A trailblazer for women’s health
A young woman has paved the way for better maternal and reproductive health care in western Afghanistan
By Zaeem Abdul Rahman and Nicole Foster
BADGHIS, Afghanistan, 8 March 2017 — Moving effortlessly between the maternity ward, consultation sessions, and the desk where she reviews data log books, twenty-six year old Rukhshana makes multitasking look easy. Her job is anything but.
When she started working with the Provincial Health Department three years ago, Rukhshana was the first Reproductive Health Officer in the western Afghan province of Badghis.
Battered by decades of conflict, health care facilities and maternity delivery rooms were in poor condition, lacked basic equipment, and female staff were noticeably absent, especially in remote areas.
Persistent and dedicated, Rukhshana has since played a central role in helping to transform both the quality and the availability of health services for women, mothers and babies in the province.
Based in the provincial capital of Qala i Naw, she monitors health facilities and mobile health teams, and leads information sessions on health, hygiene and sanitation for pregnant women and mothers, often traveling to remote areas where no one else is willing to go.
Advocating for change
During her first assignment in 2014, Rukhshana visited 12 health centres to take stock of the situation on the ground first hand. Her evaluation was damning.
“The problem was not only that the health centres were not up to standard, but that the maternity areas were in very bad condition. There was also a lack of female health workers and midwives, which made caring for pregnant women, mothers — and women in general — very challenging,” says Rukhshana, herself a mother of two.
Her report included a host of recommendations for improving the health facilities to meet the needs of women and expecting mothers, but first and foremost it highlighted the importance of training more female health workers.
“My monitoring reports helped to convince the [Provincial Health] Department to provide more health care trainings and support midwifery programmes. Now we have more female staff in clinics and health centres,” explains Rukhshana.
Better care for mothers and babies
Aabida, 29, witnessed the changes first hand.
When she gave birth to her fifth child in a health facility in Qadis district, “the delivery room was dark and hot. Men accompanying other pregnant women were waiting in the same place. It was difficult for me but there was no other option,” she says.
Two years later, Aabida was reluctant to return but a local midwife convinced her to deliver her baby at the same upgraded facility.
“She told me the room had improved and it’s true. Now it’s clean and the lighting is good. There are separate waiting rooms for women and the male relatives who accompany them. I felt much more confident.”
Adina, 28, a mother of four in the Ab Kamari district, tells a similar story.
“My family did not allow me to deliver by first three children in a health facility because female patients shared maternity waiting rooms with their male accompanists and that’s not proper. My family always insisted I deliver at home,” she remembers.
But when she started bleeding profusely after the birth of her last child, Adina had to go to the clinic urgently.
“I saw the improvements. I met with Rukhshana and she gave me advice about what to do and how to take care of my baby. She also met my family and talked to them about how important it is to give birth in a health facility,” says Adina.
Supporting mobile health teams
One of Rukshana’s main responsibilities includes monitoring UNICEF-supported Mobile Health Teams that deliver reproductive and other health services to communities in remote areas in Badghis.
Each mobile team consists of a nurse, a midwife, a vaccinator, and a driver who bring medication, vaccines, maternity and delivery kits, birth registration cards, and educational books on every visit.
“I meet and follow up with families to ensure that the teams reached them and that they got the services and support they needed,” says Rukhshana, proud of her quality assurance role. She also helps to coordinate ambulances to refer and transport pregnant women to the nearest health facility during emergency deliveries.
Rukhshana’s advocacy efforts begin in the communities she serves.
Accompanied by her husband Fakhruddin, who has been one of her greatest supporters, she visits remote areas that have been plagued by the effects of decades of conflict.
“I travel to areas where no one is willing to go because they are considered too insecure. I meet with women and elders in different communities to understand what they need,” says Rukhshana.
She’s also made a point of emphasizing hygiene promotion when she counsels women: “I think it’s the key element for the safety of mothers and children”.
But her role is no limited to monitoring and reporting, or even to counselling. Fundamentally, it is about changing attitudes towards reproductive and maternal health and the status of women in society.
“I talk with families and with elders and community leaders to convince them to let their daughters study nursing, go to midwifery school, or simply attend health classes as soon as they graduate high school,” she says.
Leading by example
Rukhshana, who graduated from the Badghis High School for Girls in 2007 and became a midwife two years later, is fortunate in that her parents and her husband in particular have been supportive of her education and career, a rare situation in conservative Afghan society.
“She’s always encouraging families to support their girls’ education,” says her husband Fakhruddin. “I’m proud of her work helping women who are deprived and vulnerable. Despite the challenges we face with, I support her. It’s the least we can do for our people.”
And she leads by example with her own children. Even though the closest school is about 4 km away from her house, education is a priority for her seven- and nine-year old sons.
“When I go to office in the morning, I drop off my children at school and my husband picks them up in the afternoon. If he’s busy, they come to my office,” she explains.
But even though Rukhshana is a trailblazer as an advocate for reproductive health, she still faces opposition parts of society, including her own extended family members who disapprove of her work.
“Some of my relatives try to prevent me from working because of traditional norms. Others bring up security reasons to dissuade me from going to remote areas,” she says, unperturbed.
But she’s not satisfied with their reasoning: “As a woman and as a mother, I feel the problems of women in my province. If I ignore them, then who will care?”
The work of Reproductive Health Officers like Rukhshana is supported by generous contributions from the Government of Japan who support maternal, neonatal, and child health in Afghanistan.