Fatemeh, a 34 year-old mother-of-three, has bitter memories of her first two deliveries. Both were home births with no formal medical assistance.

“I suffered so much during these two deliveries and I nearly died,” the Baghlan resident told IWPR.

The birth of her son a year ago was very different. Taken to the local hospital, she was under the care of trained midwives and delivered her baby safely.

“The midwives at the clinic are competent and hard-working, and they serve the residents of the whole district,” Fatemeh said, noting that maternal mortality in her area had fallen since the service was introduced.

 “Before these young midwives, large number of mothers died each year in childbirth whereas now, most mothers can hope to survive.” 

Women in the northern province of Baghlan say that successful training schemes and the efforts of international NGOs have boosted the numbers of female doctors and midwives in their local area.

The situation has improved significantly from that in the immediate aftermath of the Taleban era, when a nationwide survey found that 1,600 per 100,000 women died each year due to pregnancy or childbirth-related issues. According to the UN, this has now fallen to 400 per 100,000 women. Afghanistan’s health ministry has put the figure slightly lower, at 327 deaths per 100,000 births.

This is still one of the highest maternal mortality rates in the world, with major factors a lack of access to primary health care and conservative traditions that lead to phenomena such as child marriage and make it hard for women to see a male doctor.

Most rural areas have few trained midwives and women have to rely on traditional birth attendants with little medical knowledge.

However, healthcare professionals in Baghlan say that locally, progress is encouraging.

“Large changes may now be seen in the medical arena in Baghlan province, comparing to 15 years ago,” said Baghlan hospital administrator Abdul Halim Ghafari. “After the fall of the Taleban, there were only two or three midwives whereas now, fortunately, there are more than 100 midwives, nurses, and doctors, with the result that maternal mortality has decreased by half.”

He said that the province currently had three public hospitals and 52 clinics where women and girls could access obstetric and gynecological services. There were also more than ten private healthcare facilities in Baghlan.

Experts say that a long-term strategy of training midwives and establishing provincial midwifery schools is paying off.

In 2002, there were fewer than 500 midwives across Afghanistan. Ten years later, the number had risen to nearly 5,000.

This emphasis on training female practitioners is particularly important in a traditional society like Afghanistan where there is a taboo on women seeing male doctors.

(See also Afghanistan: "Honour" Rules Deny Care to Mothers and Babies).

Sharifeh Behzad is the owner and director of the private Maryam hospital in Baghlan’s Pul-e-Khumri city.

“In the past, most women arrived here in a really bad condition,” said the 41-year-old, a midwife for more than 20 years. “When the husbands were asked why they had not come earlier, their excuse was the absence of female doctors in the region and [the fear] of being criticised and mocked for taking their wives to male doctors. We were really shocked.

“However, fortunately, governmental and foreign institutes recently set up some clinics in most of the cities and districts with female staff, which has alleviated women’s suffering,” she said, adding that the state should continue its efforts in this field.

Access to training resources has also improved. The Hakim Sanaei private university, established six years ago in Baghlan province, provides medical courses for both male and female students.

Its head, Khairuddin Fayez, said that trainees were guaranteed hands-on experience at a local public hospital.

“The study of medicine is pointless without practical experience, so we supply these opportunities for our students,” he said, noting that hundreds of their graduates were working in the sector across Baghlan province.

Halim Ghafari, a hospital supervisor in Baghlan Province, agreed that student midwives were benefiting from the opportunity to gain practical experience working side by side with fully-trained practitioners in hospitals.

“Today, over 100 female doctors, nurses, and midwives are working across the 14 districts of Baghlan province and people are very happy,” he continued.

Another organisation, the Baghlan Health Community Institute, is affiliated to the Agha Khan Foundation and has provided free medical training in Baghlan since 2003.

A large number of women study midwifery and nursing there, including many from more outlying districts who return to work in their local area after graduation.

Shah Baig Talebi, director of human resources at the Agha Khan Foundation in Baghlan, said that free clinics had already been built in the Dandaghori Andarab and Doshi districts.

“Tens of midwives, mainly from the districts of Baghlan province, graduate each year from this institution and return to their native districts after graduation to deliver services,” he said, adding that others went on to further study at university.

“All education fees are paid by the Agha Khan Foundation and practical courses are available at both private and public hospitals in Baghlan province,” Talebi said.

Nasrin Ghafari, a 20 year-old resident of Andarab district, is a recent graduate of the institute.

“They provide all educational facilities here,” she said. “I would have never ever dreamed of fulfilling my wishes; I really appreciate the institute’s authorities helping me realise my dreams.”

Her fellow graduate, Naeimeh Nazari, a 26 year-old midwife from Baghlan’s Doshi district, qualified three years ago.

“I am really honoured to be able to serve and help the public,” she said, adding, “People are satisfied; the clinics are equipped with all facilities, even for difficult operations. Previously, it was foreign doctors who were working here, but now all our doctors are Afghans.”

Although there is still a long way to go to provide mothers-to-be with adequate healthcare, the improvements made so far have made a real difference to local people’s lives.

Davoud Khan is a 40 year-old resident of the village of Chaghmaq Sheikh in Doshi district.

He wept as he recalled how his first wife and their newborn son had died due to the lack of any local medical facilities.

“Eight years ago I lost my wife and baby boy in childbirth as there was no clinic nearby and no passable route to take my wife to Pul-e-Khumri,” he said, adding, “Now, thank God for the clinic in Doshi where, last year, my new wife gave birth to a girl.

“Kind young women work there,” Khan continued. “We are so grateful and thank these life-saving angels on behalf of our wives.”

This report was produced under IWPR’s Promoting Human Rights and Good Governance in Afghanistan initiative, funded by the European Union Delegation to Afghanistan.