My home country, Japan, is one of the safest places in the world to give birth: it has one of the very lowest mortality rates in Asia. A few years ago I had the opportunity to work on a story about midwives in Japan, and I became very interested in their role. In November 2023 I travelled to Badakhshan province in the northeast of Afghanistan, the country with the highest maternal mortality rate in Asia. I wanted to meet midwives there and see how they support women.

The Badakhshan province is far from Kabul, with rugged terrain and poor transportation and medical infrastructure. In winter, heavy snowfall blocks roads for months. Women who are about to give birth are sometimes carried on donkeys escorted by family members or neighbours on multi-day trips to clinics. The literacy rate for women there is extremely low compared with other provinces – less than 10% – which is partly why there’s a serious shortage of midwives. This combination of geographic, social and cultural factors means there are often delays responding to emergencies, and deaths from complications like excessive bleeding or infection, which might otherwise have been preventable.

This picture was taken in a small village while I was following a mobile health team of six, organised by the United Nations Population Fund. The midwife, Anisa, was giving medical checkups to women who had recently delivered a baby at home. One of these mothers took us to another woman in the neighbourhood who was nine months pregnant but had never had a checkup. Anisa is listening to the baby’s heartbeat with a stethoscope in the picture, and telling the woman: “Your baby is growing well, and if you start having contractions, be sure to call me and I’ll come right away.” Ten days later, Anisa assisted the delivery at her home.

After she finished a long day at work, I was in the same car with Anisa. She looked out the window at the narrow mountain road, and I saw a snowy peak in the distance, and said it must be so tough to travel from village to village every day, especially in winter. She replied that, even so, she would continue to do this work in an area where so many women have died – that being able to save a single life at birth is reward enough. I was really touched.

Midwives like Anisa are saving pregnant women in many ways – not only helping them give birth but also acting as unofficial therapists. Afghan women are often isolated and disconnected from society, but with the midwives they can share personal problems they would never be able to otherwise, such as struggles with mothers-in-law, or their marriages. Women who have been pregnant for years – some have 10 children – ask their midwives to help persuade their husbands to use birth control. It’s not easy, but they do succeed sometimes.

The UN team is in charge of 13 villages that don’t have any medical facilities. In conservative rural areas, it was customary for women to be accompanied by male relatives when travelling, even before the Taliban regained power in 2021. Since then, this rule is followed more stringently. This makes it difficult for women to travel to distant clinics.

After the Taliban took over, many international donors that had supported Afghanistan’s healthcare system withdrew, and hospitals and clinics have been forced to close amid concern that the maternal mortality rate will worsen. In December 2024, the Taliban banned the midwifery schools, having already banned women’s wider education. While those who had already graduated could still work, women who had not completed their studies could not.

Last month I found out that Anisa has not been able to work as a midwife since January. Since the withdrawal of international donors and US aid after Donald Trump’s suspension order to cut US foreign aid for 90 days, the mobile health team can no longer function. Anisa and her husband, who was a vaccinator on the mobile team, are both jobless for now.

Noriko Hayashi’s CV

Born: Kanagawa, Japan 1983.
Trained: Self-taught
Influences: “My grandmother, who taught me the importance of being positive, and encouraged me to pursue what I am passionate about when I started photography”
High point: “Now. I have some long-term photographic projects which I truly love. I feel privileged to be able to challenge myself to create better work which I care about. And I feel grateful when I get feedback from people saying they were touched or empowered by my work”
Low point: “Having projects interrupted because of Covid”
Top tip: “Find a personal project that you really care about and never compromise your vision – it can be your strength and will ultimately support you as a photographer”

• Noriko Hayashi is the winner of the Japan professional award at the Sony World photography awards 2025. The accompanying exhibition is at Somerset House, London, from 17 April to 5 May