A woman haemorrhages to death as she lies screaming in agony in a spartan hut in a remote region of Afghanistan. There is no doctor or midwife to help and the hospital is several days journey away.
Women die this way every day in Afghanistan, a country with one of the world's highest maternal mortality rates.
About 1,600 Afghan women die in childbirth out of every 100,000 live births. In some of the most remote areas, the death rate is as high as 6,500. In comparison, the average rate in developing countries is 450 and in developed countries it is 9.
Virtually everyone in Afghanistan can recount a story about a relative dying in childbirth, often from minor complications that can be easily treated with proper medical care.
Sharifa's sister, a mother of six, bled to death after giving birth at home.
"There is no clinic, no cars, no proper roads. It is a remote village, we could not take her to hospital. She remained at home for one day and one night, then she died," recalled Sharifa, who identified herself only by her first name.
Afghanistan's government aims to reduce maternal mortality by 20 percent by 2020 but there are many obstacles to overcome such as a reluctance by women to be examined by male doctors and a lack of female doctors, nurses and midwives.
Then there are the vast distances in this war-torn country where hospitals are generally poorly equipped and medical help is inaccessible to those living in remote locations.
HOME BIRTHS
It is an age old practice for Afghan women in rural areas to deliver babies at home. Trained midwives are rarely in attendance. If there are complications, it might take hours, even days to reach the nearest clinic.
Even when women with labour complications get to hospital alive, there are often no doctors or medical equipment to perform caesarean sections and other life saving procedures.
"In some places, there aren't even operating theatres and women just wait for their death," said Rona Azamyan, who coordinates the Midwifery Education Programme in Faizabad.
Among the prime complications of childbirth in Afghanistan are bleeding, infection, hypertension and obstructed labour.
It is not uncommon for girls as young as 13 to marry in Afghanistan and there are often complications when they give birth.
"The mothers are very young, so their (pelvic) bone development is immature," said Karima Mayar, a family planning team leader at the Ministry of Public Health.
Poor and malnourished, many pregnant women in Afghanistan are severely anaemic.
"If they get post-partum haemorrhage, they will die 100 percent of the time," said Mayar.
