The birth of hope

"Before," explains Kuchi, "women thought that you shouldn't give an egg to a baby because then the child would be [stupid]."

The proud grandmother, Nafes Gul, is glad for the help. She had six boys and two daughters, but also lost four other children in childbirth. When she had her babies, there were no professional midwives; other women in the family simply pitched in to help. She already has 16 grandchildren, she says.

"No, let's count them," says Nuriya, ticking off her siblings' children. "Eighteen."

"Yes, 18," Nafes Gul confirms with a laugh. And then she thanks Kuchi with a blessing: "May you live long."

Kuchi's final stop of the day is at a far poorer home, an adobe-style hut of packed mud. Inside, a young woman is pregnant for the first time - and nervous.

"How old are you?" Kuchi asks.

"Hmm. Maybe 20?" comes the answer in a whisper.

"Name?"

"Fatima."

Kuchi takes out one of the information cards she uses to keep track of her patients. She leaves a copy behind, trying to encourage women to chart their own progress, insisting they keep it with them like an identity card.

Fatima is from the Hazara ethnic group, and her face is an exotic mix of East and West - Asian features with fair skin and freckles. Next to Kuchi's urban clothing, Fatima's tribal garb is bright and colorful. But her mood is not - she isn't feeling well, and is worried she will have a difficult pregnancy.

Her mother-in-law, who sits next to her spinning wool, considers her daughter-in-law to be getting a late start.

Kuchi gives Fatima advice on what to eat - less meat and more vegetables, of which there are few in the Afghan diet. Then she tells her to get more rest and do less heavy work, glancing at Fatima's husband sitting in the corner.

As she leaves, she passes a collection of burqas, hanging on nails jutting out of the mud wall. Outside in the sunlight, Kuchi says she's glad she no longer has to dress in the all-encompassing women's wear that made Afghanistan famous.

"Without it, I feel young again," she says with a smile. "And every time I wore it, I had a headache - it sits so tight around your head."

The fact that most of her patients still wear burqas reminds her of how much Afghanistan has changed since she was young.

In the early 1970s, during Afghanistan's modernizing heyday, women were wearing short skirts. In those days, she wanted to be a flight attendant on Afghanistan's national airline - or a policewoman. Her father insisted she learn to be a midwife instead.

"I resented him then, but now I love it," she says, closing up her kit for the day. Plumes of powdery dust from the alleyway kick up under her heels and swirl around the midwives' long, dark coats.

Tomorrow, Kuchi and her colleague will visit more houses. They will go to several more the next day, and the day after that.

But even with their many rounds, they know they will reach just a small percentage of Kabul's expectant mothers.

Still, this is a big improvement over what life used to be. Under the Taliban, nearly all aid workers came under the suspicion of Afghanistan's leaders, which made it more difficult to address the crisis in maternal fatality rates.

Now, in a freer postwar era, the United Nations and independent aid groups have been able to invest more in training programs for midwives. But their efforts are like a few scattered raindrops on badly parched soil. Many rural provinces still have no medical/health facilities at all - and are not being served by the new programs.

The largest training course is at Kabul's Malalai Women's Hospital, which offers five weeks of classes for midwives.

Many of the students there are women who had already been working as midwives, but had never received any formal instruction.

"If someone becomes known as a midwife, everyone in the village trusts her and looks up to her," says Ziba Kamal, chief of obstetrics at the hospital, during a break in her course for midwives, some of whom have traveled several hours to come to the course.

"Usually she has watched a few others, one or two, and then she becomes a midwife."

It's difficult to know how much of an impact the additional trained midwives are having in reversing the grim statistics surrounding birth in Afghanistan.

But Dr. Kamal and midwives such as Kuchi and Musleh are doing all they can to turn things around.

As Kuchi knows from experience, mothers who have had the help of a midwife are tremendously grateful - and relieved.

The presence of a calm, knowledgeable midwife does more than alleviate fear. It can be the difference between celebration and grief.

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