Empowering Afghan Women to Save Mothers and Children

By Nangyalai E. Tannai

Kabul - - In a few months, 25-year-old Lida will be a fully trained life-saver in her remote home village in southeastern Afghanistan. For the first time ever, the women in her neighborhood will not have to rely on their mothers-in-law or traditional birth attendants when giving birth. Lida will be there for them, providing safe and clean deliveries. Women can come to her for antenatal care and Lida will be able to detect any complication that requires them to see a doctor.

Photo by Nangyalai Tannai.

Lida resuscitates a newborn baby using an Ambu bag, a handheld device that provides ventilation to a patient who is breathing inadequately.

Since August 2006, International Medical Corps has trained approximately 30 women like Lida to be midwives in Khost province. Some will work in the city hospital, but most will perform antenatal care and home deliveries.

When Lida completes her IMC training, which is funded in part by JHPIEGO, an international health organization affiliated with Johns Hopkins University, she will become the first certified midwife able to provide birthing services to the women in her village. Herself a mother of two, she will make a small but important difference in conquering Afghanistan’s biggest health challenge. The country has one of the highest infant and maternal death rates in the world. According to UNICEF, the neonatal mortality rate in Afghanistan is 12 times higher than in the United States. As many as 1,900 women out of 100,000 die in Afghanistan from birth-related causes. In the U.S. the maternal mortality ratio is 17 out of every 100,000.

Currently, women in Lida’s village who need to go to the hospital must cross the border into nearby Pakistan or travel to the provincial capital of Khost. But both trips are more than 30 miles away--and for many, the cost of making the journey is just too expensive. “If you have a midwife in the village, why should you travel to another country for treatment?” says Lida, who already has begun promoting her services when chatting with the women in her village. “Most people cannot even get transportation when they need it.”

In order to be admitted to the midwife training program, applicants must come from a remote and underserved area, and they must pass an entrance exam. “In the beginning, demand for the training slots was not overwhelming,” said Dr. Lailuma Anwar, the IMC Project Officer for the program. Communities and families were hesitant about sending their daughters and wives to live in the city. In a society where the majority of women will never work, instead transitioning from a sheltered life in their own family to a sheltered life in their husband’s family, the concept of a working woman was met with a lot of suspicion.

Photo by Nangyalai Tannai.

A group of midwives being taught the active management of third-stage labor, which involves removing the placenta.

Without the consent of male family members and village elders, the midwife training program could not operate. Parveen, a 21-year-old fellow student of Lida’s, says that her father was challenged by the other men in the village who disapproved of her learning a profession and earning an income. But after they understood that she will serve the women of the whole community, they began to support him. As Afghan men increasingly grasp the importance of a well-trained midwife, they seem to be opening up to the idea of women enrolling in IMC’s course. “We received many more applications from women who want to attend the program the second time we offered the course,” Dr. Lailuma says.

Lida is lucky; the men in her family recognized the value of the midwife training from the start. Her father, himself an educated man, supported his daughter’s training. So did her husband. “Knowing that I will be able to help the women in our village makes my husband very proud.”