Fatima’s story illustrates the dire consequences a mother’s death has for her family and her community. She and her husband Ahmed already had nine children and were barely surviving on his salary as a security guard when she became pregnant again. He nearly lost his job taking care of the family during her difficult pregnancy. Then Fatima died giving birth to twin boys in a Kabul hospital. Because Afghanistan’s shattered health care system multiplies their lifetime risks, one in every six Afghan women will die in this way, from complications of pregnancy and childbirth.

Fatima’s hospital expenses put Ahmed deeper into debt, so he took their 13-year-old son out of school to work. The twins had to be fed on goats’ milk and expensive infant formula and they were often ill with diarrhea or acute respiratory infections, the most common killers of infants worldwide. The family’s 11-year-old daughter was taken out of school to care for them. At seven months, the smaller twin died of a respiratory infection.

Ahmed remarried, adding to his debt and poverty, so he married off his oldest daughter when she turned 13. She became pregnant at 15, before her body was ready, and suffered an agonizing obstructed labour. Her baby was born brain-damaged and she was left with an obstetric fistula, an opening between her vagina and bladder that made her incontinent. The resulting wetness and odor caused her acute humiliation. Her husband abandoned her, and she had to return to her father’s home to continue a life of poverty.

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