UNFPA is the United Nations agency leading global efforts to ensure that every pregnancy is wanted, and every childbirth is safe. However, in Afghanistan where access to basic health services is a challenge, the maternal mortality rate is the highest in the region at a ratio at 638 deaths per 100,000 live births. To cover hard-to-reach and remote areas of the country, where significant portions of maternal, newborn, and children morbidities and mortalities take place, UNFPA in close collaboration with the Ministry of Public Health (MoPH) established Family Health Houses (FHHs), a community-based and led health facility, which provides Sexual and Reproductive Health (SRH) and child services.
Amina (20) was first referred to the FHH in mid-October 2020 during a life endangering pregnancy. "I advised her to go to a better equipped clinic or hospital where she could be supervised by a maternal health specialist as her pregnancy was critical,” said Spozhmai, the midwife who runs the FHH in Pichgah village of Roydoab district in Samangan Province.
However, Amina’s family was not willing to pay the additional costs needed. “They will not pay for transport and medicine to save me and my baby,” Amina expressed. This situation was not new to Amina. Health complications related to abuse during her first pregnancy resulted in the miscarriage of her first child when she was 32 weeks pregnant. “I could feel the pain increasing throughout the pregnancy. I thought I might die.” Amina remembers. “I miscarried. I was in so much pain. I lost my baby. No one helped me.”
To strengthen the midwifery profession in Afghanistan, UNFPA supports midwifery through education and training of community midwives as well as the Midwifery Helpline. The FHH in Pichgah serves a population of 4,400 and over 2,300 direct beneficiaries have received antenatal, postnatal, safe delivery, and under-five outpatient services from January - November 2020. Since becoming the community-midwife, Spozhmai has been fighting to highlight the value of health care. “It is an uphill battle to convince the community of the importance of health—especially for women. I am here precisely because of vulnerable women who no one hears. I am their voice.”
Spozhmai spoke with both Amina’s mother-in-law, husband, and the village health shura. “You have to convince everyone, not just one person,” Spozhmai explained. Eventually Amina was taken to a better equipped health facility in Ibak, the centre of Samangan province. “I wish I could have received such support during my first pregnancy as well,” Amina expressed. “Maybe then my first baby would have survived.”
Gender-based violence is one of the most prevalent human rights abuses in Afghanistan. 52% of ever-married women have suffered from spousal violence and 15% of pregnant women have experienced gender-based violence during pregnancy. Lack of access to SRH services further increases the likelihood of loss of life. Amina is one of these women. With the generous support of Canada, UNFPA is working that no women should suffer the loss of a child due to gender-based violence or an inability to access SRH services.
