Sedeqa Khavari - photo by M. Hassan Zakizadeh
Kabul, Afghanistan – Her older sister died while giving birth to her niece, and now Sedeqa Khavari feared her pregnant, younger sister, Masoma, would suffer the same fate.
Masoma had become seriously ill from hypertension, and a visit to the hospital offered no relief. After returning home, the expectant mother suffered convulsions and fell unconscious. The family rushed Masoma back to the hospital, where her premature baby was delivered by cesarean section and the young mother survived.
The experience left a lasting impression on Sedeqa and set her on a new path.
“I will never forget [that night],” says Sedeqa. “My sister was near death. I decided I have to learn more about midwifery and this way I can help all mothers in Afghanistan.”
Sedeqa followed through on her decision. In 2007, she graduated from a government-sponsored midwifery school in Bamyan Province, one of 13 across Afghanistan supported by the Jhpiego-led Health Services Support Project (HSSP). Since 2002, when Jhpiego helped develop and rebuild a national midwifery education system in Afghanistan, more than 3,000 new midwives have graduated from accredited schools, many of them returning to their communities to care for women and their families.
Sedeqa worked for two years as a community midwife and then left her home province of Bamyan in north central Afghanistan to work in Kabul at the Cure Hospital, a private health facility that employs several graduates of the HSSP-supported schools.
Working as a midwife, this 28-year-old, single mother is able to provide for her son and contribute to the improved health of mothers and newborns in her country. She says Afghanistan needs more midwives like her. “We should think about increasing the number of midwives, especially in remote areas,” says Sedeqa, after talking about her older sister, who lived and died in mountainous Ghor Province, where transportation to adequate health care is difficult. “If we continue our training and get new training, health care services would be better for mothers.”
Sitting in a small office outside the maternity ward at Cure Hospital, Midwife Supervisor Fahima Naziri is awaiting lab results for a 35-year-old woman in labor. The woman, who is carrying a big baby in a breech position, may well be suffering from pre-eclampsia, a high blood pressure disorder that can rapidly escalate into the more dangerous eclampsia.
Based on her training, Fahima predicts her patient will need a cesarean section, but the woman’s husband is opposed. “We are checking the baby’s fetal heart rate and the contractions,’’ says the 26-year-old midwife. “We are also checking the blood pressure. When the lab results return, we will decide whether to give her magnesium sulfate [the prescribed treatment for pre-eclampsia].”
In an effort to get the woman the care she needs, Fahima seeks the assistance of a colleague, a male doctor who meets with the husband and explains the situation: Do you want your wife to live?
The husband reluctantly agrees to the operation, recognizing that without his wife there will be no more children. Despite seven pregnancies, the couple has only two children. The nurse-in-charge, Jennifer Housand, explains that in the maternity ward, “Unfortunately, the woman has no say. The husband decides.”