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Direct Link to Report: The State of Afghanistan Midwifery 2014 - http://countryoffice.unfpa.org/filemanager/files/afghanistan/2014/reports/midwifery_report_2014_english.pdf
Afghanistan - Midwives Help Lower Afghan
Towering Maternal Death Rate
Fahima
Nazary, head of midwifery at the CURE Hospital in Kabul, looks over a mother
and newborn. © UNFPA Afghanistan/Rada Akbar
UNFPA –
7 January 2015 - NEW YORK/KABUL – Boosting the ranks of midwives has
helped to lower Afghanistan’s towering maternal and newborn death rates, a new
report shows.
Decades
of grinding conflict and repressive attitudes towards women had led to enormous
maternal and infant death rates, according to the report, The State of Afghanistan’s Midwifery
2014. After Taliban insurgents gained control in 1996, restrictions
on women’s health care – in particular, a prohibition on receiving care from
male health workers – left many pregnant women without the assistance of
skilled health personnel such as doctors, nurses or midwives.
By 2002,
Afghanistan’s maternal mortality ratio was one of the highest in the world. For
every 100,000 live births, some 1,600 women died from causes related to
pregnancy or childbirth, says the report, which was jointly produced by UNFPA,
Afghanistan’s health ministry, and other partners.
Empowering Midwives
To
reverse this trend, health officials and international partners sought to
strengthen midwifery services – both in hospital settings and in rural
communities, where many women live beyond the reach of conventional health
facilities. To develop the skills of midwives, UNFPA and partner organizations
supported a variety of two-year training programmes.
“In the
past, the community thought very negatively of the midwifery profession. Many
patients and their families didn't trust us and wanted doctors even for routine
procedures,” said Fahima Naziri, the midwifery head at the CURE maternity
hospital in Kabul.
“Now,
the situation has changed. With the professionalization of midwifery, people
trust midwives and respect us as health professionals,” she said.These
programmes helped increase the proportion of people living within a two-hour
walk of basic health care – between 2003 and 2009, this number grew from 9 per
cent to 85 per cent.
Today,
"Afghanistan is a regional leader in the midwifery profession and a model
for reducing maternal mortality in post-conflict settings," said Deputy
Public Health Minister Ahmad Jan Naeem at the report’s launch on 12 December.
"In 2002, there were only 467 midwives in the country. A decade later,
more than 4,600 midwives work in Afghanistan."
According
to UNFPA’s latest State of World Population report, Afghanistan’s
maternal death rate now stands at 400 deaths per 100,000 live births – still
among the highest in the world. Other estimates, from the Afghanistan Public
Health Institute, are a little lower.
Maternal
mortality in Afghanistan is “still unacceptably high,” Public Health Minister
Suraya Dalil conceded in the report, “but [it is] showing significant
progress”.
Still,
much more progress is needed. In 2012, only 23 per cent of the need for
maternal and reproductive health services was met, the State of Afghanistan’s
Midwifery indicated.
And “if
Afghanistan maintains its current graduation rate, only 8 per cent of estimated
need will be met in 2030,” it said.
Bachelor’s Degree
Programmes
In
response, health officials are redoubling their efforts. Afghanistan is now
among the first countries in the region to develop an internationally
recognized degree-level midwifery programme.
“I have
witnessed the difficulties women face in safely delivering babies,” said
Yalda, a young woman from Faryab Province . “When my cousin was
pregnant, we called the ambulance, but it didn't arrive on time. She started
bleeding and her child died.”
Yalda is
now enrolled in the four-year midwifery programme at Kabul University, where
UNFPA helped to develop the curriculum. “This is the first time I have
left my home and family,” she said, adding, “I will be the first in my
province” to earn a bachelor’s degree in midwifery.
After
she completes her studies, Yalda wants to return home to help the women in her
community. But she knows that persistent, traditional ideas about women and
childbirth will pose a challenge to her and other midwives.
“Lack of
knowledge and tradition are the key barriers for women accessing reproductive
health services. For instance, mothers-in-law will say that they delivered
their babies at home and that they didn't need to go to hospital. They will ask
their daughters-in-law why they want to go to a hospital.”
But she
and her classmates say they are undeterred by the many obstacles they face.
“I chose
to help Afghan women because they really need us,” said Nasrin, another
midwifery student at Kabul University. “Afghanistan needs many changes in
many areas. When it comes to health care, I will do whatever I can for women
and children.”