In Afghanistan's northeastern Badakhshan Province, Sharifa feeds rice and bread to her nieces and nephews. The six children are orphans who were left in Sharifa's care when her sister died.
Due to poor conditions, the children's mother bled to death while giving birth in her home. Sharifa says her pregnant sister was not able to travel over the rough roads to a medical center in the city of Faizabad -- just three kilometers from her village -- in time to give birth.
"My sister died while giving birth," Sharifa told the Reuters news agency. "Her orphaned children do not have anyone to take care of them. I am their aunt, so I have to come to take care of them. Sometimes I can't help them. There is no one to care for them. There is no clinic nearby, no cars, and no proper roads. When my sister was about to deliver a baby, we could not take her to the hospital. She stayed at home for one day and one night. Then she died."
Death during childbirth is a scourge in Afghanistan. On average, a woman dies there every 27 minutes from complications during pregnancy, according to the nongovernmental group Save The Children. It is a chilling statistic that contributes to making Afghanistan one of the most difficult places in the world to be a mother.
In fact, Save The Children's latest index on living conditions for mothers does not include Afghanistan among its ranking of 146 countries. That is because economic data was not available for one key category of the index -- a comparison of the incomes of Afghan men and women.
But the statistics that are available from Afghanistan -- data on women's health, education, nutrition, and personal safety -- confirm that life is very difficult for Afghan mothers. The data shows that one out of every eight women in Afghanistan dies during pregnancy or while giving birth. The only country where that situation is worse is Niger, where one out of every seven women dies during pregnancy or childbirth.
Ministry's Top Priority
Afghan Deputy Health Minister Faizullah Kakar says that is why maternal mortality is now the top priority of his ministry.
"Maternal mortality [in Afghanistan] is the second highest in the world. There is an African country that I think has more [deaths] than us. But our maternal mortality is 1,600 for every 100,000 live births," Kakar says. "So that is a very important area of health that we are paying attention to. That is actually our first priority in health. So we are doing quite a few things to reduce maternal mortality."
A clinic near the border with Tajikistan, in the Ishkashem District of Badakhshan Province, is one example. When Mahenow became pregnant recently, her husband escorted her to the clinic on a donkey for an examination. Mahenow says the clinic has helped her learn more about the health risks she faces.
"In the past there was no hospital, no doctor, and no medicine here," Mahenow told Reuters. "That is why we were doing the deliveries at home. Now we have clinics and good doctors. So I decided to come to the clinic in order to become more aware of health issues."
Education Seen As Key
Dozens of NGOs are also actively helping women who have little access to proper medical care. And it is not only pregnant women who are attending the NGOs' special programs.
Rona Azamyan is the coordinator of a midwife-education program in Faizabad that is offered at a series of schools. Azamyan says the goal is to educate women from isolated areas about how to help other women deliver a baby.
"These schools were established in order to bring down the rate of maternal mortality," Azamyan says. "We train local midwives who will be able to provide health services for mothers within the in communities remote areas where they are living. There are no proper hospitals in those areas. So they can save lives and help to rescue mothers from death during childbirth."
Indeed, Afghan men prefer their women to consult only women health workers. But that is easier said than done in a society where there are few female doctors or nurses and where little emphasis has been placed on educating girls.
The problem was worse during the Taliban regime, when girls were banned from schools and severe restrictions were placed on women leaving their homes. During those years, from 1996 to 2001, there were only about 1,000 female health-care workers in the entire country. They staffed female-only hospitals -- leaving women in remote rural areas without any health services. Still the situation remains far from ideal today.
Training As Midwives
One student in the Faizabad program, Momina Hinafy, says the death of her own mother convinced her that Afghanistan needs more women to be trained as midwives.
"The maternal mortality rate in Badakhshan was too high -- especially in the remote and mountainous districts," Hinafy told Reuters. "My mother died while giving birth. That is why I took the detour to become a midwife and help mothers. I want to help save the lives of other mothers."
Meanwhile, the government's plans call for more midwifery schools to be set up and for more female students to be assigned to medical and nursing schools. Authorities hope that will improve dire statistics like those compiled by Save The Children, which show that only 14 percent of all births in Afghanistan were attended by skilled health personnel during 2006 -- a figure comparable to Chad. In fact, only Ethiopia had a poorer score on that issue -- with trained health personnel attending to just 6 percent of the births there.
By comparison, qualified health personnel attended 90 percent or more of the births in countries like Iran, Kyrgyzstan, Uzbekistan, Turkmenistan, Kazakhstan, China, and Azerbaijan.
At the end of the day, Save The Children stresses that statistics tell only a portion of the story about the harm caused to the well-being of Afghan mothers and their children by years of war, violence, and lawlessness. But it hopes that focusing attention on the problem will mean that more Afghan mothers will be alive to celebrate the next Mothers' Day.
Additional reporting by Ron Synovitz in Prague