Maternal Mortality: Midwives To The Rescue In Afghanistan

Maternal mortality is still very high in Afghanistan
Maternal mortality is still very high in Afghanistan
Mudassar Shah

JALALABAD â€" Shah Zaman, 11, spends his days carting people's luggage to earn a few cents. His mother died during his birth and soon after, his father remarried.

"I wish my mother had been taken to the hospital," he says. Shah lives in Jalalabad, in eastern Afghanistan, where war and internal conflicts have weakened the local economy and health system.

Like in so many parts of the country, health facilities lack trained staff. In more remote areas, health facilities can also be hours away, making it difficult for pregnant women to reach them in time. This, in a country where women give birth to an average of six children, and where one in 11 women dies in pregnancy or childbirth, according to a 2012 report from Save the Children.

The government is working hard to address the issue by training midwives â€" more than 4,000 since the fall of the Taliban in 2002. Saliha, a midwife in the Kama district hospital in eastern Nangarhar province, thinks the initiative has helped, but says maternal mortality is still far too high. Blaming both the lack of female health providers in her area, and bad roads, she decided she would step in.

"It was my dream to be a doctor," she recalls. Unable to afford medical school, she completed a two-year midwifery course. "

A newborn baby at a Kandahar hospital â€" Photo: Staff Sgt. Arthur Hamilton

Saliha says that because patients can show up at any moment, health facilities keep midwives on call 24 hours per day. "Our services have helped reduce the maternal mortality rate," she says.

A survey by the Afghan Ministry of Health and its partners suggests that the maternal mortality has indeed dropped steeply: from 1,600 deaths per 100,000 live births in 2002 to 327 deaths per 100,0000 live births in 2010.

Medical practitioners say women in rural areas have started to trust the local health services, and rather than give birth at home, as they did in the past, are traveling to hospitals to deliver their babies.

Aasiya is Saliha’s colleague at the hospital, where she has been working for the past eight years. "Pregnant women used to give birth in their homes," she explains. "They have a false perception about deliveries in health facilities."

The women have also organized health education and awareness sessions to encourage locals to take advantage of the new care available. Nazia recently traveled to the hospital with her sister, who is having her first baby. "We are very grateful to the staff who provided us with great support, and for free," she said. "This is vital for poor people like us who can’t afford it otherwise.".

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How Thailand's Lèse-Majesté Law Is Used To Stifle All Protest

Once meant to protect the royal family, the century-old law has become a tool for the military-led government in Bangkok to stamp out all dissent. A new report outlines the abuses.

Pro-Democracy protest at The Criminal Court in Bangkok, Thailand

Laura Valentina Cortés Sierra

"We need to reform the institution of the monarchy in Thailand. It is the root of the problem." Those words, from Thai student activist Juthatip Sirikan, are a clear expression of the growing youth-led movement that is challenging the legitimacy of the government and demanding deep political changes in the Southeast Asian nation. Yet those very same words could also send Sirikan to jail.

Thailand's Criminal Code 'Lèse-Majesté' Article 112 imposes jail terms for defaming, insulting, or threatening the monarchy, with sentences of three to 15 years. This law has been present in Thai politics since 1908, though applied sparingly, only when direct verbal or written attacks against members of the royal family.

But after the May 2014 military coup d'état, Thailand experienced the first wave of lèse-majesté arrests, prosecutions, and detentions of at least 127 individuals arrested in a much wider interpretation of the law.

The recent report 'Second Wave: The Return of Lèse-Majesté in Thailand', documents how the Thai government has "used and abused Article 112 of the Criminal Code to target pro-democracy activists and protesters in relation to their online political expression and participation in peaceful pro-democracy demonstrations."

Criticism of any 'royal project'

The investigation shows 124 individuals, including at least eight minors, have been charged with lèse-majesté between November 2020 and August 2021. Nineteen of them served jail time. The new wave of charges is cited as a response to the rising pro-democracy protests across Thailand over the past year.

Juthatip Sirikan explains that the law is now being applied in such a broad way that people are not allowed to question government budgets and expenditure if they have any relationship with the royal family, which stifles criticism of the most basic government decision-making since there are an estimated 5,000 ongoing "royal" projects. "Article 112 of lèse-majesté could be the key (factor) in Thailand's political problems" the young activist argues.

In 2020 the Move Forward opposition party questioned royal spending paid by government departments, including nearly 3 billion baht (89,874,174 USD) from the Defense Ministry and Thai police for royal security, and 7 billion baht budgeted for royal development projects, as well as 38 planes and helicopters for the monarchy. Previously, on June 16, 2018, it was revealed that Thailand's Crown Property Bureau transferred its entire portfolio to the new King Maha Vajiralongkorn.

photo of graffiti of 112 crossed out on sidewalk

Protestors In Bangkok Call For Political Prisoner Release

Peerapon Boonyakiat/SOPA Images via ZUMA Wire

Freedom of speech at stake

"Article 112 shuts down all freedom of speech in this country", says Sirikan. "Even the political parties fear to touch the subject, so it blocks most things. This country cannot move anywhere if we still have this law."

The student activist herself was charged with lèse-majesté in September 2020, after simply citing a list of public documents that refer to royal family expenditure. Sirikan comes from a family that has faced the consequences of decades of political repression. Her grandfather, Tiang Sirikhan was a journalist and politician who openly protested against Thailand's involvement in World War II. He was accused of being a Communist and abducted in 1952. According to Sirikhan's family, he was killed by the state.

The new report was conducted by The International Federation for Human Rights (FIDH), Thai Lawyer for Human Rights (TLHR), and Internet Law Reform Dialogue (iLaw). It accuses Thai authorities of an increasingly broad interpretation of Article 112, to the point of "absurdity," including charges against people for criticizing the government's COVID-19 vaccine management, wearing crop tops, insulting the previous monarch, or quoting a United Nations statement about Article 112.

Juthatip Sirikan speaks in front of democracy monument.

Shift to social media

While in the past the Article was only used against people who spoke about the royals, it's now being used as an alibi for more general political repression — which has also spurred more open campaigning to abolish it. Sirikan recounts recent cases of police charging people for spreading paint near the picture of the king during a protest, or even just for having a picture of the king as phone wallpaper.

The more than a century-old law is now largely playing out online, where much of today's protest takes place in Thailand. Sirikan says people are willing to go further on social media to expose information such as how the king intervenes in politics and the monarchy's accumulation of wealth, information the mainstream media rarely reports on them.

Not surprisingly, however, social media is heavily monitored and the military is involved in Intelligence operations and cyber attacks against human rights defenders and critics of any kind. In October 2020, Twitter took down 926 accounts, linked to the army and the government, which promoted themselves and attacked political opposition, and this June, Google removed two Maps with pictures, names, and addresses, of more than 400 people who were accused of insulting the Thai monarchy. "They are trying to control the internet as well," Sirikan says. "They are trying to censor every content that they find a threat".

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