LIANE HANSEN, host:
Afghanistan's youngest citizens are in peril. The war-ravished country has one of the highest infant-mortality rates in the world. That's because nearly nine out of 10 Afghan women give birth without medical help. Now, Afghan health officials and Western aids groups are trying to change that. They've developed a program to train midwives. Women learn how to assist in childbirth and men learn to support the women in their work.
NPR's Soraya Sarhaddi Nelson sent this report.
(Soundbite of woman giving birth)
SORAYA SARHADDI NELSON: This tiny delivery room in the eastern city of Jalalabad is hardly luxurious. In it, seven women lay side by side on vinyl cots, each of them wailing and pushing, desperate to give birth.
There is no medication here to ease their pain nor are there incubators for their new borns. There's not even a curtain for privacy. Nevertheless, these women in labor are luckier than most here. They are being attended by midwives in one of the countries premier training programs which means mother and baby are more likely to survive.
Like this mother and her new born daughter, midwife trainee Selema(ph) who wears latex gloves, catches the baby girl as she comes out. She gently places the infant with glistening black hair on her mother's abdomen. She clamps off the baby's umbilical cord.
Moments alter, another midwifes trainee named Zorhe(ph) carries the baby to a table. Zorhe sucks the little girls mouth clean with a rubber ball and wraps her tightly in a blanket. The head trainer and obstetrician named Dr. Hafiza Sahak is pleased with the girls work. She believes her trainees are the only hope to curve her country's staggering infant mortality rate.
The United Nation says nearly one in seven babies in Afghanistan die before reaching their first birthday. Compare that to one in 140 American babies. Dr. Sahak.
Dr. HAFIZA SAHAK (Obstetrician, Afghanistan): Most of the work in delivery room are - and at the maternity ward are done by the midwife. All the complication covered by the midwife - all normal delivery, covered by the midwife. So for this reason, I think, midwife is so important in this situation for our country more than doctor.
NELSON: Especially these midwives she says. Her trainees come from among Afghanistan's most undeserved and dangerous provinces. Places where illiteracy is rampant, and women's roles are limited to that of subservient wife and mother. Women forced to live out their lives behind closed doors.
Dr. SAHAK: Three years before, when we started this midwifery education program, we prepared some advertisements and flyers and we distribute in different remote area. You know, in the first entrance exam, just six students coming form the whole region. And we needed 48 students.
NELSON: Now, she has so many applicants she has to turn them away. Sahak says her secret was winning the cooperation of the trainees' male relatives. For example, each girl's father - or if she's married, her husband and her father-in-law - sign or mark a contract pledging the trainee will work after graduation. The head of the tribe is also required to sign off on the deal.
In exchange, the program director houses the girls in a walled compound off-limits to men. Female relatives and in-laws visit periodically to make sure the girls are behaving. As a bonus, trainees with children have full-time, on-site day care at their disposal.
The girls say they love it here and they love what they are learning to do. Some 120 have successfully completed the up to two year training in Jalalabad and return to one of four eastern provinces. But some of the new graduates, like 20-yea-old Gul Harram(ph) say they are scared to go home.
Ms. GUL HARRAM (Midwife): (Through translator) At first, everyone in my community supported me, but now there are rumors that there are some people threatening to kill any woman who returns and uses her training and skills. This has really upset me.
NELSON: Such threats worry program director Dr. Sahak. She also worries about funding to continue her program. Grant money form International Medical Corp use to train Gul Harram and 22 classmates ran out May 31st. The California based non-profit group paid a $120,000 a year toward the Jalalabad training program.
Back in the delivery room, trainee Selema and a midwife mentor comforted patient who was giving birth to her 11th child. Gulbas(pg) who was 35 has been in labor since mid-night. And the girls administer a drug to try and speed her delivery along.
Dr. Sahak who is watching them says she wishes there was a drug to speed up the delivery of midwives across Afghanistan.
Soraya Sarhaddi Nelson, NPR News, Jalalabad.
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