Gayle Tzemach Lemmon writes about how women are helping women in Afghanistan: Midwives are reducing infant and maternal mortalities in a country strapped for cash and medical services.
Afghanistan is home to the world’s second-highest maternal mortality rate. And Badakshan, a stunningly beautiful province in the country’s north, has the worst maternal mortality figures ever reported anywhere in the globe. But with the help of international donors and a growing legion of committed midwives which grows larger each year, better health care is reaching expectant mothers in provinces all across the country. Once a maternal health basket case, Afghanistan is now a role model for other poor nations struggling to quickly scale up their efforts to save pregnant women’s lives.
Midwives are at the center of this progress. Each morning women in nearly every province in Afghanistan go door to door in teams of two visiting homes and spreading their message about the importance of protecting an expectant mother’s health. Using a picture book and a sterile birthing kit to illustrate the importance of hand washing, proper nutrition, and post-natal care, the women take their teachings to the nation’s most impoverished households. Often their visit is the only professional healthcare the women they see each day will receive.
The challenge of providing better maternal care in Afghanistan are formidable and deep-rooted. As I wrote in a recent story for The Christian Science Monitor:
In 2002, 60 percent of Afghans had no access to basic health services, according to a study led by Linda Bartlett, then of the Centers for Disease Control and Prevention in Atlanta. Furthermore, two-thirds of the country's districts had neither maternal nor child health services, with only 10 percent of Afghanistan's hospitals equipped for caesarean deliveries. Nearly 80 percent of the maternal deaths examined in Dr. Bartlett's study were judged preventable.
But today, these numbers are beginning to turn around. From fewer than 500 midwives with no standard training, Afghanistan now has more than 2,400 nationally accredited midwives who have graduated from the country’s standardized, two-year midwifery education program. Skilled birth attendants can now be found nationwide, with Johns Hopkins University research showing that even in the country’s hard-to-reach rural regions, midwife use jumped from 6 percent in 2003 to 19 percent in 2006. In fact, so much progress appears to have been made that the nation’s Ministry of Public Health is now launching a follow-up survey to assess the impact of recent maternal health efforts, just seven years after the last round of research began. And it is not just in Afghanistan that the impact of their work is being felt: In December, Afghan midwives will join colleagues from Pakistan and India in offering to help the nations of Bhutan and Nepal to establish their own midwifery associations and accreditation programs. International health professionals say that they are evaluating Afghanistan's success in rapidly scaling up emergency interventions to help them develop health strategies for women in other least-developed nations.
While Afghanistan’s grave maternal mortality problems will take time and investment to fully reverse, it is clear the country is on its way to addressing some of the most pressing issues facing women’s health. With the help of midwives, the word is spreading that small measures can save women’s lives -- and help them bring healthier babies into the world.
Gayle Tzemach Lemmon is a former ABC News producer who began writing about women's entrepreneurship during her second year of MBA study at Harvard. She currently is working on a book to be published by HarperCollins in 2010 about a young entrepreneur who supported her family and her community during the Taliban years.