“Fearing to get infected by coronavirus, I avoided giving an ultrasound test for my pregnancy,” says Mahsa, who expects to deliver her baby in two weeks now. Awaiting for years to become a mother, Mahsa is now pregnant. Her excitement to become a mother, however, appears to be eclipsed by a feeling of anxiety. “I am not sure whether this situation has affected my baby’s mental and physical health. I cannot stop thinking about delivery day and possibility of getting infected by the virus,” she says.
Mahsa hasn’t chosen a place to give birth yet. She says that “the health equipment in hospitals are not clean and delivery at home is not safe. I don’t know what to do.”
A number of pregnant women who visited doctors during the outbreak of coronavirus also complain about inappropriate behavior and low quality of health services at hospitals.
Hadeya, a pregnant woman, says “the doctors don’t explain health problems properly and drugs are low quality.”
The Ministry of Public Health (MoPH), however, claims that health services at delivery wards of hospitals are proper saying that the country’s high profile health facilities are capable of providing delivery services.
Following the outbreak of Covid-19 in the country, the government imposed restrictions on public movement in major cities. Under lockdown access to health facilities became difficult for pregnant women and a number of them intentionally avoided to go to hospitals for delivery.
“Three and half month of quarantine has exhausted me,” says Mahnaz, who is seven month pregnant. She has not avoided giving ultrasound mainly because health concerns and low-quality of health service in the country. Though she has made her mind to deliver her baby at a private hospital, signs of worry is observable on her face. “One of my relatives who work at a private hospital says there is no difference between private and public hospitals.”
Over last four months, 287,050 women have given birth in the country out of which 6,000 deliveries were carried out at homes, according to the MoPH. Official figure tells that almost four percent of women are pregnant in the country. Earlier, the United Nations Children’s Fund (UNICEF) predicted that in the next nine months, an estimated one million babies would be born in the country which now has an estimated 36 million population.
On July 06, the Afghan health authorities called on the nation to undertake family planning program until vaccine for coronavirus is not discovered. In a statement, the World Health Organization also called on nations to undertake extra-cautious family planning programs during outbreak of Covid-19 pandemic.
Adelah Achakzai, a gynecologist, says that excessive fear and misguidance of pregnant women during the outbreak deprived them of getting access to maternal and child health services in the country: “Mothers who haven’t visited doctors during pregnancy, gave birth to babies of either underweight or overweight at their homes.”
A number of mothers, who give births at home while receiving no medical advice, are prone to suffer birth fistula, says Ms. Achakzai. “I have talked to a number of mothers, who gave birth at home and suffer from a fourth-degree fistula or birth defect. There was nothing I could do, so I referred them to another hospital.”
Samira, who due to fear of getting infected by the virus delivered her baby at home, is currently suffering from fistula pain.
Razia, who expects to deliver her first baby, has decided to give birth at home. “Our mothers delivered their babies at home and they are healthy to this day. This is much better than going to hospital and getting infected by coronavirus,” says Razia.
This idea has reached Shaqayeq’s mind and led her to finalize her decision of delivering at home. “How did the grandmas deliver at home? The infection levels are high in hospitals compared to home.”
In the past four months, no pregnant women have gone to Malalai Hospital for checkup, says Homa Azir, head of Malalai Hospital. “The number of women with birth defects such as heavy bleeding and fistula and the number of babies with malnutrition have increased.”
Home delivery is not safe and increases the risk of maternal and fetal death, says Dr. Fatima Dawari. According to her, the conditions for home delivery are not available in Afghanistan. “A specialist must be present for home delivery; fetus should not be over-weighted; nothing should threaten the health condition of mother and the fetus, and if necessary, the mother should be taken to medical centers within ten minutes so that she can benefit from health services at the hospital. We do not yet have facilities to advise pregnant women to give birth at home.”
According to official figures, an estimated one million children are born in Afghanistan on annual basis.
“If the level of anxiety is so high that it disrupts daily activities, the patient must visit a psychiatrist,” says Dr. Dawari. According to her, high level of pregnancy stress and fear of getting infected by the virus, make many pregnant women think of delivering at home which may have negative consequences.
Anxiety and stress during pregnancy endanger the health of baby and mother. Sharafuddin Azimi, a psychiatrist, says that “high level of stress and anxiety will leave a life-long effect on everyone, especially pregnant women. It also affects mental health of children, and in the long-run may even lead to autism and other mental disorders.”