In this quarter's edition of DONA's publication International Doula, I read a riveting article called "War Zone Doula" about a woman who traveled to Afghanistan to volunteer as a doula at the largest maternity hospital in the country. Similarly to my post recently about A Book for Midwives, this article was also difficult to read because of the conditions in which the women labored and the manner in which they were treated. Afghanistan has the highest maternal death rate in the world and conditions in the hospital described were deplorable--no hand washing, reusing the same gloves, women all laboring in the same room, women having to labor two to a bed, only one cup to drink water with, and things like that. What we are familiar with as the Midwives Model of Care was not present and, as described in this article, the midwives, nurses, and doctors working with these women did not speak to the women, make eye contact with them, offer them information following exams, or show any empathy or nurturing towards them.
This was a very interesting article and if you have a chance to read it, I'd recommend it!
Edited to add: Sheridan left a comment on this post wondering about what kind of access these women have to giving birth at home instead. I don't know, but it is a good question--what is the availability of homebirth midwives like in Afghanistan? Since the hospital culture described seems similar to US hospital culture in the late 1800's and early 1900's when birth was moving into hospitals, I wonder what the homebirth midwifery environment is like? Here is an article and a link to the Midwifery Today page about Afghanistan.