surgery to remove it, he had to go to India. Although doubtful that surgery would benefit him in any way as the mental damage has already been done. His epilepsy medicine is 400Afs ($9 / month), and AWEC could not provide it for him in upcoming months. He typically suffered around two seizures a week. Danielle and I took a picture of the boy and will be posting it on the website if anyone would like to sponsor Ramatullah so that he receives his medicines monthly. We asked the social workers to identify any others that had special needs and we would see what we could do to help.
We were taken on a tour of the center and we got to go into the boys classrooms as well as the girls. There were about 40 boys sitting on the floor in the boys classroom. There was one light bulb in the ceiling that cast very little light. The boys were working on their penmanship when we arrived. All of them were very curious about the two American girls and we were told that the boys all work either as street vendors pushing food carts, selling calling cards, or other items. They come to the center after they spent all morning working.
Practicing writing in a dark room
The girls were on the other side and they were reciting passages from the Koran. There were also around 30 girls in the classroom and they were so adorable! The younger girls allowed us to take their pictures but the older girls covered up as they didn’t want their pictures taken. A storm was kicking up so our time was short lived on the girls side and we quickly said our goodbyes and made it back to the car before the downpour of rain started.
