Médicos sin fronteras

[miro_onreturn]

Where women give birth with their trousers on
Date Published: 01/07/2004

As a female midwife I had an incredible insight into the lives of women in Afghanistan.
When I would arrive for a birth all the women in the family - and the neighbourhood, it seemed - would come in and watch. So this was a great opportunity to train them in good practices. Traditional Afghan birthing practices are pretty dangerous for both mother and child, for example it is common to pull the cord to remove the placenta, which can invert the uterus. Also hygiene conditions are very poor - most women give birth onto a mud floor and the traditional birth attendents (TBAs) don't wash their hands. I suspect that more women die post-natally from poor hygiene than die during childbirth. Finally, there is a great taboo about getting undressed. In the UK women generally don't have any such inhibitions when they're in labour, but in Afghanistan it is not uncommon for women to give birth with their trousers still on!

I will never forget my first home visit: I had been told that the woman was having twins - the first had been born ten hours earlier and there was still no sign of the second. I got there and the room was packed with women. I couldn't see the first baby until they lifted up the girl's dress - the baby was under there, still attached to the cord! I felt her stomach but couldn't feel a second baby, just a very full bladder and the placenta. So I cut the cord, encouraged her to have a pee, put the baby on the breast and then got her to squat. Sure enough, the placenta came out no problem. And there was no other baby. It was very satisfying to be able to solve the problem without any real medical intervention.

Often, women did need a bit of help. Most had had nothing to eat or drink for the duration of their labour, so were very dehydrated. I would often put a drip in and lo and behold, the contractions would start again.

My average day would start at around 7, and I would start the midwifery clinic at 8. Every day it was full. Women would come from up to eight hours away for their ante-natal appointments. I would examine them and give them vitamins, iron tablets, clean birthing kits for the delivery and tetanus jabs. Most days, clinics would be interrupted by reports of a woman having difficulty in labour. I soon learned that it was better to send an ambulance to collect these women rather than abandon the clinic and go for a home visit. It was very important that I was a female medic as there is a BIG taboo about women being seen by men, even if their lives are in danger and the man is a doctor. One man told me, "I'd rather let my wife die than let the man doctor see her". My poor (male) interpreter got used to sitting in the corner of the room shielded by a blanket during the births.

Life for women in Afghanistan is tough. They are generally married early to much older men (it is not uncommon to see man of 60 with a 16 year old wife). They are stuck in their homes for most of the time and would not dream of leaving their homes without express permission from a male relative and never on their own.



Ally's project was handed over to another NGO on the same day as the five MSF staff were murdered in the province of Badghis. This was the worst atrocity ever suffered by MSF and has led to a scaling-down of our work in Afghanistan. For more details about our colleagues who were killed, click here.