Maternity care in Afghanistan: “What this all-women team is achieving is phenomenal”

They arrived on a motorbike. It’s hard to imagine the journey, because Jamila* was heavily pregnant and having repeated seizures. To make the three-hour trip possible, Jamila’s husband did the only thing he could think of, tying Jamila to his own body so that he could keep her on the bike as they travelled, by night, through rural Afghanistan.

I’m an obstetrician-gynaecologist and was on assignment with the MSF team at Boost Hospital in the city of Lashkar Gah. MSF has supported the hospital for more than 15 years, co-managing the facility with the Afghan Ministry of Public Health. The focus is on mother and child health, and although it’s in the city, the hospital covers all the surrounding rural areas too: around three million people. That’s one hospital to cover a population equivalent to all of Wales.

Jamila was unconscious when they arrived. Quickly her husband unwrapped the ties that had kept her upright on the bike, and the hospital porters helped them to the doors of the maternity ward.

As the midwives rushed to take care of Jamila, they asked her husband to stay by the door. Any surgery on a female patient requires the written consent of a male relative and Jamila had all the signs of eclampsia, a dangerous pregnancy complication often requiring an emergency caesarean section birth.

Antenatal care

Women will ideally have at least four antenatal appointments during a pregnancy. During these visits, the healthcare professional will check things like the size of the baby, but they will also measure the woman’s blood pressure, which is one of the primary warning signs for eclampsia.

This monitoring is essential, as a woman with rising blood pressure may not be aware of it until they have serious complications: their kidneys stop working normally, and they start to have seizures. Without access to treatment, at this point both the baby’s and the mother’s life are at risk.

In the southern region of Afghanistan, few people have access to antenatal care. This is especially true in rural areas, where families can face long and difficult journeys to reach a health facility. However, these delays in accessing care mean an urgent health situation can quickly become an emergency.

Jamila had been having seizures at home for a day before her husband managed to bring her to the hospital. When she arrived in the maternity unit, our all-women team started the emergency protocols they have drilled for.

Jamila was given simple medications to stop and prevent further seizures and then prepared for an urgent caesarean section.

Highly skilled team

Experiencing the efficiency of the team that day, I felt immensely privileged to be able to work alongside them. Women face significant challenges to work in Afghanistan and often face pressure from the authorities or even their families to stay at home. But female staff are required in the healthcare sector, especially in maternity care, where only female midwives and gynaecologists are permitted.

To provide this service, the whole team works incredibly hard during long hours. It’s very difficult to recruit enough female doctors because of government-imposed restrictions banning women from attending secondary school in 2021, university in 2022, and from studying at medical institutes in 2024. Even women who were in the middle of medical degrees when the change of government took place in 2021 have not been able to finish their studies.

It was already difficult to recruit skilled gynaecologists and midwives in Helmand, and these laws further reduce the number of qualified female medical professionals available.

A healthy baby

Without her husband’s determination to get her to us, and without the swift, professional care provided by the MSF team, Jamila would almost certainly have died. With blood pressure that high, it’s likely that she would have had a stroke, or sustained organ damage.

As it was, a very short time after arriving at the hospital unconscious, she had made a full recovery and was able to go home with her healthy baby.

Phenomenal achievement

Since the end of the conflict in Afghanistan the security situation has improved, and more families feel confident to travel to the hospital to access care. This is good news, but it also means that, despite the challenges they face, the team is busier than ever.

Jamila’s baby was just one of between 80 and 100 babies who are born every day at Boost. At any one time there could be 10 to 15 women labouring. Because of the lack of access to antenatal care and the distances they must travel, a significant proportion of women arrive with potentially life-threatening complications. Up to 10 per cent of the women who come to the hospital will need an emergency caesarean section.

I’ve spent my entire career working in women’s health. And I can tell you that what this team are managing to achieve, with very limited resources, is phenomenal.

*The name of Jamila has been changed to protect her identity.

Pauline Lynch is an obstetrician-gynaecologist from the UK. After retiring from her role in the NHS, Pauline has recently completed her first assignment with MSF, aiming to share her skills and experience with teams working in humanitarian settings. Her inspiration to work with MSF came from her sister, who first worked with the organisation ten years ago.