When the first and only midwifery school was opened in 2004 in Bamyan city, central Afghanistan, not a single application was received for the 18-month course. Today, the school has to turn down dozens of applications from women all over the province because it cannot accommodate more than 25 students at a time.
“We have earned the peoples’ trust in our work,” Saleha Hamnavazada, coordinator of Bamyan Midwifery School, told IRIN. “We have created a reliable learning environment for women and have assured their men that women are totally safe and protected here.”
Conservative traditions in Afghanistan have restricted women’s and girls’ access to education, work, healthcare and other social activities across the country, albeit in varying degrees.
Women and girls are often stopped from going to health centres or schools because of a lack of female health workers and teachers.
The consequences are severe: annually, 24,000 women die before, during or just after childbirth because of a lack of healthcare; and the female illiteracy rate is one of the highest in the world at more than 85 percent, according to UN agencies.
Photo: Masoud Popalzai/IRIN
In addition to providing essential obstetric care, midwives raise awareness of family planning and HIV/AIDS
Breaking down barriers
“I want to break superstitious taboos in our society which impede women’s education and work,” Masooma, a midwifery student from Daikundi Province, told IRIN. “I saw the deaths of my two sisters-in-law during childbirth because there was no midwife or doctor to save them.”
However, the midwifery profession is starting to be considered both decent and lucrative for women, particularly in rural areas.
“A midwife works only for women so it is acceptable,” said one man in Bamyan city, who requested anonymity.
The number of midwifery schools in the country has increased from six in 2002 to 31 in 2009, according to Pashtoon Azfar, director of the National Association of Midwives (NAM). Since 2002, more than 2,000 midwives have been trained and employed by the Ministry of Public Health (MoPH) and NGOs in health centres across the country, Azfar told IRIN.
Midwives are believed to have improved women’s access to essential health services and have reduced maternal mortality in some parts of the country.
“Maternal death during child delivery has decreased by about 50 percent,” Zainab Rezayee, an obstetrician in Bamyan Provincial Hospital, told IRIN, referring to her hospital. Both Bamyan Provincial Hospital and Bamyan Midwifery School are managed by the Aga Khan Development Network.
In 2004, two to four babies were born every month at health centres in rural Bamyan. Today, more than 35 are born in medical centres every month thanks to 41 graduated midwives in the province. Deliveries at Bamyan Provincial Hospital have increased from 30 a month in 2004 to more than 130 in 2009, Rezayee said.
Across the country, the percentage of women receiving antenatal care increased from 4.6 percent in 2002 to 32 percent in 2006, while the rate of child deliveries attended by a skilled health worker increased from 8 percent to over 19 percent in the same period, according to NAM.
In addition to facilitating childbirth, midwives increase women’s awareness about family planning, HIV/AIDS and transmittable sexual diseases.
Photo: Akmal Dawi/IRIN
|Afghanistan needs up to 8,000 midwives to curb its high infant and maternal mortality ratios|
Officials in the health ministry say it is time to re-assess Afghanistan’s poor maternal mortality record – rated the second-worst in the world after Sierra Leone, with 1,600 maternal deaths per 100,000 live births, in a 2006 nationwide assessment.
“We need a new assessment to gauge how much the ratio has dropped,” said Azfar, who also heads the main midwifery school in Kabul.
No quick fix
Afghanistan has one of the highest fertility rates in Asia and the average Afghan woman gives birth to six to seven children in her life, according to the UN Population Fund.
There are about 2,400 midwives in the country but about 8,000 are required to provide basic obstetric services for all Afghan women, NAM said.
“We train 300-400 midwives every year at 31 midwifery schools in the country,” said Azfar, adding that one school would be opened by the end of 2009 in the Paktika Province where women have very little access to basic healthcare.
At this rate, it will take at least 14 years to train the needed 5,600 extra midwives. Until then, thousands of women will continue to die from preventable deaths.