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For International Womens Day 2017, Mdecins Sans Frontires puts the spotlight on pregnancy and childbirth in Afghanistan, one of the worlds most dangerous countries to give birth in.

March 8 has always been a special day for me and my family not only is it International Womens Day, its also my birthday. Throughout my childhood, we often celebrated my birthday by attending International Womens Day events.

Perhaps that spirit of advocating on behalf of women influenced my career choice as an obstetrician, ensuring that women are able to give birth safely.

One of the most dangerous countries to give birth in is Afghanistan. There are an estimated 396 maternal deaths for every 100,000 live births there. By comparison, the figure in Australia is six maternal deaths for every 100,000 births.

Why are Afghani women so much more likely to die during pregnancy and childbirth?

During my field placement at Mdecins Sans Frontires maternity hospital in Khost, Afghanistan, I met many women who shed some light on the complex answers to this question.

In Afghanistan, two out of every three deliveries take place at home, without a skilled birth attendant. In Khost we frequently saw women who had attempted to deliver at home before coming into the hospital with a complication, such as post-partum haemorrhage.

I remember one woman who had delivered at home and then started bleeding profusely. She had been able to access some care at home but because it was night time she was unable to travel safely to the hospital. By the time she arrived the next morning she was moribund, completely unresponsive and with a very weak pulse. Despite immediate medical attention, she unfortunately passed away.

Many women now prefer to come to the hospital to deliver but it can still be very difficult to access. They often have to travel long distances and road travel can be extremely dangerous.

Dr Rasha Khoury conducts a caesarean section in Khost maternity hospital. MSFs Khost maternity hospital opened in 2012 and is able to handle complicated obstetric emergencies and offer caesarean sections 24-hours a day.

In many parts of Afghanistan theres very little preventive and antenatal healthcare available, so women and their caretakers dont always recognise the danger signs of pregnancy and when they should seek assistance.

Another issue is that women are not usually the decision-makers. So even if they think they need medical care, that decision is usually made by their husbands and mothers-in-law. In addition, women may need a male caretaker to accompany them to hospital and to consent to any surgery or family planning method.

In obstetrics, we have a mantra for the risk factors for maternal deaths: too early, too late, too many and too close together. Sadly, all these elements apply in Afghanistan.

Afghani women tend to get married and have children early in life, and because they are expected to have a lot of children, they often continue having babies into their 40s. Complications often occur at these two extremes of the age spectrum so our facilities see a lot of women giving birth to their first child and many older women having their ninth or tenth.

On top of that, women often dont have the capacity to space out their births because they cant access family planning, and arent in control of decisions around their fertility. Pregnancies that are too close together are risky for mother and baby because the womans body may not have time to recover for instance to replace nutrients such as iron, calcium and folate, which are depleted during pregnancy.

Although the risks are unacceptably high for women giving birth in Afghanistan, Mdecins Sans Frontires work is making an impact.

Women waiting for post-natal and family planning consultations in MSF Ahmad Shah Baba hospital in Kabul.

In places like Khost, where there is such a huge need for maternal services, our facility is well respected for the quality of care it provides. Our presence is changing attitudes towards where women give birth and the importance of having a skilled birth attendant. During my placement we held a jirga, a meeting with community leaders, where we discussed the idea that to be an honourable man, its important to take your wife to hospital to ensure she has a safe delivery.

We focus on caring for women with complicated deliveries who require the high-level care that Mdecins Sans Frontires can provide. In 2016 we strengthened our health promotion activities to improve recognition of complications throughout the community, including through radio messaging. Weve also worked with private clinics to ensure that women with complications are swiftly referred to our hospital.

In all our projects, we emphasise teaching and training local doctors and midwives, which is incredibly important because international staff come and go but local staff stay . Historically, womens lack of education meant there were few female doctors and midwives to look after women in labour. Yet, culturally, many families only seek care from a female. Training local female staff means that were leaving something positive behind. And as well as training within our facilities, weve also trained midwives in local health centres to improve care of normal deliveries.

Just the sheer numbers of babies Mdecins Sans Frontires delivers in its four maternity services across Afghanistan makes a huge impact. In 2016, more than 66,000 babies were delivered by our teams in Afghanistan, which equates to more than 180 babies every day. In Khost, approximately one out of three babies born in the province is delivered in our maternity hospital. So many women and babies are surviving as a result of Mdecins Sans Frontires being in Afghanistan.

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Afghanistan: Reducing risks for pregnant women - Mdecins Sans Frontires (MSF) International

Medical facilities in Afghanistan endured more than 240 attacks by armed groups in 2015 and 2016, resulting in extensive damage to equipment and buildings, deaths of staff members and patients and a worsening situation for the health of the country's children.

Detailed in a report released Monday by Watchlist on Children and Armed Conflict, the attacks were mainly carried out by the Taliban and other anti-government groups. However, the Afghan National Defense and Security Forces (ANDSF) also carried out more than 35 attacks, the group said, adding that it wants U.N. Secretary General Antnio Guterres to list the ANDSF as one of the parties responsible for the attack.

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The report focuses on four provinces: Kunduz, Nangarhar, Helmand and Maidan Wardak. As of November 2016, more than 30 percent of Afghanistan did not have access to health care, according to the countrys Ministry of Public Health.

Violent attacks on medical facilities are making worse the dire state of health care in Afghanistan, according to the report. Nearly five million people in the countryare in critical need of health care, including more than a million children suffering from acute malnutritiona 40 percent increase since January 2015. Measles rates have increased by 141 percent, and child casualties rose by 24 percent between 2015 and 2016, according to the U.N. Assistance Mission in Afghanistan (UNAMA). Among children, deaths from preventable diarrhea-related diseases and polio have also increased, the report says.

