Doctors See Surge in Birth Defects

In a rented house in Kabul’s eastern Kart-e-Naw district, Seema frets over her one-year-old daughter, who was born with a cleft palate and whose cheeks are torn and practically shredded.

"I don't know what to do," cried the 38-year-old mother. "I wish God hadn't allowed her to be born so that I wouldn't suffer this pain at seeing her."

Seema's husband is a labourer and hardly earns enough to keep the family in food. The baby has already undergone one unsuccessful operation at the Child Health Hospital here and the family is too poor to take their daughter outside the country for treatment.

"We don't have money to take our daughter to Pakistan and we have been given a negative answer by the doctors here," said Seema.

Seema’s daughter symbolises what doctors say is a growing problem of children born with physical and mental birth defects, despite the best efforts of local and international health officials to stem the increase.

Medical experts blame more than two decades of warfare and the resulting poverty and stress for the increase. They note that pregnant women often suffer from physical and psychological abuse and point to the increase in illegal drug use, all conditions that can harm an unborn child.

But some cite a tradition much older than Afghanistan’s recent troubles for a number of children suffering birth defects.

"One of the main reasons for birth defects is marriage between first cousins," said Dr Alberto Cairo, head of orthopaedic programmes for the International Committee of the Red Cross in Afghanistan.

While no statistics are available for the nation as a whole, Dr Zubaida Sediqi, an administrator at the Child Health Hospital, one of the largest in the country, estimated that birth defects had increased by 50 per cent in recent years. She was not able to say exactly when the increase began.

"I began treating birth defects eight years ago, and would say that they've affected 18,000 to 20,000 children during that time," said Cairo.

In one of the hospital’s wards on the day IWPR visited, Aaqila's 20-day-old baby lay with deformed feet and an enormous boil on her back. Her father is a labourer and lucky if he can find employment one day a week.

"During my pregnancy, I was hungry, I wanted to eat fruit but I often couldn’t afford it. I couldn't even get vegetables," said Aaqila, adding that she had also taken heart medication, which she felt had affected her child.

In the same room, an 18-month-old boy lay silent on another bed, his legs held steady by rope, his pelvis twisted.

"I don't know what major sin I have committed that God has burdened me with so great pain. I wish either I or this child had died during the delivery," said his mother, Feriba.

Dr Safi Samsoar, in charge of the orthopaedic section of the hospital, lists a number of reasons he blames for the surge in birth defects.

"War, poverty, migrations and psychological problems, physical and mental pressure over the women are causes of child defects," he said. "Although cases like this have occurred in the past, they were much less in comparison to nowadays."

Dr Sediqi also noted that some pregnant women, especially in remote areas where medical facilities are limited or non-existent, sometimes treat themselves with opium to relieve pain or depression.

"A lack of medical facilities in remote areas prompts people to use opium as a pain reliever," she said. "Pregnant women who don't know any better use it too."

Dr Zakia Amin of the Swedish Save the Children Clinic said that five of every 300 mothers coming in for examinations each week are carrying children with a mental or physical defects.

Many pregnant women suffer vitamin deficiencies, mostly because of poverty, and many are forced to work through their pregnancies, she said.

She added, "As seen in our clinic, cases of birth defects have increased by 30 per cent compared to the past."

Fiona Smith, who also works with Save the Children, cited wife beating as another factor.

"If a mother is struck by her husband or someone else, it's certain to be traumatic both physically and mentally, and the child will be affected too," she said.

Smith said the government and international organisations should undertake an education campaign against the abuse of women, and also conduct regular vaccination programmes.

But other doctors, like the Red Cross’s Cairo, emphasised that arranged marriages between first cousins was largely to blame.

While it is impossible to obtain accurate figures, such marriages are widespread. One of the main reasons is that Afghan parents almost always choose their son's bride. Knowing her family well is seen as a way of ensuring that she will make a good daughter-in-law.

"Since the father and mother have similar chromosomes, their kids may be born with defects or disabilities," said Cairo.

Salima Ghafari is an IWPR staff reporter in Kabul.