Her husband and his brothers felt that hiring a car was too expensive. They ignored her terrified pleas, saying, "Don't worry, everything will be fine. God is kind." Nevertheless, her baby died, and she barely survived.
When the baby didn't come, Qurban-Bibi was first taken to the local bazaar. A quack gave her an injection that caused her to haemorrhage. Several hours passed, and it wasn't until she nearly bled to death that the men finally relented and brought her to the provincial hospital in Faizabad, where Dr. Wakila Karim saved her life.
The men's disregard for Qurban-Bibi's well-being is contrary to Islam, according to leaders of a new campaign to educate Afghan men and adolescent boys about women's health and rights during Friday prayers and at village-level discussion groups.
Left injured, incontinent and alone
The undelivered infant had caused a large hole to form between Qurban-Bibi's bladder and birth canal. The injury, an obstetric fistula, left her incontinent, reeking of urine and shunned.
The story is not unusual. In Afghanistan, 86 per cent of mothers deliver at home without skilled help. One woman in eight dies as a consequence of pregnancy and childbirth, and many more are severely injured.
There is a grave shortage of trained midwives, and emergency obstetric services are practically inaccessible from many villages. But additionally, many families are reluctant to send women out of the home for medical care due to extreme poverty as well as notions of propriety.
A faith-based initiative supported by UNFPA, the United Nations Population Fund, seeks to counter this neglect. Drawing on Islamic teachings and Afghan cultural values, Muslim clerics are being trained to teach their congregations about 'healthy family relationships'. Their lessons cover reproductive health, the harm caused by gender-based violence and early marriage, and the benefits of spacing births.
The training began as a pilot project early this year in Badakhshan, which has the country's worst maternal health statistics. Six more provinces recently started similar activities.
'Be fair to women'
In a mosque not far from the hospital where Qurban-Bibi was treated, Maulawi Abdulwali led two dozen local leaders in a dialogue. "The Holy Koran teaches that we must be fair to women," he told them, adding that the practice of men marrying girls as young as age 12 is not consistent with this teaching. A lively discussion followed.
Maulawi Amanudin, a Ministry of Religious Affairs official who also took part in the discussion, explains the approach: "When Afghan people are given instruction based on their religious values, they will listen and accept."
Those trained have been mullahs, Shura scholars and other religious leaders with influence in their communities. The messages conveyed in their sermons will be reinforced with public events, TV and radio spots, posters and pamphlets. The trained leaders will also arrange meetings in nearby villages.
This initiative grew out of a plan begun in 2007 by the Ministry of Women's Affairs, UNFPA and the Asia Foundation to reduce domestic violence by promoting a model of healthy family relationships. Involving religious leaders was identified as a key strategy, and the Ministry of Haj and Religious Affairs and the Supreme Court were brought into the campaign.
The effort illustrates UNFPA's endeavour to use culturally sensitive approaches in advancing women's health and rights, which is a focus of The State of World Population 2008 report.
Mawlawi Saddiq Muslem, a senior Supreme Court official who worked closely with UNFPA in developing the project, says religious teachings can convince men to pay more attention to women's health: "Having a healthy mother and a healthy family is what it means to have a healthy marriage in Islam."
Such awareness might have helped Nasira, who was married at age 12. At 18, she endured days of painful suffering while trying to give birth at home without skilled help. After her baby was stillborn, she developed a severe infection and high fever. Yet for nearly two weeks, the men who make decisions in her household did not take her to a doctor. Fighting between rival warlords made the roads unsafe, they said.
Near death, Nasira was eventually brought to the Faizabad hospital, 80 kilometres from her remote village. Dr. Karim did not expect her to survive. The surgical team saved Nasira but not her uterus. She will never have children.
The low awareness of Afghan men on women's health and rights issues is in part due to deep poverty and decades of conflict, states Maulawi Abdulwali. "Because of the war and ongoing tribal disputes, most people live in ignorance," he contends.
But he is hopeful. "When issues are raised in light of religious values, it has an impact," he says. In the past, war and poverty drove families to marry off their daughters at very early ages. While early marriage persists, Abdulwali sees a change in attitudes. He believes most fathers can be persuaded not to make their daughters marry before age 18.
Using religious values is essential when trying to change behaviour in a devout society like Afghanistan's, Saddiq says. "The Afghan people believe in resolving issues from a religious perspective."
Increasing the time between pregnancies could significantly reduce maternal mortality in Afghanistan, where the average woman bears seven children. But very few couples practise contraception - just 1 in 20 - in part because of a common but mistaken belief that Islam does not allow it. Saddiq believes faith-based education can make a difference.
"Our religion clearly states that there should be 30 months between births to protect the health of children and mothers," he notes. "When our religious leaders and communities understand that this is what the prophet Muhammad says, then all the misconceptions that exist within families can be resolved and dealt with."
Some Muslims incorrectly fear that spacing births will weaken the next generation of Afghans, Saddiq argues. "Family members need to learn what birth spacing is, and that it is allowed in Islam," he says. "Spacing births won't reduce the next generation but will lead to a stronger, healthier generation."
- William Ryan