Midwives defy tradition and save lives
BAMYAN, 12 August 2009 (IRIN) - 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.
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
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 City Hospital, told IRIN, referring to her
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 City 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.
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
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
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