KANDAHAR, Afghanistan - Life in Afghanistan can be dangerous enough, but Afghan women face a special hazard all their own -- pregnancy.
Now, a Canadian-funded project is trying to reduce one of the worst rates of maternal mortality in the world. The "maternal waiting home" at Kandahar's Mirwais Hospital may be modest in size, but those behind the project hope it will be widely copied throughout Afghanistan and help change attitudes toward maternal health in the country's deeply conservative rural districts.
"It's risky for women to get pregnant here," said Viola Cassis of the Canadian International Development Agency, which is spending $350,000 to build and equip the facility.
Afghanistan is one of the few countries in the world where men have a longer average lifespan than women, and maternal deaths are one of the main reasons.
Afghan women have a one-in-eight lifetime chance of dying in childbirth. And Kandahar province has the second-worst maternal death rate in the country -- 1,600 for every 100,000 live births.
The comparable Canadian figure, depending on how you count, is between four and six.
Very few Afghan women have access to any kind of trained medical care before or after birth. Only 14 per cent of them see any kind of skilled birth attendant, said Roselyn Joseph of UNICEF, which is managing the project.
Rural health care is scarce to non-existent. Taliban insurgents have even been known to assassinate government-trained midwives.
The new 17-bed waiting home, which will become Afghanistan's first when it opens in a few weeks, will provide women with a place to stay for a few days before and after giving birth. Potential complications can be monitored, and the new mothers can receive some education.
Breastfeeding, for example, isn't common in Afghanistan, said Joseph. Mothers often feed newborns sweet syrups and food they've softened in their own mouths.
As well, the concept of special nutrition for pregnant women or new mothers is largely unknown.
Attending a health-care facility in advance of absolute need is a new idea for Afghanistan, where most women simply deliver at home or show up at the hospital as the baby is arriving.
"Some of them come in a tuktuk (a rickety, three-wheeled open taxi) as they're delivering," said Joseph.
And Dr. Sharifa Seddiqi, head of the Mirwais Hospital, acknowledges that its services will be a tough sell in a culture which severely restricts the movement of women.
"Culture is a big problem in our country for women," she said. "Some families don't like to come to a hospital for their wives and daughters."
That's why the home -- bright and cheery, with a small central garden -- offers beds for trusted family members to accompany the expectant mother. Although hospital food will be available, a kitchen will also allow guests to prepare some of their own foods.
Anything to draw women in from the rural regions, said Joseph. The hope is that they'll spread the word about the facility as well as what they've learned, such as the advantages of breastfeeding, to other women.
"What we're really trying to do is tap into those outlying districts," she said. "That will take some time."
"We're working against cultural norms here."
Kandahar's dicey security situation is also likely to discourage women from travelling.
The maternal waiting home is small and won't come close to being able to accommodate every woman who can use its services.
But it's only the first of several other similar facilities planned across the country.
And it will save lives, said Siddiqi -- both those who come here and those who benefit second-hand.
"Maybe the women who come to this centre will talk to their families about it. And what they learned here."
