Celebrate Solutions: Recognizing the Midwives - Making Afghanistan Safer for Mothers and Newborns

By: Rati Bishnoi, Special Projects Intern for Women Deliver

In December, Mahila became the first winner of UNFPA’s Delivering Health, Saving Lives award for outstanding Afghan midwives. At the young age of 25, Mahila has delivered hundreds of babies and is now recognized as the best midwife in the northeastern province of Badakhsan.

In 2008, Mahila graduated from the Community Midwives Education Programme after spending two years gaining basic level knowledge and skills related to obstetrics, neonatology, public health, family planning, prenatal care, delivery, and post-pregnancy care. Armed with this technical knowledge, Mahila and other graduates of the Afghan Midwives Association and UNFPA-supported midwifery programme are helping to make Afghanistan a safer place for mothers and their children.

Currently, there are approximately 2,300 midwives to serve the 6.4 million women of reproductive age in the war-torn country. Save the Children’s 2011 State of the World’s Mothers report ranks Afghanistan as the “worst place” to give birth, with one in 11 women estimated to die in pregnancy or childbirth. Unfortunately, dangerous pregnancies and deliveries are not the only threat Afghan mothers face. As in many other cultures with a large gender equality disparity, giving birth to a daughter often means family and community disdain and fewer opportunities for mother and daughter. In some extreme cases, it means death. Last week, for example, 22 year-old Storai Mohammed was strangled to death by her husband and mother-in-law for giving birth to a girl, and not the son they had demanded of her.

Even though many barriers—such as poor education, child marriage, domestic abuse, and inadequate maternal and sexual health care—persist, heroes like Mahila are helping build healthier, more stable futures for Afghanistan’s mothers, families, and communities; and their effort is paying off. According to UNFPA, maternal mortality has dropped from an estimated 1,800 maternal deaths per 100,000 live births in 2000 to 1,400 maternal deaths per 100,000 live births in 2008.

Once trained, graduates of the Community Midwives Education Programme commit to returning to their villages and providing midwifery services for their community from their “family health house” for a minimum of six years. Midwives operating the family health house or clinic, with the help of two community health workers, are responsible for providing services to all women living within a two-hour walking distance from their clinic.

The family health house consists of two rooms, built using donated UNFPA materials such as roofing, beams, tiles, and windows. After obtaining community approval and endorsement for the clinic, which the programme receives by engaging the midwife’s husband, father, and father-in-law, the community provides free labor to build the structure.

The programme’s growing cadre of midwives and family health houses will be critical in reaching up to 4,000 girls and women by next year. In addition to helping women have safer pregnancies and deliveries and healthier newborns, the programme and its midwives are growing in popularity. According to UNFPA, increasing numbers of women are competing to enter the training programme and, as an unexpected side effect, more men are apparently seeking wives who are midwives because of their ability to earn income and higher standing in the community.

The Delivering Health, Saving Lives award is an important acknowledgement of the hardworking, committed, and powerful midwives reshaping their communities. As part of her award package, Mahila received a certificate signed by the Ministry of Public Health and a midwifery kit. Mahila’s leadership and impact on women’s lives will be recognized again in May, when fellow leaders and award winners will be honored in Kabul on the International Day of the Midwife. 

UNFPA photo courtesy of Zubaida Akbar