MATERNITY CARE IN THE FACE OF CHALLENGES

They arrived on a motorbike. It’s hard to imagine the journey because Jamila* was heavily pregnant and having repeated seizures. To make the three-hour trip to the hospital possible, Jamila’s husband did the only thing he could think of: tie Jamila to his own body so he could keep her on the bike as they travelled, by night, through rural Afghanistan.

Despite the challenges facing female healthcare workers in Afghanistan, at Boost hospital in Lashkar Gah, Helmand, the all-women maternity team of Doctors Without Borders/Médecins Sans Frontières (MSF) helps thousands of women to give birth safely every year.

MSF has supported Boost hospital for more than 15 years, co-managing the facility with the Afghan Ministry of Public Health. The focus is on mother and child health, and although it’s in the city, the hospital covers all the surrounding rural areas too – around three million people.

Jamila was unconscious when they arrived. Quickly her husband unwrapped the ties that had kept her upright on the motorbike and the hospital porters helped them to the doors of the maternity ward.

As the midwives rushed to take care of Jamila, they asked her husband to stay by the door. Any surgery on a female patient requires the written consent of a male relative and Jamila had all the signs of eclampsia, a dangerous pregnancy complication often requiring an emergency caesarean section birth.

PRENATAL CARE CRITICAL IF COMPLICATIONS ARISE

Women will ideally have at least four prenatal appointments during a pregnancy. During these visits, the healthcare professional will check things like the size of the fetus and also measure the woman’s blood pressure, which is one of the primary warning signs for eclampsia. This monitoring is essential, as a woman with rising blood pressure may not be aware of it until they have serious complications: their kidneys stop working normally and they start to have seizures. Without access to treatment, at this point both the baby’s and the mother’s lives are at risk.

In the southern region of Afghanistan, few people have access to prenatal care. This is especially true in rural areas, where families can face long and difficult journeys to reach a health facility. However, these delays in accessing care mean a critical health situation can quickly become an emergency.

Jamila had been having seizures at home for a day before
her husband managed to bring her to the hospital.

When Jamila arrived in the maternity unit, our all-women team started the emergency protocols they have drilled for. She was given medications to stop and prevent further seizures and then prepared for an urgent caesarean section.

Jamila had been having seizures at home for a day before her husband managed to bring her to the hospital.

FEMALE STAFF REQUIRED BUT RESTRICTIONS MAKE RECRUITING DIFFICULT

Experiencing the efficiency of the team that day, I felt immensely privileged to be able to work alongside them. Women face significant challenges to work in Afghanistan and often face pressure from the authorities or even their families to stay at home. But female staff are required in the healthcare sector, especially in maternity care, where only female midwives and gynecologists are permitted.

To provide this service, the whole team works incredibly hard during long hours. It’s very difficult to recruit enough female doctors because of restrictions imposed by the Islamic Emirate banning women from attending secondary school in 2021, university in 2022 and from studying at medical institutes in 2024. Even women who were in the middle of medical degrees when the change of government took place in 2021 have not been able to finish their studies.

It was already difficult to recruit skilled gynecologists and midwives in Helmand, and these laws further reduced the number of qualified female medical professionals available.

A HEALTHY BABY

Without her husband’s determination to get her to us and without the swift, professional care provided by the MSF team, Jamila would almost certainly have died. With blood pressure that high, it’s likely she would have had a stroke or sustained organ damage.

As it was, a very short time after arriving at the hospital unconscious, she had made a full recovery and was able to go home with her healthy baby.

PHENOMENAL ACHIEVEMENT

Since the end of the conflict in Afghanistan the security situation has improved and more families feel confident to travel to the hospital to access care. This is good news, but it also means that, despite the challenges they face, the team is busier than ever.

Many women arrive with potentially
life-threatening complications.

Jamila’s baby is just one of between 80 and 100 babies born every day in Boost hospital. At any one time there could be 10 to 15 women in labour. Because of the lack of access to prenatal care and the distances they must travel, a significant proportion of women arrive with potentially life-threatening complications. Up to 10 per cent of the women who come to the hospital will need an emergency caesarean section.

I’ve spent my entire career working in women’s health. And I can tell you that what this team is managing to achieve, with very limited resources, is phenomenal.

*Name changed to protect identity.