1 00:00:00,000 --> 00:00:03,680 From the fall of the Taliban to the rebuilding of a shattered nation, 2 00:00:03,680 --> 00:00:07,600 Afghanistan is a country undergoing extraordinary change. 3 00:00:07,600 --> 00:00:10,000 But when it comes to pregnancy and childbirth, 4 00:00:10,000 --> 00:00:13,360 mothers and their babies are still fighting for their lives. 5 00:00:18,480 --> 00:00:21,360 The city of Talikhan, northeastern Afghanistan, 6 00:00:21,360 --> 00:00:23,360 is facing a new challenge. 7 00:00:23,360 --> 00:00:43,360 A mother here is 200 times more likely to die in childbirth than her sisters in Europe. 8 00:00:43,360 --> 00:00:46,560 Outside the city, in the remote villages, 9 00:00:46,560 --> 00:00:50,560 pregnancy is a death sentence for one mother in three. 10 00:00:52,320 --> 00:00:54,080 According to official figures, 11 00:00:54,080 --> 00:00:58,800 the maternal mortality rate in Afghanistan is now the worst in the world. 12 00:01:00,560 --> 00:01:05,200 In this strict culture, women are confined to their homes for most of their lives. 13 00:01:06,960 --> 00:01:11,280 They can't even go to the hospital to give birth without their husband's permission. 14 00:01:11,840 --> 00:01:14,240 And permission is often denied. 15 00:01:14,960 --> 00:01:19,600 Most of the women who come to the district hospital here come in an emergency, 16 00:01:20,160 --> 00:01:23,200 the last resort when a pregnancy goes wrong. 17 00:01:25,200 --> 00:01:28,240 Dr. Bari Yusayeva is a gynecologist in Talikhan. 18 00:01:44,240 --> 00:01:46,720 They're not allowed to open their face. 19 00:01:46,720 --> 00:01:52,880 They're not allowed to go anywhere without permission, husbands or mother-in-law. 20 00:01:56,320 --> 00:01:57,760 Her name is Chiringi. 21 00:01:57,760 --> 00:02:02,560 She's 20 years old, maybe younger, and she's carrying her first baby. 22 00:02:04,000 --> 00:02:09,280 To get here, she's traveled nine hours by jeep along rocky mountain tracks. 23 00:02:10,240 --> 00:02:14,480 It emerges that a woman in her village, a traditional birth attendant, 24 00:02:14,480 --> 00:02:19,280 gave her injections of oxytocin, the drug used to induce labor. 25 00:02:20,400 --> 00:02:22,800 The contractions began three days ago. 26 00:02:23,360 --> 00:02:28,080 But her pelvis is too small, and now the baby's heart is failing. 27 00:02:30,240 --> 00:02:32,320 They wheel her to the operating theater. 28 00:02:35,440 --> 00:02:38,880 If the baby is not delivered immediately, it will die. 29 00:02:40,240 --> 00:02:42,800 She, too, is in great danger. 30 00:02:42,800 --> 00:02:45,520 There is a risk that her womb will rupture. 31 00:02:47,680 --> 00:02:51,280 But doctors decide on an emergency caesarean. 32 00:02:53,440 --> 00:02:57,520 She's still in her day clothes as she's helped onto the operating table. 33 00:03:10,080 --> 00:03:17,520 So, 34 00:03:25,200 --> 00:03:28,960 less than a quarter of an hour later, they deliver her baby. 35 00:03:31,280 --> 00:03:33,840 She makes no sound, but she is still alive. 36 00:03:36,640 --> 00:03:38,160 They give the baby oxygen. 37 00:03:39,760 --> 00:03:43,840 The baby's heart is not so good. 38 00:03:47,840 --> 00:03:50,240 She cannot hear the baby's heart. 39 00:03:56,080 --> 00:03:58,480 The appalling death rate among mothers 40 00:03:58,480 --> 00:04:02,320 is one of the priority areas in the reconstruction of Afghanistan. 41 00:04:03,280 --> 00:04:06,640 In a cornerstone effort, the World Health Organization 42 00:04:06,640 --> 00:04:10,480 has set up a project to train 1,000 midwives in the country. 