High infant, maternal mortality rates cause anguish in Afghanistan

KABUL, Afghanistan -- Fayruza's doll-sized body leans limply across the forearm of her aunt, who became the infant's mother minutes after her birth.

The death of the withered baby's natural mother during childbirth epitomizes the leading health crisis in war-ravaged Afghanistan, where U.N. officials say 600 infants and 50 mothers die on average each day.

President Hamid Karzai, addressing a health conference Wednesday, called the appalling rates of infant and maternal mortality his nation's "great tragedy."

Cradling Fayruza in the cramped confines of a ward at Kabul's Indira Gandhi Children's Hospital, the baby's aunt recalled her birth three months ago.

"The morning she was born I became an aunt," said Shirinja, who goes by one name. "But by the afternoon, after my sister died, I had become her mother."

The baby has spent the last 18 days in the hospital, suffering chronic malnutrition.

Afghanistan has the world's second-worst rate of mothers dying during childbirth -- 1,600 per 100,000, according to UNICEF. The worst is Sierra Leone. Child mortality is also among the world's highest: Some 135 children die within the first year of life out of every 1,000 born. An additional 220 die before they reach age 5, compared to eight in the United States.

A quarter-century of war and Taliban rule all but destroyed Afghanistan's meager health services. Deep poverty, restrictive social customs and illiteracy have compounded the crisis.

"Our country is rebuilding itself with the help of the international community after almost three decades of conflict, war and infighting, and in every sector we have problems and challenges, particularly health," said Dr. Abdul Salam, director of Indira Gandhi Hospital.

Almost 90 percent of the hospital's patients come from remote provinces where the health problems are worst. Access to health care is limited by widespread insecurity because of militant attacks and banditry, and by the isolation of communities.

Another obstacle is poor education, particularly among women.

"Illiteracy is one of the biggest problems because people don't know how to take care of their children," said pediatrician Dr. Hamid Mazin, 37, as he helped feed formula to malnourished babies. "Women have no right to leave their homes due to village traditions, so they remain inside to the very end, even if they are having pregnancy complications."

Health Minister Mohammed Amin Fatemi said most births are not attended by trained medical staff and occur in homes in remote villages far from health centers equipped to deal with childbirth emergencies.

Training 12,000 community health workers -- half of them women -- and 6,000 midwives by 2010 is a Health Ministry goal for trying to deal with the child and maternity death rates, Fatemi said on the sidelines of the regional health conference Wednesday.

Afghanistan's widespread poverty must also be addressed if health indicators are to improve, he said. "We have to break this vicious cycle, where poverty causes these mortality rates and mortality rates contribute to poverty," Fatemi said.

Chronic malnutrition -- primarily a lack of energy and protein -- runs at 54 percent for children under 5 in Afghanistan, behind only Burundi at 57 percent.

Poverty's bitter relationship to child and maternal health in Afghanistan are evident inside the bombed-out ruins of west Kabul's Aliabad Hospital, once the capital's leading medical facility. Now, it is home to 50 refugee families too poor to afford to rent or buy a home.

Sixty-year-old Alam Gul lives with his wife Ghutai, who is roughly half his age, and their nine children, including infant twins, in a tiny room without electricity, running water or gas. Cold drafts blow down the corridor toward bathrooms in which cracked pipes leak human waste onto the floor from families living above.

"My children are very sick because of the dirty water, diseases and unclean state of everything," Ghutai said, showing The Associated Press the family's bereft home. "My baby twins are ill and hungry because they don't have enough mother's milk. I don't know how we will all keep living."