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25 Feb 14 01 Aug 16

Photostory: Labour pains in Afghanistan

While there has been much progress in maternal healthcare in Afghanistan over the past decade, the country is still one of the most dangerous places in the world for a woman to give birth.

Insecurity means that many women hesitate to make the long, dangerous and often expensive journey to health facilities offering quality maternal care. Too many women still die preventable deaths because they do not have access to the essential care they need.

Read MSF's latest report: 'Between rhetoric and reality - the ongoing struggle to access healthcare'

Photostory: Labour pains

Women and girls in Afghanistan must overcome significant obstacles when they need to access healthcare. Low literacy rates, a lack of knowledge of health problems, and restrictions on their movement and access to money all limit women’s ability to access health services for themselves and their children. For cultural reasons, men are not considered appropriate healthcare providers for women, so the dire shortage of female midwives, nurses and doctors poses a huge barrier for many women.

Médecins Sans Frontières/Doctors Without Borders (MSF)’s specialised maternity hospital in Khost provides a safe environment for women to deliver free of charge. MSF tries to have an all-female medical team providing care to the patients. However, the lack of qualified female medical staff living in or willing to relocate to Khost is a major challenge. 

MSF’s international doctors and midwives help fill the gap and train local staff. In general, qualified medical workers choose to work in big cities, which leaves large gaps in healthcare in rural areas. The ongoing conflict further aggravates this, as the few female doctors and midwives are even more reluctant to work in the insecure areas. 

Women in labour try to relieve their pain at Ahmad Shah Baba Hospital, supported by MSF since 2009. Deliveries have doubled over the last two years to reach an average of 1,000 deliveries per month. To address the growing need for maternal healthcare at the hospital, MSF recently opened a new maternity ward with 21 additional beds. 

In more remote areas, many public clinics are only open in the morning, which does not fit with the reality of labour, as women need access to delivery services at any time. 

Women who go into labour or experience bleeding in the late afternoon or at night are often unable to find free care nearby and are forced to either travel far at significant risk and cost, or to deliver at home. Without skilled medical help, these women are more at risk of illness or death if they face complications. 

At MSF’s maternity hospital in Khost, women and their babies receive care from qualified doctors and midwives who can identify complications early and perform life-saving surgery. The hospital is equipped with 83 beds, including a 15-bed neonatal unit. 

In Khost, MSF staff assisted nearly 12,000 deliveries in 2013, helped more than 2,000 women who had complications and performed 372 caesarean sections. The team sees many sets of twins, often small and premature, who need extra medical attention. 

Women in most areas of Afghanistan require permission from their husbands to visit a health facility and are usually obliged to be accompanied by a male relative. If there is no man available to take them, this can delay or prevent them seeking medical care. 

MSF in Afghanistan

MSF provides emergency obstetric services in three hospitals in Afghanistan – in Khost in the east, Helmand in the south, and in eastern Kabul. Across MSF’s maternity wards in 2013, medical staff delivered more than 33,500 babies.

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Find out more about MSF's work in Afghanistan