New Internationalist

Those we lost

Issue 420

Afghanistan has the second highest maternal mortality rate in the world. Here we tell the stories of three women, two of them in words (their families did not wish to be photographed) and the other in pictures.

My sister’s story

My sister was called Rahima. She was two years older than me. We have five brothers so Rahima and I were always together. She was very beautiful, her eyes were big like almonds. She got married seven years ago. We both cried so much when she left for her husband’s house. Her husband was a good man, a labourer. His family found out about my family from his aunt. They came to see my sister and ask for her hand. They kept coming for months until one day my father said yes. There was a small engagement party and they were engaged for a year; her husband’s family brought us gifts at Eid and New Year. Then they got married. The wedding was also small. She wore a white dress and then changed into green. She looked so beautiful.

She had a daughter a year after her marriage. My mother and I stayed with her when she was about to give birth. We brought a midwife from her village who attended the birth. She was an old lady and she had learnt how to be a midwife the traditional way – by going to births with her mother, who was also a midwife. When Rahima was giving birth my mother and the midwife were with her in the room. I was not married then so I wasn’t allowed in the room; that’s the tradition. I waited outside and boiled water that the midwife needed. The midwife said that the birth went well. After 40 days my mother and I came back home and my sister was healthy and so was her baby.

She gave birth to two more children, both boys. She had three children within five years of marriage. All of her children were lovely. Her husband was a good man, very respectful. They lived with her in-laws, two brothers-in-law that were younger and the old father-in-law. Rahima was the only woman in the house. Her husband’s sisters were all married and used to visit her sometimes. Her life was good; she didn’t have any more or less trouble than most women. Her husband never lifted a finger on her, which is good and my mother prays for him for this.

When Rahima was having her fourth child we went there again. We brought the same midwife. I stayed outside to boil water and look after the children. It was exactly like the three previous times. The midwife came out and said that my sister and the baby were both well and it was a girl.

But the next night Rahima woke up burning in fever. Her eyes were red. Her baby was burning in fever too. She tried to breastfeed the baby but the milk wouldn’t come out. We pressed cold cloths on their heads but by the morning my sister couldn’t keep her eyes open and she couldn’t lift her arm up. We brought the midwife. She told Rahima to stop trying to feed the baby her own milk. She told us to mix a very small amount of cow’s milk with water and give it to the baby. She said if the fever didn’t go down we should take my sister to the hospital in the city.

We waited. We gave milk to the baby but the baby wouldn’t drink it. She was shivering now and so was Rahima. Both were sweating and hot but were also shivering. My sister’s husband went to find a car to take my sister and the baby to the hospital, which is about two hours away. And my mother fetched the midwife again.

The midwife looked at the baby and said the baby would start stiffening up soon and her mouth would shut and she would definitely die. My sister would survive if taken to the hospital where she would be given an injection. We didn’t know what to do. I stayed with the baby and tried to feed her and keep her awake but she was shaking and sweating. Her head was wobbling and she was refusing to swallow the milk. Her jaws were getting tight and her mouth was closing. I was alone and the baby was on my lap. I was horrified when she died but I was a little happy for her because I thought she was in pain when she was alive. Her body turned very stiff very quickly. I wrapped the body and put it above the pile of mattresses and closed the room because I didn’t want the other children to see the dead baby.

Rahima was looking yellow, she was shivering and her temperature was extremely high. There were more neighbourhood women in the room. They were asking my sister to try eating to keep her energy up but my sister couldn’t even reply. She couldn’t even get the flies off her face. I didn’t tell my sister that her baby had died.

It took my brother-in-law about an hour to borrow a tractor to transport my sister to the hospital. His sister came along. I took her aside and told her about the dead baby. She promised to take care of it. My brothers and father arrived too. My brother-in-law and my brothers carried my sister and put her on a mattress in the trailer attached to the tractor. My mother and I climbed in too.

The nearest hospital is about two hours away in a car but a tractor is so slow that it took us almost twice as long. The roads are not tarmacked in my area so the ride was rough and when the tractor went in and out of the ditches we all got thrown around. Rahima would give a little moan. She was so weak. Her eyes had sunk very deep. We bought her some biscuits and juice but she refused to eat them.

After three hours Rahima’s body went very limp and then, when we were very close to the city where the hospital is, she took a long breath and she left this world.

We let my brother-in-law continue driving. We arrived at the hospital with the dead body. The doctor came out and looked at my sister’s body in the tractor and told us she was gone. My parents cried but my brother-in-law and I kept quiet.

The journey back was hell. I read all of the prayers I knew. I was very angry as well because my only sister had been taken away from me. I wish the hospital had been closer so we could have taken her there as soon as she had got ill, and maybe if she had given birth at the hospital she would have been fine. I just don’t understand why the first three births went so well and the fourth one killed my sister.

