In Afghanistan’s remote northeast, midwives deliver against the odds
Harsh winters and towering mountains are all in a day's work for Shazia, who cares for pregnant women and makes sure babies are delivered safely.
A bumpy ride between snowcapped mountains and across the picturesque Kokcha River brings us to Loyaba village in Afghanistan’s northernmost province, Badakhshan. Harsh winters and snowstorms cut off this province from the rest of the country for part of the year, and rural villages like Loyaba are often cut off from the provincial capital, Faizabad. Nestled in the foothills, overlooking the river, is the UNICEF-supported basic health centre. This facility provides health services to a population of around 9,000 people, most of whom live in remote mountain villages.
Every morning, the health centre bustles with patients. In an overcrowded waiting room, women and children wait for their turn. In a small corner room, Shazia Shayan is checking pregnant women, some of whom have walked miles to reach the health centre. Many of these women are anaemic and malnourished because of a diet lacking in key nutrients – a situation that is all too common with Shazia’s patients.
Shazia has been working as a midwife at the health centre for the last ten years. Through rain and snow, she defies the elements and other daily challenges to provide this critical service to women and children even in the most isolated areas of the province.
“There are times when I have to attend two deliveries simultaneously. It becomes extremely challenging given there is only one delivery room, and I am the only midwife at the centre. My job doesn’t end at the health centre. When women can’t get to the health centre, I go to their homes to deliver their babies,” explains Shazia.
Badakhshan is a difficult place to give birth. For many women living in this rugged and remote part of the country, the distance to hospitals from their homes can be the difference between life and death.
“I have conducted more than 200 deliveries in the last ten years. I have been lucky not to witness losing a child or a mother during childbirth, but this is not always the case. The distance to health facilities combined with poverty means families can’t always afford the cost of transportation. I often pay the transportation costs out of my own pocket to send my patients to the provincial hospital,” says Shazia.
Across Afghanistan, the UNICEF-run and World Bank-funded Health Emergency Response Project (HER) plays a critical role in supporting the operational costs of around 2,400 health facilities, including paying the salaries of around 27,000 health workers, like Shazia. As a frontline female health worker, Shazia plays a critical role in delivering health care services in Afghanistan, especially to those who may otherwise struggle to access these services, including children and women. This year, with the support of UNICEF and the HER, health workers like Shazia have reached nearly 20 million children and their families with essential health and nutrition services.
Shazia is on a double shift. She conducted a delivery at midnight and is attending the antenatal clinic this morning. She checks a young mother for anemia while answering questions over the phone from a pregnant woman who is due to deliver soon. Midwives like Shazia are some of Afghanistan’s most vital frontline healthcare workers, ensuring that babies and their mothers survive and thrive in even the most remote rural areas. Over the last two decades, the increased presence of midwives has played a crucial role in improving the lives of mothers and babies. The difference is clear: between 2002 and 2023, Afghanistan’s maternal mortality rate dropped by two thirds. To maintain these decades of progress, training and resources need to continue at this level, at the very least.
