The Afghan Midwives Association: A traditional calling on a new path
Through its participation in the Rural Expansion
of Afghanistan's Community-Based Health (REACH) Program,
Jhpiego is applying its training approach and capacity-building model to address the urgent
need for healthcare providers—especially midwives—and the long-term goal of
rehabilitation of maternal health care in post-conflict Afghanistan.
This story was written by Judie Schiffbauer of
Management Sciences for Health (MSH), Writer/Editor on the USAID/REACH Program in
Afghanistan.
Two women: One, an American, born in 1881; one, born 80 years later in Ghorban,
Parwan province, Afghanistan. The first rode on horseback to help women giving birth in
isolated areas of the Appalachian mountains in east Kentucky; the second has delivered
the babies of Afghan refugees and braved the rough terrain of northern Afghanistan to
train others in bringing life. Kentucky’s Mary Breckinridge and Afghanistan’s Pashtoon
Azfar never met, but the former devoted her life to a cause the second is now spear-heading
half a world away: the establishment of trained midwifery as a profession—and as a calling
worthy of support and respect.
The first to bring nurse-midwifery to the United States, Breckinridge founded
the Frontier Nursing Service (FNS), the forerunner of the Kentucky State Association of
Midwives, later to become, in 1929, the American Association of Nurse-Midwives. Like
Breckinridge, who acted in response to alarming rates of maternal and child mortality
in the United States at that time, Pashtoon Azfar, Midwifery Education Manager for the
REACH Safe Motherhood Unit, and Chairperson of the newly formed Afghan Midwives
Association (AMA), is a pioneer.
Afghanistan’s maternal and child death rates are among the highest in the world,
yet the Taliban permitted no new nurse-midwives to be trained during its 6-year reign. As
a result, Pashtoon is one of only 537 skilled, trained midwives (kabilaha) estimated to
be in the country.
Pashtoon is working with REACH to triple that number. To date, $6.5 million
in REACH grants have been awarded to support midwifery training at the Institute of Health
Sciences in Afghanistan’s four most populated provinces and six Community Midwife Education
Programs. The programs will graduate approximately 720 newly qualified midwives by the
end of March 2006.
Before joining the REACH Safe Motherhood Unit in April 2004, Pashtoon
spent seven years heading Save the Children’s US Clinic for Primary Health Care and
Reproductive Health in an Afghan refugee camp in Peshawar, Pakistan; she returned to
Afghanistan in August 2003 to train midwives and community health workers as part of
the International Medical Corps’ Rabia Balkhi Hospital Project in Kabul.
Rebuilding and revitalizing Afghanistan’s midwifery training programs
after years of neglect requires unflagging energy and determination: Pashtoon is
actively providing REACH technical assistance to the Institute of Health Sciences in
both Kabul and the provinces as they rehabilitate their Schools of Midwifery and implement
REACH Safe Motherhood objectives. Along with colleagues from the Safe Motherhood Unit,
she also conducts clinical and training skill courses for REACH NGO trainers, who are
responsible for preparing others involved in competency-based midwifery education.
And she is actively involved in the implementation of standardized national midwifery
and community midwife curricula, which will educate Afghan midwives into the future.
However, knowledge and desire alone can’t always effect wide-reaching
change. In March 2004, at a workshop on Reproductive Health sponsored by REACH and
the Afghan Ministry of Health, Dr. Mehr Afzoon Mehr Nessar, Director of the MOH Women’s
and Reproductive Health Directorate, publicly expressed her belief that Afghanistan’s
kabilaha should continue their work with the strength and moral support, the opportunity
for professional growth, and the heightened status that combining their numbers in an
professional association of Afghanistan’s midwives. Pashtoon heard a long-held dream
of her own being voiced, and she soon found herself talking to others about the
possibility of forming the Afghan Midwives Association.
Few women could have been busier, but when her colleagues encouraged
her to undertake the task of being Chairperson at the first AMA meeting on June 6,
2004, Pashtoon accepted.
Aided by REACH Midwifery Advisor—and Jhpiego employee—Sheena Currie,
Pashtoon is tackling an ambitious agenda. At a recent AMA meeting held at Rabia
Balkhi Hospital in Kabul, 25 nurse midwives, all practicing in clinics, health centers,
and hospitals in Kabul, gathered to discuss ways to increase membership. "Nurse-midwives
in every Afghan province must learn of and be represented in the Association,"
says Pashtoon. "The greater our number, the greater good we can do for women,
mothers, and families in this country."
Razia, one of eleven nurse-midwives attending an AMA meeting for
the first time, echoed Pashtoon’s view: "All of us need the support an organization
like this can provide. Until now, we’ve had to work alone."
Before the meeting ended, the group had discussed drafting a
constitution, producing and distributing a newsletter, and finding funds for a
national conference of midwives timed to celebrate International Midwives Day in
Kabul in the spring of 2005.
Within a cultural context that has long excluded women from
educational and professional opportunities, under Pashtoon’s leadership, and
with the support of the MOH and REACH, the Afghan Midwives Association is working
to expand its membership and taking the steps necessary to qualify for membership
in the International Confederation of Midwives. "Afghanistan faces many problems,"
says Pashtoon. "The path will not be easy, but if we travel it together, giving
strength to one another, we can do so much more to help solve them."
In a letter seeking the International body’s support and guidance,
REACH’s Sheena Currie wrote, "The history of midwifery in Afghanistan has yet to
be recorded...". When it is, Pashtoon Azfar will have a proud and prominent place
in its annals.
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