As the world marks United Nations Population Day, which emphasizes the right to reproductive health for everyone everywhere, Pashtana, an illiterate mother of seven, may be living proof that Afghanistan’s past is no longer the future of its women.Her first child, 20 years ago, was stillborn and the ordeal began miserably – and predictably enough – at home in Charbagh, in the eastern province of Laghman. Her youngest child, who is three, was delivered in ease and comfort at a Charbagh clinic, which monitored the health of mother and fetus at regular three-month intervals.
“When I had my first child, there were no clinics, no doctors, no nurses,” recalls Pashtana, who was just 17 at the time. “There were some dais (traditional birth attendants) but even they were too far away to be able to come and help. At the time, many women in my village lost babies because they were born too early and there was no medical help.” Till 2010, premature labor was one of the commonest causes of infant mortality in Afghanistan. More than a hundred babies died per 1,000 live births.
Though Pashtana’s mother, Bihaji, does not know those grim statistics, she speaks from experience: “I lost a baby because it was born prematurely and too weak to survive” says Bihaji, “and my mother lost six of the nine children she produced. All six were under five when they died.”
Pashtana says the reality of an Afghan woman’s life has changed a lot in the last decade. “The Charbagh clinic, where I had my last baby, registered me, gave me a card and checked my blood pressure regularly.” She adds that her 19 year-old daughter Ruhina can look forward to a very different future. “She has three children and I have already told her to start using the pichkari.” It is a reference to the injectible contraceptive that Afghans call “pichkari”, the Dari word for water pistol. “I’ve been using the pichkari myself for two years,” says Pashtana contentedly, “It’s free.” This is the point all three generations of women seem to agree. “If I had any pichkari available to me, I too would have used it,” declares Bihaji, who has nine living children.
According to the Afghanistan Mortality Survey 2010, the first comprehensive national study of key health and quality-of-life indicators, 6 in 10 Afghan women now see a trained healthcare provider while pregnant, family sizes are down from six children per mother to five and nearly 80 per cent of the population has access to community midwives and health workers, community outreach and first referral hospitals.