The Tragedy of Reproductive Biology

This essay developed into the central thesis of Women in the Line of Fire: that historically high rates of maternal mortality have governed male-female relationships since time out of mind, and that only since women have ceased to die wholesale in childbirth (in America, about 1940, when the average woman’s lifetime risk of maternal mortality dropped below 1%) has it begun to be possible for women to have human (and thus intellectual, economic, social, political) worth equal to that of men.

The SEATTLE POST-INTELLIGENCER, Friday, March 11, 2005

For Afghan women, biology is tragic


BAGRAM AIR FIELD — In War, wrote Carl von Clausewitz in “On War,” everything is simple. But simple things become very difficult.

In Afghanistan, everything is hard. Existence is war for survival. Terrain and climate, poverty and isolation, religion and history have made this a society based upon family, clan and tribe — based upon them because, under such conditions, only small, cohesive units survive, and only to the extent that they remain cohesive. Their ways are brutal because isolation breeds brutality, because brutality feeds on isolation, and also because far too often, brutality works.

In the mountains of Afghanistan, as in the deserts of Araby, it doesn’t pay to trust.

The people of Afghanistan are weary, some weary enough even to try the 21st century. But to make it into the world, they need to develop something they’ve never had before.

Trust. The kind of trust that makes society more than a collection of feuding factions. The kind of trust that has less to do with elections held and aid disbursed and the standard indices of progress — how we Americans do love our standard indices of progress — than with the people of Afghanistan learning to trust each other. Such nation-building trust, I am convinced, can take root only when men and women learn to trust one another as equals and begin to redeem their civilization together as equals.

That will be hard. Death gets in the way.

According to the CIA World Fact Book, the average Afghan woman has 6.78 children. According to a nurse in the Salang District Clinic, Parwan Province, she currently sees one or two maternal deaths per hundred births. But that was what she saw: an average lifetime risk of dying in childbirth between 6.78 and 13.56 percent. Elsewhere in the same district, it could be considerably worse. Afghanistan’s birth rate is 47.27 per thousand people. In the district of Shekh Ali, also in Parwan Province, the elders said their first need was for a clinic. One or two hundred of their women died every year in childbirth. I asked them how many children they had and what the district population was. They said the district had about 70,000 people and that while men normally had only one wife, 15 or 16 children was the norm. That means between 100 and 200 maternal deaths per 3,308.9 live births.

Two questions came to me. Do you mean one wife at a time? How many wives does it take to produce those children?

Do the math. What are the odds that she will survive all those births? Worse than the odds against U.S. combat soldiers during WW II. Or if you favor a more standard index, the U.S. maternal mortality rate is about 7.5 women per hundred thousand births.

But I did not ask those questions. I could only think that if they had any feeling at all, their manhood must lay heavy upon them. As it must have lain heavy upon our own ancestors, before the advent of antiseptic surgery, reliable contraception and safe abortion.

In driving back to Bagram along the Ghorban Road, I spent four hours passing the wreckage of the Russian War — unintended memorials silently screaming, This is what happened here — I could not but look upon the women and their daughters, working in the fields, somewhat differently.

I realized that to be female in Afghanistan is to live under sentence of death. It was then that I understood (but did not condone) the emphasis on daughters marrying virgin, to proclaiming it a matter of honor and pride to kill (it is never called murder) a daughter who wasn’t. When your daughter, if fertile, will have many children, you want her and her children provided for. The future of the clan, the tribe, requires it. But if she is likely to lose her child, and even more likely to be killed or maimed in childbed, you want her at least to be mourned. And if she is unmarried and pregnant, at least she is killed by her family, not cast off by strangers to die. Such daughters dishonor their families by giving their lives to men who do not value them.

As for the men squatting like gargoyles by the side of the road while the women worked: When you can expect your wife to die, and your children, and your neighbor’s wives and children, what point is there in getting too attached? What point is there to learn to recognize and honor and enjoy their full humanity?

Slowly, as Afghanistan begins to emerge from centuries of backwardness filtered through two decades of lunatic war and oppression, women begin to take their rightful place, and in more places than the big cities. I was thrilled in Wardak Province to see women with their burqas thrown back, talking to men in public and to learn that they will soon have women police. I was thrilled in a clinic in Gazhni Province when a woman in a burqa demanded to speak with me, her eyes lighting up with the contact, or on a staircase at the Ministry of Education when two women in burkas grabbed my hand and the hands of the female soldiers. These, too, are indices of progress.

For most of human history, biology was not just destiny. It was tragedy. For women and for men. It need not be that way any longer. Anywhere.


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