Zubaida travelled from the rural outskirts of Khost in eastern Afghanistan to give birth at a maternity hospital specialising in complicated cases, fearing a fate all too common among pregnant Afghan women – either her death or that of her child.

She lay dazed, surrounded by the unfamiliar bustle of the hospital run by international medical charity Doctors Without Borders, known by its French initials MSF. She was exhausted from the delivery the day before, but also relieved.

Her still-weak newborn slept nearby in an iron crib with peeling paint, the child’s eyes lined with kohl to ward off evil.

“If I had given birth at home, there could have been complications for the baby and for me,” said Zubaida, who doesn’t know her age.

Not all women who make it to the hospital are so lucky.

“Sometimes we receive patients who come too late to save their lives” after delivering at home, said Therese Tuyisabingere, the head of midwifery at MSF in Khost, the capital of the eastern province of Khost.

The facility delivers 20,000 babies a year, nearly half of those born in the province, and it only takes on high-risk and complicated pregnancies, many involving mothers who haven’t had any check-ups.

“This is a big challenge for us to save lives,” said Tuyisabingere.

She and the some 100 midwives at the clinic are on the front lines of a battle to reduce the maternal mortality rate in Afghanistan, where every birth carries major risks and with the odds against women mounting.

Afghanistan is among the worst countries in the world for deaths during childbirth, “with one woman dying every two hours”, said Stephane Dujarric, the spokesperson of United Nations Secretary-General Antonio Guterres, this month.

The Afghan Ministry of Public Health did not respond to requests for comment.

According to the latest World Health Organization (WHO) figures, from 2017, 638 women died in Afghanistan for every 100,000 viable births, compared with 19 in the United States.

That figure conceals the huge disparities between rural and urban areas.

Terje Watterdal, country director for the non-profit Norwegian Afghanistan Committee (NAC), said they saw 5,000 maternal deaths per 100,000 births in remote parts of the country.

“Men carry the women over their shoulders, and the women die over the mountain trying to reach a hospital,” he said.