Targeted attacks on medical facilities have decimated Afghanistans fragile health system, preventing many civilians from accessing life-saving care, Christine Monaghan, research officer at Watchlist and author of the report, said in a statement on Monday. Children suffer as a resultwe are seeing more deaths, injuries and the spread of disease.

The report also includes details of the October 2015 attack by U.S. forces on a hospital in Kunduz, run by Medecins Sans Frontieres (Doctors Without Borders). Following an investigation, the U.S. military called the hospital strike, which killed 30 people, a tragic mistake.

The group is callingon all partiesincluding Afghan and international forcesto stop attacks on medical facilities and personnel.

See more here:
Attackers Target Afghanistan Health Centers 240 Times in Two Years: Report - Newsweek

New York Times

Travel Ban, Turkey, Afghanistan: Your Morning Briefing New York Times At least 15 people were killed after a faction of the Pakistani Taliban attacked three posts on the border with Afghanistan. [Al Jazeera]. Sea Shepherd, a conservationist group, said that large volumes of shark fins are still entering Hong Kong by ...

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Travel Ban, Turkey, Afghanistan: Your Morning Briefing - New York Times

NEW DELHI: In a clear reference to Pakistan, the National Security Adviser of Afghanistan today said if a country cannot be designated as sponsor of terror, at least individuals hiding behind state protection should be identified.

Without taking Pakistan's name, Hanif Atmar said his country is engaged in an "undeclared state-to-state war" and talked about certain terror groups getting Islamabad's support.

He also said associating terrorism with Islam was wrong, misleading and inappropriate, holding that the Muslim community has been making huge sacrifices to defeat terrorism.

Speaking at a conference on combating terrorism, he hailed India's contribution to Afghanistan's stability and reconstruction and said his country considers the relationship with New Delhi as a "national treasure".

Atmar said Afghanistan's ties with India is as important as its relationship with the US and the NATO, indicating that India was playing a major role in enhancing the war-torn country's defence and security.

Demanding concrete action against countries sponsoring terrorism, he said if that is not possible than people supporting terror groups while hiding behind the state must be named.

"We often hear from the international community that it is difficult to designate a state as sponsor of terrorism as there are many implications.

"If we do not have the courage to designate a state, then let's designate individuals who are sponsoring terror and hiding behind the state. Let's hold them accountable for supporting terror," he said.

He also said that the South Asian Region including the Af-Pak region has the highest concentration of organised terrorists anywhere in the world and a clear strategy was required to defeat them.

The Afghan NSA said associating terror with Islam will make it difficult to understand and deal with terrorism, adding collectively the Muslim world is losing more people to terrorism than any other civilisation.

He called Muslims reliable partners in defeating extremist ideologies.

Rejecting any distinction between good and bad terrorists, Atmar said such approach can change a perpetrator to a victim as well because "such terrorist organisations are capable of morphing into a Frankenstein monsters and they will come after their own masters."

"Despite international investment in countering it, terrorism is growing its capabilities and presence in our region," he said.

Atmar said Afghanistan considers terror outfits LeT and JeM as enemies and that Pakistan should never allow them sanctuary.

"We share the region with Pakistan which has the highest concentration of terrorists anywhere," he said.

According to him, nearly 10,500 people lost lives in terror strikes in Afghanistan in the the last 14 months.

See the article here:
People supporting terror should be designated: Afghanistan - Economic Times

A former soldier who served two tours in Afghanistan with the US military and where he suffered serious head injuries, is fighting an order to deport him to Mexico.

Military veteran Army Private 1st class Miguel Perez was born in Mexico and grew up in Chicago. He sustained a brain injury on his second tour of duty and suffers from post-traumatic stress disorder, his family said.

But now, Mr Perez faces being sent to Mexico. Four years he left the military, Mr Perez served prison time for a drug offence which sparked the deportation proceedings. Mr Perez, 38, was a legal permanent resident when he joined the army and said he thought he became a legal US citizen when he enlisted, but that was not the case.

Family, friends and supporters have urged the courts to allow Mr Perez to stay (Facebook)

Mr Perez is one of thousands of green card veterans who face deportation, according to the Ashleys Memory Project, which was started by the immigrant mother of a deceased veteran, and a local church. They said many enlist with the promise of citizenship.

Hes more American than most of us standing here, because he did pick up arms to defend this country, his mother, Esperanza Perez, told reporters at Lincoln United Methodist Church in the citys Pilsen neighbourhood.

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Mr Perezs family has claimed that the former soldier did not did not get adequate medical attention when he returned home and turned to self medication with drugs and alcohol.

The Chicago Tribune said that a judge is weighing up the case and will issue a written response in weeks. Immigration judge Robin Rosche, is considering Mr Perezs claim under the United Nations Convention against Torture, a protection that resembles asylum.

Under that provision, the US agrees not to deport people who are not American citizens or nationals to another country where they could be tortured. Mr Perez told the judge that he fears for his life if he is sent back to Mexico.

His lawyer, Chris Bergin, said Mr Perez and other veterans who have been sent back to Mexico are targeted.

Those kind of people are immediately targeted upon entry to Mexico as people who can help criminal gangs, cartels, through their military experience, their weapons training, all that. They are targeted in the sense that, You either work for us or we kill you, Mr Bergin said.

Mr Perezs battle follows the issuing of an executive order by Donald Trump who told his administration to step the seizure and deportation of undocumented migrants. While Barack Obamas administration deported hundreds of thousands, they prioritised people with convictions for serious crimes.

Originally posted here:
US Army veteran faces deportation to Mexico after serving two tours in Afghanistan - The Independent