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Midwives Bring Skilled Care to Women in Afghanistan

The goal is to reduce the deaths of mothers and babies

Midwife Sadiqa Husseini counsels a young Afghan mother on healthy birth spacing, which can help reduce maternal and newborn deaths.
Midwife Sadiqa Husseini counsels a young Afghan mother on healthy birth spacing, which can help reduce maternal and newborn deaths.

Shah Foladi, Afghanistan—Sadiqa Husseini was there the night her sister nearly bled to death giving birth. Ever since, she has wanted to become a midwife. With the proper education and training, the Afghan community health worker felt she could help prevent the tragic circumstances that left her sister near death and emotionally scarred for life.

“My older sister had a difficult pregnancy . . . After the birth, the whole placenta didn’t come out and my sister suffered terrible bleeding. I didn’t have the technical knowledge at the time to know or understand what was going on,” Sadiqa recalls of that wintry night five years ago.

“All we could do was traditional medical techniques that we knew—like laying her in a blanket, swinging her from side to side to try and make the placenta come out, and putting some herbs in her nose. She nearly died because of the heavy bleeding and eventually went into shock.

“Early in the morning, we took her to the side of the road and flagged down a vehicle that took her to the hospital 20 km away in Bamyan. It was a very dangerous and difficult journey . . . there was a lot of snow and ice on the road. We eventually made it and they were able to treat her properly at the hospital.”

But her sister never fully recovered: “She has a mental problem now and has been unable to have any more children.”

That experience left its mark on Sadiqa: “When I saw this happen in my own family, I wanted to become a midwife… . I didn’t want other women to suffer like my sister and her family have done.”

Sadiqa got her chance to pursue her goal in 2008. She was working at the health clinic in Shah Foladi when she and her fellow community health workers were told about an opportunity to attend a midwifery school in Bamyan province. The school was part of a program funded by the U.S. Agency for International Development (USAID) and supported by Jhpiego and implementing partner Aga Khan Foundation.

There was one spot available and 12 health workers took the exam. Only Sadiqa achieved an acceptable score and met the minimum requirements outlined by the national midwifery education program. But the winning candidate had to have the backing of the community health council.

As part of the USAID-funded program to increase the number of midwives providing health care across Afghanistan, community leaders are asked to help identify possible candidates and participate in selecting the student midwife. It’s an endorsement of a young woman’s potential and a commitment by the community to support her work and improved health care for residents.

Sadiqa was their choice: her husband and family escorted her to Bamyan where she lived in a hostel for 18 months and attended school. Her education was paid for through the Health Services Support Project. After graduation in June 2009, Sadiqa returned to Shah Foladi to begin work.

“I am very happy to have qualified. Everyone in this village was very happy that I took the decision to become a midwife and were very excited when I graduated,” says the 24-year-old mother of two daughters, ages five and two.

Sadiqa’s day usually begins at 8 a.m. Pregnant women arrive at the Foladi Health Center for prenatal care appointments. Others come for information on family planning or to attend a health education class.

Then there are the calls to help deliver a baby.

“Most of the deliveries we do here happen at night,” says Sadiqa, who earns $150 a month to help support her family. “I try and encourage women to come to the health center to give birth . . . People in these rural communities prefer to deliver at home—I am happy to do this and will take my midwife kit to their home—but I try and explain that the facilities in the health center are much better for them and they can get more comprehensive care there.”

Afghanistan has the second highest maternal and infant mortality rates in the world, a situation in part due to the deterioration of the health care system and the dearth of female health care providers during the years the Taliban ruled Afghanistan with strict Islamic laws. Increasing access to and improving the quality of emergency obstetric care with a skilled birth attendant is at the forefront of the Ministry of Public Health’s strategy to improve maternal and newborn health.

Since the end of Taliban rule, with the support of USAID, Jhpiego and partners have worked with the Ministry of Public Health to establish a national midwifery education system, train and support skilled birth attendants, and improve the quality of health care service delivery. Accredited schools now exist in almost every province and more than 2,000 midwives have graduated.

The impact of this growing force of maternal health specialists is reflected in the increasing number of Afghan women who give birth with skilled care. Deliveries assisted by a skilled birth attendant have increased from 8 percent in 2003 to 19 percent in 2006, the most recent data available.

Health care choices for many Afghan women have increased significantly as more midwives were educated and returned to their home communities to work. As of last year, 86 percent of midwives educated in the new system were working. In provinces with midwifery schools, more women are getting prenatal care services and delivering with skilled birth attendants than in areas without midwifery schools.

Through the USAID-funded program in partnership with the Afghan health ministry, the ranks of the country’s midwives have grown from 467 to more than 2,000. With the support of local health committees, midwives across Afghanistan are strengthening the health care system and improving the quality of care delivered to women and families.

Sadiqa is living proof of that. She is the most respected lady in Shah Foladi. Whereever she goes, the villagers proudly say, “That’s our girl.”

Jhpiego believes that when women are healthy, families and communities are strong. We won’t rest until all women and their families—no matter where they live—can access the health care they need to pursue happy and productive lives.

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