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Amid war Afghanistan trains thousands of new midwives

Afghanistan's health system is still deeply troubled after decades of war. But progress is being to reduce infant and maternal mortality.

(Page 2 of 2)



Midwives see progress

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Midwives working in the field say that they see signs of improvement every day in the communities they visit. This is thanks in large part to the growing role of skilled birth attendants whose services are now accessible to many women throughout the country, including those in hard-to-reach rural regions, where midwife use jumped from 6 percent in 2003 to 19 percent three years later, according to Johns Hopkins University research.

Dr. Noorkhanoom (some Afghans use only one name), has been making house calls to Kabul's poorest families since 1996, when she went to work for TDH. She joined TDH, a Swiss nongovernmental organization, after being barred by the Taliban from her university job teaching medicine.

During this home visit, Noork­ha­noom shakes her head when a woman in the group says that her husband is beating her. The men of her own family are coming to talk to her husband today, the woman tells the doctor, looking down at the worn trousers of her mint-green pants suit.

The doctor turns to the woman's mother-in-law and asks her what can be done. The mother-in-law shrugs and confesses she is unable to meddle in her son's affairs.

The group is silent for a moment before the midwives resume their presentation, using a young woman in the group who is 17 and pregnant with her first child to demonstrate how to keep the delivering mother comfortable during labor. They show how to support the baby's neck when it emerges and how to cut the umbilical cord. The women seated before them listen rapt with attention, asking questions throughout. When the visit is finished an hour later, each of the ladies rises to hug the midwives and the doctor.

The visits are part of TDH's Maternal and Child Health Home Visiting Program. Six days a week, from early morning to dusk in Kabul and Kandahar, TDH's 50 midwives, working in teams of two, knock on doors and follow up on referrals, bringing their presentations to as many women as they can gather together. The program counts 110,000 beneficiaries in the capital alone.

Azfar, of the Afghan Midwives Association, says the increase in the number of trained midwives is not only a lifeline for mothers – it's an economic boon for the midwives.

"If people think a midwife in their family will be contributing to the household, fathers and brothers will support their mothers and wives and daughters," says Azfar. "If a woman has any economic role in the family, for sure she has some decisionmaking role as well. That is why I am an advocate of this. It is not just for midwifery – it is for change."

Both Azfar and Noorkhanoom say the best way to cement such gains is to improve security. "You cannot expect so much change in one or two or even five years," says Noorkhanoom. "I hope the international community will continue to support us; they left us once, and they saw the negative results.... If they leave this country again, it will be a crime."

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