A little over a month ago, a young woman named Nazifa passed away while giving birth to her seventh child in a village near Jalalabad, Afghanistan. She was just 28. Her children are far too young to understand that their mother will never come back.
Nazifa was 17 when her family married her to a farmer. Without access to contraception, she continued to have child after child—then died because her body couldn’t handle another pregnancy. She had high blood pressure and her body was exhausted and her health deteriorated after back-to-back babies.
When she got pregnant, Nazifa only went to the doctor once. The doctor told her that the pregnancy would be a big risk to her life. Nazifa had never been to a hospital before—it was far from where she was living and expensive, too. She didn’t know about contraception or maternal health. She gave birth to all her children at home, but this time it never happened. Instead, she went into a coma and died during a C-section procedure at the nearest hospital, which was two hours away.
Nazifa’s tragic story is unfortunately not unique. Despite some improvement, Afghanistan has one of the highest rates of maternal mortality in the world. The Health Ministry of Afghanistan confirms that about 18,000 Afghan women die during childbirth every year. Save the Children has ranked Afghanistan as the worst place to give birth.
One of the biggest contributors to Afghanistan’s high maternal mortality rate is lack of access to and knowledge of contraception.
Birthing many children without having enough gaps between pregnancies can increase the chance of maternal mortality drastically. (Early pregnancy is another major contributor. Research shows that girls younger than 15 are five times more likely to die in childbirth than women in their 20s. In Afghanistan, early and repeated pregnancies continue because, especially in rural areas, most women are married too early and receive little to no information about contraception.)
According to a survey by BioMed Central Women’s Health journal, only 21.8 percent of Afghans report having used any contraception. Even though access to birth control has increased in Afghanistan and pills, condoms, IUDs and even implants can be found in local pharmacies at government subsidized price, usage remains low.
Zuhra Bahman, who studied contraceptive access in the region as part of her phD program, found that myths about the adverse impact of contraception may contribute to the persistent gaps in use. “There is a wide spread belief among Afghan women that long-term use of hormonal contraceptives results in infertility,” Bahman says. Many Afghan women also believe birth control will cause cancer or mental health issues.
Negeen Kargar, a scientist researcher based in London who recently interviewed Afghan women on the topic, agrees. “I witnessed a woman going through her eighth abortion because her husband did not allow her to use contraception,” Bahman says. “She already had nine children and she was very poor. She begged the doctor for a hysterectomy but the doctor couldn’t perform that without her husband’s consent.”
Dr. Tahmina Samandari believes that there is an urgent need for more awareness raising about contraception in Afghanistan. She argues that women need to know about the variety of options at their disposal so that they can make decisions based on what works best for them, and that partners and families need to be educated too.
“In reality, pregnancy is riskier for women’s health than birth control,” she says. “But women don’t know that.”