It has experienced a civil war and 3 changes in government since then. 100 times the rate in countries like Canada. This was not always the case in Tajikistan. During this time, the majority of women had their deliveries in hospitals, attended by midwives and obstetricians. Only international aid prevents complete collapse.
Few women have antenatal care.
The challenge for MSF is to design and implement a project to improve the health status of women and newborns in a context in which overall poverty significantly contributes to the underuse of available services and trained health personnel. For a woman to deliver in a hospital, her family must transport her there, pay all the health personnel as well as the cleaner, bring their own sheets and food, along with coal or wood to heat the room, and supply all the drugs and medical materials. Many cannot afford all this. It was felt that the strategy required activities that targeted different levels of care. First, we needed to improve the knowledge, skills and practices of those who attend home deliveries.