We arrived at Rahima’s house and laid her dead body in the yard. Next day we buried her and her baby side by side. It is impossible for me ever to forget my sister or to stop missing her, but in the few days after her death we started to think about her children. There were no women left in the house to look after the children so we decided to bring them to our house. Their father would sometimes visit the children but it was hard for him and the children missed their father.

Then one day Rahima’s widower came to my house and asked my father if he would give me to him as his wife. He said that it was the best thing to do because the children were used to me and I would love and care for them as if they were mine. But my father had already promised my hand to someone else – I was to get married after the mourning period of my sister was over. So my father said no to my brother-in-law, who then took all the children back to his own house. The relations between our families were broken. We couldn’t go and visit the children as there were no women in their house and he refused to bring them to us.

A year passed and I got married too. Then one day we heard the news that Rahima’s widower had married again. My heart sank when I heard it because stepmothers are always cruel. I am not sure what she will do to my niece and nephews. All I can do is pray for them. It’s their bad luck. We don’t have a right to bring them to our house and look after them. My father and brothers can’t afford to feed three mouths, so we must just hope for the best.

I have now been married for a few months. Sometimes I wake up in the morning thinking of my sister and wondering why she was the one that died. She was so good. I am not scared of having children because I think if death in childbirth is my fate then I can’t stop it; but I do wish there was a hospital where I could be taken when the time comes so that doctors can help if needed.

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My wife’s story

I got married three years ago. She was my cousin; my maternal aunt’s daughter and very dear to my mother. I was living in Iran where I was a labourer. One day I received a letter from my family saying that they had decided to arrange the marriage with her. I remembered her well and knew that her family is good. Besides, my mother would be happy and I was coming to an age when marriage had to happen so I said yes. Iran wasn’t a good place for Afghans any more; people were being deported back to Afghanistan. I came back to my village in Badakhshan.

I arrived with some money which I used for the wedding. My wife came to my house and I was happy with life. She was a very good woman. She never had problems with my family, unlike other women.

A year and a half after our marriage she got pregnant. We were very happy, especially as it had taken a bit longer for the pregnancy – in my area if the couple don’t have a child in first year people talk. When the baby was being born there were some complications. She was ill for two days. I could have taken her to the doctor but that was six hours away and I was scared that if she gave birth on the way it would be more dangerous. It was snowing quite badly too and the way could have got blocked any time. There was one midwife in the village next door who came to help, but she refused to accompany us to the hospital because she didn’t want to leave other women in the area unattended.

The baby was finally born after two days. My wife didn’t get better. After giving birth she could not keep herself clean. Her body was torn. She stopped eating and started getting very thin. The snow was getting heavy and the way to Faizabad was closed, so we couldn’t take her to the hospital. She got weaker and weaker. She cried all the time and on the fourth day she stopped eating and talking altogether. She looked yellow and weak.

On the fourth day she died. We buried her and came home and everything had changed. The baby is beautiful. She’s very big. My mother is looking after her but she is old and after my wife’s death she has gone quiet. She can’t really look after my daughter. The last few months my mother has started to talk of my remarriage but I am ignoring her. It’s her right to ask me to marry because my wife would give her a hand looking after the baby and would take over the house now that she’s old. But I am not sure what to do. I worry about the baby because if I remarry the stepmother may not treat her well. I can only do so much, but I can’t keep an eye on them when I am out at work. I can’t expect another woman to love my child like it’s hers.

I don’t think I will marry. I have moved to Kabul now, I work as day labourer here. I make very little and I go back to Badakhshan two or three times a year. It’s winter now and I am not going back until spring because there’s no work there for me.

I should’ve still had my wife. She died a useless death. She must have been in so much pain and maybe she could have been made better, but there was no-one to help – no doctors, no nurses. This government has done nothing for poor people. They know that people in my district get cut off from the big cities when it snows but they still haven’t managed to make hospitals or clinics there.

I think no-one cares for our women. I hope that no other child is left destitute again as mine is, living without a mother in the care of an elderly grandmother. Children and women suffer most I think.

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Qamar’s story

Photographer Jean Chung documented the last days of Qamar’s life, with the permission of her family. Qamar is 26 and is shown first looking at her newborn baby and her mother-in-law Khalisa. She lost her first child two years before and has this time been delivered by caesarean section in Faizabad Provincial Hospital, in the Afghan province of Badakshan.

Postpartum complications soon set in, however, and two weeks after the birth Qamar dies – her eyes closed by Khalisa while her husband Azibullah waits outside. The family transports the body back to their village, where Azibullah mourns beside Qamar’s body. His baby son is wrapped up tight, the remaining hope of the family.

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