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The birth of hope

Afghan midwives teach expectant mothers to replace superstition with sanitation.

(Page 2 of 3)

Kuchi, who has six children of her own, asks the three women who are due next month to approach her. Each is a wife of one of the family's eight sons; a new wife usually moves in with her husband's family. Kuchi moves her hands over each rounded belly, listening with a rudimentary stethoscope for a baby's heartbeat.

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Then Kuchi and her midwife partner, Gul Ghuta Musleh, lead an informal class in how to deliver a baby.

Assembled on the carpet are all the women of the extended family, as well as girls from the age of 10, some of whom can expect to be mothers in the next four to five years.

Most of the women will bear their children here, in this cement room where a chilly draft wafts through windows that sit askew.

Hajira is on her sixth birth, although she's already lost two infants along the way. A baby-faced woman in a dark-blue scarf, she looks too young to have been through so much. But at 20, she's already been married for six years, and had one pregnancy a year.

"We didn't know what to do, really," says Hajira. "Now we know more, because [the midwives] come to visit and they keep coming back.

"She's always reminding us what to do," the young woman says of Kuchi, "because it's good to hear it more than once. Sometimes we forget."

Next, the midwives hand out sealed bags, free kits from the United Nations that come with the bare essentials - a clean sheet and plastic, plus a string and a razor for cutting the umbilical cord.

Using a doll - which looks more like a gingerbread man with a tube coming from its stomach - Kuchi demonstrates how to treat the newborn. She carefully shows the women how to make two knots in the umbilical cord, a distance apart, and then cut in between.

While the procedure looks simple enough, thousands of Afghan infants die each year of tetanus acquired from cutting the cord.

If pregnant women don't have one of these ready-made kits, Kuchi says, they need to make one. Boil the string. Wash the cloth and plastic and hang them out to dry. No one who hasn't just washed her hands should be allowed to touch it. In a pop quiz, Kuchi asks a few women to reenact what they just learned.

"If the time comes and we're away, then you can help each other," Kuchi tells them. When in doubt, she says, send for her.

Many families, however, will not - or won't have the option. Some are afraid of having to pay costs they assume are associated with employing a midwife. Kuchi and Musleh, however, do not take any fees. Their visits are paid for by Terre des Hommes, a Swedish aid organization.

"Most of our patients want to have the child at home," says Kuchi. "This way, they can rest there and they don't have to travel and pay for the transportation."

In more remote, rural areas of Afghanistan, where the mortality rate is the highest, there are very few trained midwives, and the lack of transportation makes getting help almost impossible; some villages are accessible only by donkey.

Moreover, many families are unable to recognize an emergency when it occurs. Training by the midwives gives them a better sense of when to know it's time to ask for help.

Toward the end of Kuchi's visit, the women have more questions. One wants to know why she can't conceive - and many others want to know how they can stop.

Birth control, says one of the wives, Mektup, a mother of seven, is a controversial issue: "In Islam, they say it is a sin to take birth control pills, but what should I do? I already have seven children. I pray to God that all my children live, but I don't want any more. All of our husbands are poor, and we cannot afford to have more children."

Kuchi doesn't answer. She bids farewell and heads off to another Kabul home at the end of a rocky, dirt road. Here, a woman named Nuriya gave birth to Suriya, now 6 weeks old, and Kuchi is visiting them for the first time since the delivery.

Wrapped up and sitting in Nuriya's lap, Suriya has eyes that jump out like those of a model in a fashion magazine. The upper and lower lids are rimmed with black kohl, which the family believes will protect her from harm.

"We put the 'black stone' on her eyes so she looks beautiful - so her eyes will be healthy and her eyesight will be good," says Nuriya, a young mother of three whose husband is unemployed. "We put black on her eyes now so she'll be able to see at night when she gets older."

Nuriya's mother, Nafes Gul, nods approvingly.

Now that she knows Suriya is doing well, Kuchi gives Nuriya tips on what to feed the baby. This is, after all, a country with no equivalent of books like "What to Expect in the First Year," and no Baby Gerber jars on the shelves.

After six months, she says, you can feed the baby spinach, but don't add oil or salt. Protein isn't a bad idea, either.