KABUL — In Badakhshan, Afghanistan, for every 100,000 births, 6,500 young mothers die. This is a record unrivaled anywhere in the world. In other parts of Afghanistan, too, the rates of maternal mortality continue to be among the highest in the world.
Roughly 75 percent of Afghan newborns that die do so because of lack of food, warmth and care. Unloved little girls fare the worst. In Afghanistan as a whole, a woman dies of pregnancy- related causes every 27 minutes — and perhaps even more frequently, because many such deaths go unrecorded. Many, perhaps most, are under 16 years of age.
The Taliban have officially been gone for nearly seven years, so why are conditions still so abysmal?
In Kabul and Herat, mobile phones abound, the Internet works, there are ATM machines, sophisticated heroin laboratories, four-wheel drive vehicles, five-star hotels, ads for private banks — all the trappings of globalized modernity. Yet so many women die like flies, in pools of blood and deep-rooted indifference.
While billions in aid have led to improvements in urban areas, where health facilities have been built and midwives trained, overall maternal death figures have hardly changed. As one doctor said: “A competent midwife or nurse would rather be out of work in Kabul than stuck in a remote village.” But most Afghans live in remote villages.
This miserable situation has been attributed to various causes, mainly lack of infrastructure and local economic conditions. But cultural questions must also be addressed, because gender discrimination is the most important cause of maternal mortality.
In Afghan society, discrimination begins at birth. One obvious reason is that a boy is destined to support his parents and much of his family all his life, and therefore represents a long-term investment, whereas a girl will be given over to her husband’s family as soon as possible. Feeding a girl is seen as effectively looking after someone else’s property.
Once, I heard a dreadful story of a breech birth that a traditional midwife did not know how to handle. In the end, she wrenched the baby’s body out, severing it from its head, which remained inside the mother’s womb. It took six days to get the woman to a hospital in Jalalabad though it was not very far from where she lived. She somehow survived, with major health complications, including permanent fistula, which will condemn her to a life of exclusion from her family and unrelieved misery.
That tragedy can be read on many levels, each more heart-rending than the next. But note that it occurred near a health facility. As soon as the midwife saw that the baby was coming out feet forward, she must have known that there was little she could do to save either mother or baby. Even before that, she would have noticed that the child had not turned properly, and that major problems were on the way.
This means that someone — a husband or mother-in-law — had taken the decision not to send the young woman to the hospital, instead keeping her in inhuman suffering for nearly a week.
The solution is not just to build more hospitals, but also to change deep-rooted disdain for women. And, sadly, things have become worse in the past 30 years, as Afghanistan’s particular brand of Islam, combined with its legacy of dire poverty and war, compounds an already misogynist pre-Islamic tradition.
Maternal mortality is a sinister consequence of this complex situation. The legal system, schools, and the media could bring change, but no official entity takes the problem seriously enough to initiate effective action. The central reason is despairingly simple: Women’s lives are not valued, and even women themselves perceive their suffering as being unavoidable.
What Afghanistan needs is an inquest after each death and laws making it a criminal offense to forbid access to medical aid, when available, to women and children (or, more correctly, to children and their children, given that girls are often married by age 14). Prisons, I fear, would be full of abusive husbands and, I regret to say, vengeful mothers-in-law. Health education through public media, reaching distant areas of the country, is an urgent priority, but has been utterly ignored in favor of commercial priorities.
Questioning culture is, of course, a politically incorrect approach. But we must refuse to bow before the altar of tolerance when it comes to what is truly unacceptable, wherever it occurs, and this is what the world is witnessing passively in Afghanistan.
Does diversity authorize such brutal deaths and violence against women simply because some supposedly traditional practice allows them to be married before their bodies are ready and denies them health care when they give birth?
The fight against maternal mortality in Afghanistan must become a global priority. Ultimately, a society that allows women to be brutalized will remain a breeding ground of generalized violence.
Carol Mann is director of FemAid and teaches at the Sorbonne in Paris.© 2008 Project Syndicate