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The birth of hope

Afghan midwives teach expectant mothers to replace superstition with sanitation.

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It's not clear who will be first, but one thing is certain. Three women in the Sakhi family are due to give birth in the next month, and Nasima Kuchi, a midwife, wants to make sure they know what to do - and what not to do.

The birthing bed should be covered with a clean towel and plastic, she explains to a rapt audience of women in the family's front room, usually reserved for male visitors.

To Westerners, the need for sanitary conditions at a birth may be obvious. But not necessarily in Afghanistan. In one old tradition, women would spread a layer of earth in the place where the woman was to give birth as a way to protect the house.

Perhaps it should come as no surprise that Afghanistan has the second-highest maternal mortality rate in the world. Only Sierra Leone's is higher.

Of every 100,000 women who go into labor in Afghanistan, about 1,900 die, according to Dr. Tessa Wardlaw, a senior program officer for UNICEF, the United Nations Children's Fund. In the US and Japan, by comparison, the number is 8 in every 100,000 women. Afghanistan's infant mortality rate, at 165 per 1,000 live births, is also among the world's highest.

But Mrs. Kuchi is trying to change those grim statistics. She and others are part of a new breed of midwives who go house to house, teaching Afghan women about sanitation, childbirth, and infant care. A Swedish charity pays for the cost of the midwives' training and services.

Still, Kuchi and her handful of colleagues know they have their work cut out for them. Although midwives have been around for many years, few have had much training. The vast majority of Afghan women give birth at home, helped along by other family members following customs passed down from generation to generation. Much of their information entails more myth than methodology.

Replacing old ways with new

Thus Kuchi spends a great deal of time explaining the basics, specifically what they should not do. For example: After the baby is born, don't put lipstick on its navel, where the umbilical cord has just been cut.

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