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Baku, Azerbaijan—In her relatively short life, Mabuba Rasulova got pregnant 14 different times, most of them unplanned. Six of the pregnancies she aborted, and although she delivered eight children, only four of them survived. Because the family was poor, it was difficult for her to get adequate nutrition. During her last delivery she began to bleed heavily. By the time she was able to make the long journey to the hospital from her remote village it was too late; Mabuba Rasulova had died at age 35.
“My mother passed away because she was ignorant about family planning methods,” says Mabuba's daughter Sadigat. In the small village of Azerbaijan where Sadigat’s mother lived, contraception is rarely discussed, nor is it available. “Like many women, she had little knowledge of reproductive health, so she didn’t understand the importance of taking care of herself during pregnancy.”
Sadigat’s life was transformed by her mother’s death. A modest housewife, her loss led her to become a leader in her community. As a Community Action Group (CAG) member, she educates women in her village on reproductive health and family planning. “My mother lived in a community where access to accurate information about women’s health issues was denied,” says Sadigat. “That’s why she died. I can’t get her back but I can help improve other women’s health so they can give birth to sweet, healthy babies.”
Sadigat’s input to community development is part of a larger health-reform effort called Primary Health Care Strengthening (PHCS). Funded by the US Agency for International Development (USAID), the program is being implemented by a consortium of leading public health agencies led by International Medical Corps. When she speaks with pregnant women, Sadigat stresses the importance of going to a health facility in case complications arise during pregnancy or at the time of delivery. She also works to reduce abortion rates in her community by promoting family planning methods.
Despite some improvements in regional health infrastructure in Azerbaijan, a large number of women in isolated communities still do not receive even a minimum level of health care during pregnancy. According to UNICEF, the risk of maternal death in Azerbaijan is one in 520, compared to one in 30,000 in Sweden. In many remote villages in Azerbaijan, the majority of pregnant women have never seen a health worker. Poor maternal nutrition, short birth intervals, and inaccessibility to emergency obstetrical services contribute to maternal and neonatal mortality and morbidity.
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“For years I avoided asking myself why my mother died and just lived my life,” says Sadigat. “Honestly, I was about to replicate my mother’s story. I did not practice family planning and it started to damage my health. Through PHCS I’ve changed my attitude, behavior, and life. I am now healthy and strong and eager to motivate others to change.”
Among the targets of her campaign: her 23-year-old friend Najiba. Najiba is due to deliver a baby in five weeks, yet she has never seen a gynecologist. “Why should I go to a gynecologist during pregnancy? I am not the first to give birth,” she says.
“Like many other women in remote places, Najiba has very little knowledge of reproductive health and therefore can’t understand the importance of health care during pregnancy,” says Sadigat. But she has faith that her friend will give birth to a healthy child and that the child will have proper care. “Because I’ll be there with help and advice,” she says.
Teaching women the basics about their bodies
In Ismayilli, a picturesque region high in the mountains of Azerbaijan, the majority of women are housewives. Due to the widely practiced tradition of early marriage there is very little awareness about contraceptive methods among yound brides. “It’s hard to believe, but there are women who have more than ten grandchildren, but have no idea how their reproductive organs work,” says Dr. Shahla Babayeva, a community health worker with the PHCS who is committed to teaching women to understand their own bodies.
Most women in Ismayilli don’t practice family planning at all. “Most of them have no idea what an IUD is,” says Dr. Shahla. “During a health education session, I demonstrated an IUD to a community of women. It was followed by a barrage of questions including: ‘What is that? How is it used? Is it dangerous to my health? Can it cause infertility?’ “
The learning curve is steep for most women who have been exposed to the PHCS project. Tarana Akparova, 22, a pregnant woman from a village in Ismayilli, recently attended a PHCS community-based training session. In Tarana’s community, women generally rely on traditional birth attendants or family members to determine whether they are pregnant. “When I came home from the session on reproductive health and family planning, I started a campaign among my fellow villagers trying to convince them of the importance of health care during pregnancy,” Tarana says.
The following day, Tarana went to a local clinic where she was told she had a virus in her blood that jeopardized her pregnancy. The doctor advised Tarana not to panic and to get the necessary treatment. Not only did she go on medication, she also revised her approach to work. Like most pregnant women in rural areas, Tarana had continued to carry heavy loads and to exert herself in the fields during her pregnancy. “But now I am aware that physical stress can cause pregnancy complications, so I try to avoid hard work,” she says.
Tarana now has a better understanding of how to take care of herself during her pregnancy. She is vigilant about visiting her doctor, and she is determined to do whatever it takes to ensure that she and her baby stay healthy.
