(WOMENSENEWS)--Sedika Mojadidi, an Afghan American filmmaker, watched in horror as an expectant mother gasped for breath in the maternity ward of Rabia Balkhi Hospital in Kabul, Afghanistan, in August 2003.
The young woman had been brought by her family to the largest women's hospital in the war-torn country. Suffering from preeclampsia--dangerously high blood pressure during pregnancy--the woman began to have seizures, and fearing she was possessed, her family took her to a mullah who beat her into unconsciousness in order to drive away the evil spirits. The lack of proper health care and cultural obstacles had taken their toll, and the woman's baby died in utero.
Despairing scenes like this are common in Afghanistan where 16 percent of women die while pregnant or during childbirth, one every 30 minutes. Afghanistan today has the second highest maternal mortality rate in the world, behind only Sierra Leone, according to the United Nations. In some areas of Afghanistan, maternal rates are as high as 6,000 per 100,000 women.
Afghans' hopes were high that maternal health would improve in the country in October 2001 when the U.S.-led invasion toppled the hard-line Taliban regime. Hundreds of reporters poured into Afghanistan to describe the establishment of a new government and plans to build hospitals and schools. But by 2003, most journalists had departed for Iraq, when Mojadidi and her father returned to their native Kabul from Jacksonville, Fla., where the family had immigrated in 1973.
Dr. Qudrat Mojadidi, an obstetrician specializing in high-risk pregnancies, had been recruited by the U.S. government to help rehabilitate Rabia Balkhi Hospital, including a unit that was renamed as the Laura Bush Maternity Ward. Sedika Mojadidi had come along to make "Motherland Afghanistan," a behind-the-scenes documentary that looked at the crippled health care system and its impact on women.
Elizabeth H. Williams, acting director of the Asia Society's Asian Social Issues Program, said the film, coupled with data and other public health efforts, might spur changes in public policy and generate funding by highlighting a rare issue in today's media coverage of war and reconstruction.
"To do a feature-length film on maternal mortality is really important, because there are not a lot of people out there doing that," she said. "It's one of the key issues."
Concentrated on Systemic Neglect
Unlike other reporters who have focused on the continuing U.S. military presence and the hunt for terrorists in Afghanistan, Mojadidi concentrated on how the systematic neglect of basic services such as prenatal care is undermining U.S. efforts to win hearts and minds.
"I hope the film will give American audiences a more realistic view of Afghan women," said Mojadidi in an interview before a sold-out February screening at the Asia Society in New York. "For the past 25 years, Afghan women have either been ignored in news reports of the Russian occupation and the subsequent civil war, or portrayed in TV films as victims. However, the women in my documentaries don't consider themselves victims; they do everything possible to keep themselves and their children alive."
To film Afghan women living under the brutal Taliban for her first film, "Kabul, Kabul," in 1996, she hid a tiny camera under her veil and traveled in a hospital van to avoid being stopped by police.
For "Motherland Afghanistan," her second film, Mojadidi tapped her experience as a field producer and cameraperson on several medical shows on the Learning Channel. Coming up with a script was difficult because so many factors influence maternal mortality, she said.
High Death Rate for Women
Most Afghans are desperately poor; the United Nations Development Program estimates that 70 percent of the population lives below the poverty line of $2 a day. Although the legal marriage age is 18, 57 percent of girls marry before 16. Few women deliver in a medical facility because there are only 1,100 clinics and 100 hospitals serving 30 million Afghans. As a result, half of all deaths among women of reproductive age are the result of pregnancy and childbirth.
"I decided that the best way to personalize the crisis was to make my father the central character because he has devoted his life to delivering babies and training doctors in Afghanistan," Mojadidi said. "In 2002, he was nominated for a Nobel Peace Prize for his 20 years of work with Afghan refugee women."
The Laura Bush Maternity Ward was not what the Mojadidis had expected.
"Although the U.S. Department of Health and Human Services had touted the hospital as a state-of-the-art facility on its Web site and press releases, it was a disaster," she said. "Infection control was nonexistent; patients delivered on the same plastic sheets one after another. Patients had to buy medications for their surgeries from a pharmacy near the hospital because promised supplies never arrived."
U.S. officials discouraged her from filming the delivery rooms and interviewing the overworked staff.
Struggle to Improve Maternal Care
Her father, Dr. Mojadidi, realized that he couldn't do enough to improve health care at the hospital and resigned after several months. Two years later, an Afghan-led nongovernmental organization that manages hospitals, schools and shelters in Central Afghanistan persuaded him to come back to work at Shuhada Hospital, a rural facility that emphasizes prevention and education. Sedika spent two months there finishing "Motherland Afghanistan."
"Every day my father resisted being on camera but relented because he and the staffs of the hospitals agreed that showing him treating patients in such deplorable conditions was the best way to get the truth out about the maternal mortality crisis," said Mojadidi. "Making the film gave me new insights into the challenges he has faced in his profession and brought us closer. However, making a film together is not an experience that either of us wants to repeat; it is too stressful."
The film's final scenes are profiles in perseverance and hope. After delivering a premature baby, Dr. Mojadidi shows the staff how to treat the infant's respiratory problem. He also instructs the team in the latest methods of treating obstetric fistula and the resulting urinary incontinence following childbirth. As a result, they successfully complete a complicated surgery and, despite the odds, are able to cure a young mother who had been unable to leave her home for eight months and traveled for three days to reach the hospital.
Since "Motherland Afghanistan" was completed, Dr. Mojadidi has trained the first five doctors in an obstetric-gynecological fellowship program for CURE International Hospital in Kabul.
Mojadidi is also working on a new film project that focuses on another common experience of Afghan women: arranged marriages.
"Many people in the independent film business have warned me that a film about a young Afghan woman who comes to the U.S. and meets her husband for the first time will never attract audiences because Americans are only interested in films about the war in Iraq these days," said Mojadidi. "But I'm going ahead because I think that everybody can identify with a resilient Afghan woman who creates a new life in America."
--Alison Bowen contributed to this story.
Sharon Johnson is a New York freelance writer.
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For more information:
"Motherland Afghanistan," Independent Lens, PBS:
"Filmmaker Sharpens U.S. Focus on Fistula":
"U.S. Success in Afghanistan Questioned by Experts":