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It was midnight in the remote mountainous village of Arvige in Chesht-e Sharif district, Herat province of Afghanistan. Khurshid, an Afghan mother was 16 weeks pregnant with her 5th child. Amena, 22, the midwife at the UNFPA supported Family Health House (FHH) funded by Italian Agency for Development Cooperation; was examining heavily bleeding and unconscious Khurshid. Amena had been working at the FHH for two years and knew it was a miscarriage, one of the main causes of maternal death in Afghanistan.

In this remote village people are living with harsh conditions and the Family Health House is the only health facility available to them. That night Khurshid fell unconscious after suffering from severe pain and bleeding at home. Once she was unconscious the family arranged for a vehicle to take her to family health house.

Abdul Malik Faize, UNFPA Reproductive Health Program Officer says “UNFPA pilot project has established Family Health Houses to provide basic maternal and reproductive health services to women living in the most underserved and remote areas.

Maternal and child mortality in Afghanistan

Afghanistan Demographic and Health Survey 2015, reported a maternal mortality ratio (MMR) of 1,291 deaths per 100,000 (released with observations from the Ministry of Public Health) live births during the five years preceding the survey.

Maternal mortality is associated with mothers’ age, limited education, multiple pregnancies, economic situations and limited access to health services.

Khurshid, now 35 years old, was married at the age of 12.

In Afghanistan 60 percent of the population live within an hour’s travel from a health facility, and 88 percent are within two hours’ travelling time (AFDHS, 2015). The poor infrastructure, mountainous terrains, and economic problems further hinder access to health services. Furthermore, cultural constraints make it difficult for women to access obstetrics care.

Back in the Family Health House, Amena checked Khurshid’s vital signs and helped her to gain consciousness by injecting intravenous fluid. After Amena ensured it was indeed a miscarriage that caused the bleeding, she started the evacuation procedure and administration of uterotonic medicine to stop the bleeding.

Reproductive health services in underserved communities

UNFPA piloted 123 family health houses in the provinces of Faryab, Daikundi, Herat and Bamyan. This was an innovative means of reaching Afghans living in remote areas where the comprehensive health centers are located more than three hours away. Aimed at providing skilled birth attendance, Family Planning, basic health care and referrals, the FHHs are staffed by a midwife with 24/7 services in her own village.

“Khurshid was brought to the clinic, unconscious and bleeding. Her state shocked me,” said Amena. “I am so thankful to God that I was able to help save her life. I could see the appreciation in the faces of her family members.”

Amena is one in few Afghan women who has the support of her family to become educated, work and serve her community and the nation, besides taking care of her two children. She works despite cultural, social and security barriers that limit the lives of Afghan women.

“Now I feel healthy and am very much thankful to Amena, who has helped me recover of a mortal situation and saved my life.” expressed Khurshid.