Awesta Telyar Azada
A little over a month ago, a young woman named Nazifa passed away while giving birth to her seventh child in a village near Jalalabad, Afghanistan. Nazifa’s family is mourning for her and her little children are far too young to understand that their mother will never come back. She was 28 years old.
Nazifa was 17 when her family married her to a farmer and without access to contraception, she continued to have child after child until she died because her body couldn’t handle another pregnancy. She had high blood pressure and her body was exhausted and her health deteriorated after back-to-back babies.
When she got pregnant, Nazifa only went to the doctor once. The doctor told her that the pregnancy would be a big risk to her life. Nazifa had never been to a hospital before, because the hospital was far from where she was living, and too expensive. She didn’t know about contraception or maternal health. She gave birth to all her children at home, but this time it never happened. Instead she went into a comma and when her husband took her to the nearest hospital which was two hours away she died during a C-section procedure.
Tragic rates of maternal mortality haunt Afghanistan
Nazifa’s tragic story is unfortunately not one of a kind. Despite some improvement, Afghanistan has one of the highest rates of maternal mortality in the world. The Health Ministry of Afghanistan confirms that about 18,000 Afghan women die during childbirth every year. In fact, Save the Children has ranked Afghanistan as the worst place to give birth.
One of the biggest contributors to high maternal mortality rate in Afghanistan is lack of access to and knowledge of contraception. Birthing many children without having enough gaps in between pregnancies can increase the chance of maternal mortality drastically. Early pregnancy is another major contributor. Research shows that girls younger than 15 are five times more likely to die in childbirth than women in their 20s. In Afghanistan early and repeated pregnancies continue because especially in rural areas, most women are married too early and receive little to no information about contraception, says Dr. Tahmina Samandari.
“Today, women in cities are more or less aware of the importance of spacing their pregnancies, but women in rural areas are deprived of this life-saving information,” Samandari says.
Contraception myths prevent usage
According to a survey by BioMed Central Women’s Health journal, only 21.8% of Afghans report using any contraception, including traditional methods. Even though access to birth control has increased in Afghanistan and pills, condoms, IUDs and even implants can be found in local pharmacies at government subsidized price, usage remains low. Myths about adverse impact of contraception is one main reason, says Zuhra Bahman who studied access the topic for her PHD program.
“There is a wide spread belief among Afghan women that long-term use of hormonal contraceptives results in infertility,” Bahman says.
Negeen Kargar, a scientist researcher based in London who recently interviewed Afghan women on the topic agrees. Many believe birth control will cause cancer or mental health issues too, but the high fertility rate also impacts women’s health and maternal mortality she argues.
“Many families want to have more boys so they ignore the health consequences of repeated pregnancies to ensure higher number of boys in their families,” Kargar says.
Lack of contraception may cause families to have more sons but it also leads many women to death or illegal dangerous abortions.
“I witnessed a woman going through her 8th abortion because her husband did not allow her to use contraception. She already had nine children and she was very poor. She begged the doctor for a hysterectomy but the doctor couldn’t perform that without her husband’s consent,” Bahman says.
The way forward
Dr. Samandari believes that there is an urgent need for more awareness raising about contraception in Afghanistan. She argues that women need to know about the variety of options at their disposal so that they can make decisions based on what works best for them.
“In reality, pregnancy is riskier for women’s health than birth control,” she says. “But women don’t know that.”
But it is not enough just to raise women’s awareness. Partners and families need to be educated too.
“Many women’s families do not permit them to use contraception. Couples also do not know a lot about barrier methods. Most couples use the withdrawal method as a form of contraception. This tends to fail often,” Bahman says.
In addition to awareness raising through campaigns and schools, religious leaders can play an important role in promoting contraception in Afghanistan, Dr. Samandari says. Many pro-Taliban religious leader call modern contraception methods “illicit and non-Islamic” and discourage their use. Religious leaders, who are aware of the fact that Islam has no opposition to birth control, have to speak up.
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