JALALABAD — 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 — 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. "

[rebelmouse-image 27089977 alt="""" original_size="800x536" expand=1]

A newborn baby at a Kandahar hospital — 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.".