In higher-income countries, one doesn’t hear the term “midwife” very often. It can evoke images of a bygone era, before intricate health systems with complex technology became accessible for many. But in other parts of the world, midwives can still make the difference between mothers and newborn babies thriving—or dying.
Every year, an estimated 300,000 women and 3 million newborns die from complications during pregnancy, childbirth or other neonatal causes. Some 92% of these deaths occur in low- and middle-income countries. Most of these deaths could be prevented with low-tech, low-cost care in the form of a skilled midwife—a profession that is tragically under-represented across the world.
According to The State of the World’s Midwifery 2014, trained midwives could provide 87% of the essential care needed for women and newborns. Midwives can identify complications around pregnancy and childbirth early, provide first-line emergency care and, when needed, refer cases to appropriate higher-level care. When adequately trained, midwives can also provide prenatal care, family planning, testing and counseling for sexually transmitted infections, assistance at delivery, postpartum care, newborn care and breastfeeding support.
Afghanistan remains in dire need of such trained professionals. A decade ago in Afghanistan, more than 1,600 out of every 100,000 women were dying of causes related to pregnancy and childbirth. But thanks to a dramatic increase in midwife training, Afghanistan’s current maternal mortality rate has dropped considerably, to 327 deaths per 100,000 births.
To help address Afghanistan’s high maternal mortality, International Medical Corps started a midwife training program in 2002, in collaboration with Jhpiego (of John’s Hopkins University) and the Afghan Ministry of Public Health. We targeted rural communities, where adequate maternal health care was virtually nonexistent, training more than 2,000 Afghan midwives over a decade—each of whom was able to provide lifesaving care to hundreds of women in their own community.
Though Afghanistan’s maternal mortality rate remains unacceptably high, thousands and thousands of Afghan mothers and babies have been saved by the courageous and committed midwives we helped train. One such midwife, Fatiha, shares her story below.
“I was born in a small village in Wama District, in Afghanistan’s Nuristan Province, to a family of four girls and two boys. Growing up, I noticed the women in my village and the surrounding communities suffering immensely due to gynecological issues and complications with childbirth. I used to wonder how I could help solve these problems.
For many years, I knew about International Medical Corps’ work, as they had been implementing health programs in Wama District. When they started a Midwifery and Nursing program in Nuristan, I signed up to learn how to help the women in my community. The two-year midwifery project ended up playing a vital role in addressing many of the problems in our community—because women’s health creates community health.
I found International Medical Corps’ midwife training program to be well-disciplined and high-quality. The program hosted 48 female students—24 in the nursing program and 24 in the midwifery program. The teachers were all talented, punctual and caring, with full command over their subjects and tons of encouragement for their students. I received training in many aspects of maternity care, including delivery, prenatal and postnatal care, and how to respond in cases of pre-eclampsia, anemia or when women become unconscious during delivery.
When I first finished the program, I lived in Mandy village, where a number of internally displaced families from the Bargimatal district had settled. One day, I learned that one of the displaced women was in serious distress during childbirth. I used the maternal first-aid kit that International Medical Corps had provided me at graduation, along with the skills I had learned in the program, to help save the mother’s life and assist in the delivery of twins. We delivered one baby healthy; the other had died in the uterus hours before. I referred the mother to a community health clinic in Paroon, where she recovered fully. This mother was the first of many whom I have helped to survive childbirth, along with their babies.”