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Increase in Skilled Midwives in Afghanistan Leads to More Women Surviving Childbirth

Baltimore, MD—The number of midwives providing skilled health care to women in Afghanistan has more than tripled under projects implemented by Jhpiego and partners, leading to significantly more women surviving childbirth.

Jhpiego, an international health non-profit and affiliate of Johns Hopkins University, has been at the forefront of efforts to prevent childbirth-related deaths in Afghanistan since 2002. In partnership with the Afghan government, and funded by the U.S. Agency for International Development (USAID), Jhpiego helped revitalize the Afghan midwifery workforce by developing a national education system to train midwives to provide competent, skilled care to women during childbirth.

In 2003, Afghanistan’s maternal death rate was the second highest in the world. With only 467 midwives in a country of 20 million, less than 8 percent of pregnant women gave birth with skilled providers at their sides, and only one province offered midwifery education.

Today, as the USAID-funded Health Services Support Project (HSSP) concludes, the state of midwifery in Afghanistan is vastly improved:

  • More than 3,000 new midwives have graduated from a network of government-accredited schools, whose curricula and competency-based training were developed by Jhpiego in collaboration with the Afghan Ministry of Public Health and other partners;
  • The percentage of women giving birth in health facilities has increased from 19 percent in 2005 to 32.4 percent in 2011;
  • Midwifery programs have increased from one in 2002 to 30 today;
  • 86 percent of graduates of community midwifery schools obtained jobs;
  • A professional organization of midwives was started and supported with the help of USAID; the association has more than 2,000 members across 33 of 34 provinces;
  • More than 17,000 health care workers, supervisors, faculty and health ministry staff have been trained in 28 areas of care, from emergency obstetric and newborn care to family planning and mental health;
  • 505 health facilities across 21 provinces are using a new quality improvement and assurance system to provide better services to Afghans; and
  • Community health workers have educated more than 10,000 pregnant women living in remote areas on self-administration of misoprostol, a potentially lifesaving drug to prevent postpartum hemorrhage; the drug is taken if women can’t reach health facilities to give birth.

The Afghanistan Mortality Survey released last year by the government showed a significant reduction in the number of women dying in childbirth. The study found that 327 Afghan women die for every 100,000 births, in contrast to 1,400 per 100,000 births, the ratio reported in 2008 by the World Health Organization.

Jhpiego President and Chief Executive Officer Dr. Leslie Mancuso said Jhpiego’s innovative strategies to enhance the capacity of Afghan midwives and to strengthen health facilities throughout the country have helped to save thousands of women from dying from childbirth in Afghanistan.

“The fact that more Afghan women are surviving childbirth is a testament to the newly educated midwives who are working in their communities to prevent the needless deaths of women and families,” said Dr. Mancuso. “Jhpiego’s focus on skilled care and innovative strategies to prevent the deaths of women shows that continued investment in strengthening the Afghan health system will save lives.”

Innovating to Save Lives: Improving Maternal and Newborn Health in Afghanistan Health Services Support Project