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Feroza Mushtari’s lifelong career as a midwife and advocate for Afghan women’s health began with a heart-pounding ride in a taxi cab. As a young girl educated at home under the harsh rule of the Taliban, she was posing as a boy to escort a pregnant woman to the hospital so mother and child could be saved.
“Then I decided to help women, and not let them die because there is no professional to help them when they need it,” says Ms. Mushtari, a driving force in transforming childbirth safety who is credited with swelling the ranks of midwives in Afghanistan. But she’s had to pound on doors.
“It took me years … to convince decision-makers to let me sit at decision-making tables,” she says. “I was, on my own, knocking on the door and entering the room. I said, ‘I am a midwife, and this is a midwife-related agenda, and I want to talk.’ At first, they wouldn’t allow me ... to speak, even when raising my hand,” she says. “They said, ‘Oh, we didn’t invite you.’ And I said, ‘Yes, that is why I am here.’”
Feroza Mushtari was barely a teenager – just 12 or 13 years old – when a desperate knock on the front door changed her life.
Darkness was falling over Kabul on that pre-winter day two decades ago when her mother answered the door. Outside was an older woman who had brought a younger relative, heavily pregnant and in need of urgent help.
The archconservative Islamist Taliban then ruled Afghanistan: Was a man available, as required, who could escort them to the hospital?
The pregnant woman “was twisting in pain and screaming,” and within minutes went into labor and began to bleed, a shocking scene for the young Afghan girl, Ms. Mushtari recalls today.
There were no men around, so the girl came up with a bold plan. She would disguise herself as a boy and be the “male” escort herself. She put on one of her uncle’s turbans, which partly covered her face, and draped a broad-shouldered man’s jacket over her petite frame.
With some Quranic verses slipped into her pocket, Feroza then stopped a taxi and jumped in the front seat, a place reserved only for males. The two women climbed into the back.
“On the way to the hospital, I was practicing how to talk like a boy, if our car was stopped by the Taliban,” Ms. Mushtari recalls. “I remember hearing my heartbeat, just drumming and drumming!”
They arrived safely, and the woman gave birth to a son. The new mother was so grateful, she named the boy Feroz, after their barely teen savior.
Transforming maternal health
And Feroza was so happy at seeing them both survive that she decided to devote her life to becoming a midwife in Afghanistan, a country with some of the worst birth statistics in the world.
“Then I decided to help women, and not let them die because there is no professional to help them when they need it,” says the soft-spoken Ms. Mushtari, speaking with a passion that is radiant with confidence. Today she is an adviser on health affairs for Afghanistan’s first lady, Rula Ghani.
Her climb from housebound bookworm during the Taliban era – albeit one willing to risk danger for the right cause – to being a leading maternal health advocate has been a driving force in transforming childbirth safety for Afghan women.
In 2002, a year after the Taliban were forced from power, the United Nations Children’s Fund (UNICEF) reported there were just 467 trained midwives in the entire country – a number that has surged to 15,000 today, says Ms. Mushtari.
Just a decade ago, Afghan women faced a lifetime risk of death from causes related to pregnancy or childbirth of 1 in 8, the second highest rate in the world, UNICEF reported.
Even in 2014, an Afghan woman still died every two hours from causes related to pregnancy, the U.N. noted in a report that year. But Afghanistan by then had also become “a regional leader in the midwifery profession, and a model for reducing maternal mortality in low-resource post-conflict settings.”
The country has lowered maternal mortality from 1,600 deaths per 100,000 live births to between 1,200 to 800 deaths, though some reports have suggested an even more dramatic improvement, to below 400.
Highlighting Ms. Mushtari’s role, a 2014 U.N. report on midwifery in Afghanistan described her “passion” for her work. And in 2015, she was featured in a “Celebrating Afghans” profile and video to mark the 70th anniversary of the U.N.
“Other midwives, they are trying, because when we see Feroza Mushtari, we are encouraged about how we can work hard, about how we can serve our people in the community,” says Mursal Musawi, president of the 3,000-member Afghan Midwives Association (AMA) and a former student of Ms. Mushtari’s.
Most recently, Ms. Mushtari used her position to raise midwife issues to the cabinet level, where last year her advocacy, with her lobbying, helped establish the country’s first official regulatory body, the Afghanistan Midwives and Nurses Council, says Ms. Musawi.
Bundles of books
Ms. Mushtari’s education began at home when her father, a Soviet-trained engineer, would visit every three months from his job in the Taliban stronghold of Kandahar.
Each visit he brought 40 or 50 books for the bespectacled girl and her siblings to read. She estimates she read more than 1,000 books in the five years of Taliban rule, everything from school textbooks to novels – including stories of characters who changed their appearance to get something done, which helped inspire her to dress up as a boy for the emergency hospital visit.
Feroza Mushtari finished ninth grade two years early, and enrolled in the country’s first formal midwifery school, where she says she studied midwifery “with all my heart.” The day after she graduated in 2004 she began to work. She then learned English and traveled to India to study health psychology.
But Ms. Mushtari soon felt the difficulty of making a difference in a rudimentary health system dominated by male doctors who often dismissed issues of pregnancy, motherhood, and newborns as “caring” issues only.
A crucial turning point came in 2005 with the creation of the AMA. Ms. Mushtari was the first vice president, and later served as president, but found that she had to fight to change attitudes.
“It took me years to find my place and my position within the health system, to convince decision-makers to let me sit at decision-making tables, and talk,” she says.
‘We didn’t invite you’
“I remember when [Health Ministry officials] didn’t inform the association of any decision-making meetings,” she recalls. “I was, on my own, knocking on the door and entering the room. I said, ‘I am a midwife, and this is a midwife-related agenda, and I want to talk.’
“At first, they wouldn’t allow me to sit in the first row [or] allow me to speak, even when raising my hand,” she says. “They said, ‘Oh, we didn’t invite you.’ And I said, ‘Yes, that is why I am here.’
“I had to jump in. Just after two or three meetings, when I started talking, they were listening to me,” she says. “Then I realized, ‘Yes, Feroza, now you know your position, which door to knock on, where to enter. You shouldn’t wait until they invite you.”
But it wasn’t just Afghanistan’s decrepit health system that needed opening up.
In the decade after the fall of the Taliban, with an infusion of tens of millions of dollars from foreign donors, a system of midwifery schools was created, even in remote, deeply conservative regions.
Ms. Mushtari trained midwives for several U.N., local, and international organizations. And as a member of the midwife association’s accreditation body, she traveled to the provinces and heard firsthand about the challenges faced by mothers and newborns.
“At the beginning we had to travel [countless] kilometers to talk to hundreds of people, elders of the community, influencers – always men,” recalls Ms. Mushtari. “It took us weeks to convince them to let their daughters come to midwifery schools. Then after a year we were receiving thousands of applications.”
Pillar of empowerment
The result was twofold and profound, with women becoming breadwinners in their family, and gaining respect through an increasingly accepted profession that is available 24 hours a day, for every family.
“It was not only saving the lives of mothers and babies, it was also educating women,” says Ms. Mushtari. “Now when we talk about women’s empowerment, midwifery is one of the pillars of that [by] educating thousands of women who are now proud midwives, proud teachers, and proud mothers, and proud community mobilizers.”
Yet maternal death rates are still too high in Afghanistan, Ms. Mushtari says. And the country remains an active war zone, where survival is often top priority, and health issues fourth or fifth on the list.
Different strategies are now required to reduce mortality rates, to shift from midwife schools to changing minds, she says.
“It is not only to knock on the door and enter, now you need to knock on their mind and enter inside their minds,” she says. In the past “it was a hardware process, but now it’s a software process.”