Azfar is a midwife, teacher and public servant dedicated to women's health issues. With the help of American-based charity Jhpiego (full disclosure: I worked with their CEO Leslie Mancuso for a conference in a prior job), she's attempting to increase the numbers of and training for midwives in Afghanistan to combat a serious maternal mortality problem. Writes Denise Grady in the New York Times:
Afghanistan has the world's second-highest death rate in women during pregnancy and childbirth (only Sierra Leone's is worse). For every 100,000 births, 1,600 mothers die; in wealthy countries the rates range from 1 to 12. In one remote northeastern province, Badakhshan, 6,507 mothers die for every 100,000 births, according to a 2005 report in the medical journal Lancet. In all, 26,000 Afghan women a year die while pregnant or giving birth.
The main causes of these deaths are hemorrhage and obstructed labor, which can be fatal if a woman cannot obtain a Caesarean section. Even if the mother survives, obstructed labor without a Caesarean usually kills the baby. Most of the maternal deaths - 78 percent, according to the Lancet report - could be prevented.
Azfar does see some reason for optimism.
She ran through statistics showing notable increases recently in the country's number of midwives, their education and the percentage of women who give birth with the help of a "skilled attendant," usually a midwife. The United States, the World Bank, the European Commission, Unicef, the Hopkins group (known as Jhpiego) and other donors have all helped Afghanistan's Ministry of Public Health to make improvements.
But there is a long way to go. Most women in Afghanistan, as many as 80 percent, still give birth without skilled help, and only a third receive any medical care at all during pregnancy.
Azfar, working tirelessly despite 5 children of her own, has been using her own training and the money she raises to help improve the quality of training and the number of Afghan midwives.
Joya came to her political activism from another profession serving women: she was an underground school teacher during the Taliban years. Johann Hari writes in The Independent:
She soon discovered that she loved to teach – and, when she turned 16, a charity called the Organisation for Promoting Afghan Women's Capabilities (OPAWC) made a bold suggestion: go to Afghanistan, and set up a secret school for girls, under the noses of the Taliban tyranny.
So she gathered her few clothes and books and was smuggled across the border – and "the best days of my life" began. She loathed being forced to wear a burka, being harassed on the streets by the omnipresent "vice and virtue" police, and being under constant threat of being discovered and executed. But she says it was worth it for the little girls. "Every time a new girl joined the class, it was a triumph," she says, beaming. "There is no better feeling."
Teaching — and avoiding the Taliban — gave her the courage to take on the directorship of the charity and then to open a women's clinic, just before September 11th.
But after the Taliban fell, she saw life getting harder for herself and the women she served, as the warlords that ruled Afghanistan in between the Soviet withdrawal and the ride of the Taliban came back to power right under the Americans' noses.
As an example, she names the former governor of Herat, Ismail Khan. He set up his own "vice and virtue" squads which terrorised women and smashed up video and music cassettes. He had his own "private militias, private jails". The constitution of Afghanistan is irrelevant in these private fiefdoms.
Joya discovered just what this meant when she started to set up the clinic – and a local warlord announced that it would not be allowed, since she was a woman, and a critic of fundamentalism. She did it anyway, and decided to fight this fundamentalist by running in the election for the Loya jirga ("meeting of the elders") to draw up the new Afghan constitution. There was a great swelling of support for this girl who wanted to build a clinic – and she was elected.
Naturally, her new status as a woman in the Parliament meant little to the warlords in it, many of whom were (and are) notorious abusers of women and human rights. Joya couldn't stay silent.
When her turn came, she stood, looked around at the blood-soaked warlords on every side, and began to speak. "Why are we allowing criminals to be present here? They are responsible for our situation now... It is they who turned our country into the centre of national and international wars. They are the most anti-women elements in our society who have brought our country to this state and they intend to do the same again... They should instead be prosecuted in the national and international courts."
These warlords – who brag about being hard men – could not cope with a slender young woman speaking the truth. They began to shriek and howl, calling her a "prostitute" and "infidel", and throwing bottles at her. One man tried to punch her in the face. Her microphone was cut off and the jirga descended into a riot.
Joya had to be placed under near-constant protection, and American and NATO forces explicitly told her to stop antagonizing their warlord allies.
But the US and Nato occupiers instructed Joya that she must show "politeness and respect" for the other delegates. When Zalmay Khalilzad, the US Ambassador, said this, she replied: "If these criminals raped your mother or your daughter or your grandmother, or killed seven of your sons, let alone destroyed all the moral and material treasure of your country, what words would you use against such criminals that will be inside the framework of politeness and respect?"
Khalilzad was unmoved, and the constitutional convention went forward. On the strength of her speech and the backlash it engendered from men, Joya was elected to Parliament and the death threats only mounted.
She started her maiden speech by saying: "My condolences to the people of Afghanistan..."
Before she could continue, the warlords began to shout that they would rape and kill her. One warlord, Abdul Sayyaf, yelled a threat at her. Joya looked him straight in the eye and said: "We are not in [the area he rules by force] here, so control yourself."
The shouting didn't quiet Joya, and the men got angrier and angrier, eventually (and illegally) stripping her of her Parliamentary seat for questioning the amnesty-in-perpetuity they elected to provide themselves with for war crimes. This, notably, is the same Parliament — and President — that was more than willing to legalize marital rape for electoral success.
These days, she spends her hours moving in between safe houses while criticizing the government. She was married in secret two years ago to a man who supports her work, but they remain too concerned for his safety to live together. She expects that, sooner or later, the fundamentalists gunning for her will succeed.
Where does this courage come from? She acts as if the answer is obvious – anyone would do it, she claims. But they don't. Perhaps it comes from her belief that the struggle is long and our individual lives are short, so we can only advance our chosen cause by inches, knowing others will pick up our baton. "When I die, others will come. I am sure of that," she says.
She has written a book, to make sure something of her struggle to bring education to girls, health care to women and democracy to her country are remembered after her death. And, perhaps it even won't.