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As a newlywed, Maryams husband promised to let her finish her university degree. Then she got pregnant, and everything changed.

For a week, I was in shock. If my husbands family knew I was pregnant, they would never let me finish university, Maryam said.

So she acted promptly. She found a midwife willing to perform a surgical abortion, selling jewellery from her dowry to raise the required 250,000 afghanis (2,900).

At the clinic, something went wrong. Maryam ended up in hospital where she awoke to find her husband shouting angrily: Why did you do this? Why did you kill my child?

The punishment started as soon as she was discharged. In Afghan society, abortion is seen as a blot on a familys honour; Maryams husband defended his by beating her viciously and shaving her head.

To show I was a whore, she said.

Maryams story is not uncommon. Abortions in Afghanistan are severely stigmatised, and rarely legal. Yet, according to health workers, the number of Afghan women resorting to illegal, unsafe abortions is consistently growing, partly due to an increased number of trained midwives in the country.

One sign that abortions are becoming more widespread is the price, which has dropped since Maryam had her abortion four years ago. Clinics now charge15-20,000 afghanis for a surgical procedure, while a medical abortion costs about 6,000. For young, often unemployed women it is a hefty but not always ruinous fee.

Karima had been a nurse in Kabuls Karte Se district for three months before she discovered what went on in the clinics closed-off rooms.

At first, she was ridden with guilt. One particular memory, of flushing a four-month-old foetus down the toilet, still haunts her. But, she says, she discovered that abortions save more lives than they take.

The honour of these girls is more important than religion. If I dont do anything for her, it will be shameful for her family. They might kill her, Karima said.

Among those who come to Karimas clinic for abortions are single women with boyfriends, wives with drug-addicted husbands, and couples too poor to care for a child.

The honour of these girls is more important than religion

If they were legal, abortions would be much safer, she said. Sometimes Im afraid the police will find out. But I am happy to help save the honour of the girls, especially those who are not married.

Another midwife, Laila, said abortions have become more commonplace in recent years. She said she has performed more than 50.

Sometimes I feel guilty; when the babies are over five months old, Laila said.

In Afghanistan, abortions are legal to save a mothers life or if the child will be born with severe disabilities. In rare instances, women can also get an abortion if deemed too poor to raise a child. That judgment is up to a religious council.

Perhaps surprisingly, councils in Taliban-controlled areas are most likely to justify an abortion based on poverty, said Farhad Javid, country director for Marie Stopes International, the leading post-abortion care provider in Afghanistan. Communities under Taliban influence are often desperately poor and burdened with large numbers of children, Javid said.

His charity recently launched Afghanistans first advert for post-abortion care in Afghanistan.

Marie Stopes International, along with organisations such as the Afghan Family Guidance Association, an affiliate of the International Planned Parenthood Federation, provides post-abortion care only for women who undergo legal procedures in government clinics.

Marie Stopes also trains midwives and nurses, and imports an annual haul of 100,000 Misoprostol tablets, an abortion drug available at private clinics. Misoprostol is safe to use within the first 12 weeks of pregnancy but, because it is more affordable than a surgical procedure, many women will use it, illegally, far beyond the recommended period.

For most women, though, the only available abortions are illegal, in private health clinics, at the hands of untrained nurses.

Afghanistan has one of the worlds highest birth rates. The number of mothers who die from pregnancy-related complications is also at the upper end of the scale.

Unsafe abortions can be hard to conceal because they often result in complications.The stigma that follows can be deadly.

Unfortunately, [pregnant] girls can get killed by parents. If we facilitated services for them, we could save the lives of these girls, said Javid.

I think the midwives and doctors are making a big mistake. God will never forgive them

Shabana, 16, had an abortion after her brother-in-law raped her. I am the victim, but I am a criminal, she said.

Shabanas sister did not believe her husband would rape her. Neither did the teenagers parents: as punishment, they banned her from leaving the house.

Marriage is now a distant dream. Everyone knows she had an abortion. Her reputation as a non-virgin will deter most potential suitors.

What was my crime? Shabana said. I am in jail, a jail my family made for me.

Without education about contraceptives, unsafe abortions become a form of birth control. There are no precise statistics for Afghanistan but one in eight annual maternal deaths worldwide roughly 50,000 women is caused by unsafe abortions.

Even among staff at clinics, opposition to abortion runs deep. In one of them, Tajwar has worked for five years as a cleaner. It took her two years to discover what was actually going on. One day, a teenage girl came to the clinic, crying. After her operation, Tajwar cleaned the room and noticed a large pool of blood.

I dont agree with abortion. I think the midwives and doctors are making a big mistake. God will never forgive them, she said. I have thought about calling the police, but then I remember my young children. If I lose my job, who will take care of them?

Despite the countrys laws, prosecution for abortion is rare. Judgment is primarily social.

Maryam was forced to sleep for seven months in a cold, unfurnished room before she was sent back to her parents. For months, she begged her husband to take her back. He refused, and remarried. Four years later, at 23, Maryam still struggles with depression, compounded by damage done to her reproductive organs by the botched abortion. She can no longer conceive.

Some names have been changed to protect sources identities

Link:
'I am a criminal. What is my crime?': the human toll of abortion in Afghanistan - The Guardian