43 00:04:12,880 --> 00:04:14,480 At the age of 18, 44 00:04:14,480 --> 00:04:19,280 Manijar Abdullah Halik is one of the youngest on the midwife training course. 45 00:04:24,080 --> 00:04:25,680 I'm studying in Taleghan. 46 00:04:25,680 --> 00:04:30,160 This is important for our people because after 25 years of war, 47 00:04:30,160 --> 00:04:32,000 we have lost a lot of people, 48 00:04:32,000 --> 00:04:35,440 and we have a very high level of maternal mortality, 49 00:04:35,440 --> 00:04:37,600 and we need midwives and doctors, 50 00:04:37,600 --> 00:04:40,560 and we need a health clinic to treat our people. 51 00:04:46,640 --> 00:04:51,920 Recruiting women from remote, conservative communities like Barak was difficult. 52 00:04:53,040 --> 00:04:56,080 Dr. Bari from the midwife school in Taleghan 53 00:04:56,080 --> 00:04:59,360 says it takes a long time for men to get to the hospital. 54 00:05:00,160 --> 00:05:02,800 It takes a long time for women to come around. 55 00:05:03,360 --> 00:05:05,840 Here is a lot of challenges in Afghanistan, 56 00:05:05,840 --> 00:05:08,640 but step by step, slowly, slowly, 57 00:05:08,640 --> 00:05:11,040 and just now we are a big family, 58 00:05:11,040 --> 00:05:13,600 and when their fathers allow them, 59 00:05:13,600 --> 00:05:15,040 just now they say, 60 00:05:15,040 --> 00:05:18,640 go to the school because Bahri is your mother. 61 00:05:22,000 --> 00:05:26,320 Riding a donkey is not so easy when you're wearing a burqa. 62 00:05:26,320 --> 00:05:28,160 Her father helps. 63 00:05:28,160 --> 00:05:32,320 Bani Zha must not show her face to men outside her village. 64 00:05:34,240 --> 00:05:38,560 Once she's a midwife, this will be her sole form of transport, 65 00:05:38,560 --> 00:05:42,160 and the clinic where she'll work is an hour's ride away. 66 00:05:48,000 --> 00:05:51,520 Once she reaches the clinic, she's permitted to show her face again. 67 00:05:52,160 --> 00:05:56,160 Simply by giving these women access to skilled medical care, 68 00:05:56,160 --> 00:06:00,160 the number of deaths in childbirth could be cut by three-quarters, 69 00:06:00,160 --> 00:06:02,160 according to World Bank estimates. 70 00:06:06,160 --> 00:06:08,160 Her name is Bakhdagal. 71 00:06:09,360 --> 00:06:14,960 She tells Bani Zha she's ridden three hours on a donkey to get to the clinic. 72 00:06:14,960 --> 00:06:18,960 She's 30 weeks pregnant, and she is in great pain. 73 00:06:21,840 --> 00:06:23,760 This is her 12th child. 74 00:06:24,560 --> 00:06:26,960 All were born at home without help. 75 00:06:27,920 --> 00:06:32,080 Bani Zha tells her her baby is OK and that she has a month to go. 76 00:06:37,120 --> 00:06:39,360 Don't worry. You should use family planning. 77 00:06:40,960 --> 00:06:41,840 Enough is enough. 78 00:06:45,680 --> 00:06:48,320 A year from now, if all goes well, 79 00:06:48,400 --> 00:06:53,280 Bani Zha will be one of the new midwives saving lives of mothers and children 80 00:06:53,280 --> 00:06:55,680 in the remote communities around Talakhan. 81 00:07:00,160 --> 00:07:04,320 As for Chiringui, she will live, but it was too late to save her baby. 82 00:07:05,040 --> 00:07:07,680 Had there been a trained midwife in her village 83 00:07:07,680 --> 00:07:12,160 instead of the woman who induced labor before her body was ready? 84 00:07:12,800 --> 00:07:14,240 Had she been educated? 85 00:07:14,240 --> 00:07:19,200 Had she known even a day earlier that she needed help?