Increase in skilled midwives saving lives in Afghanistan

The number of midwives providing skilled health care to women in Afghanistan has more than tripled under projects implemented by Jhpiego and partners, leading to significantly more women surviving childbirth.

Jhpiego, an international health nonprofit and affiliate of Johns Hopkins University, has been at the forefront of efforts to prevent childbirth-related deaths in Afghanistan since 2002. In partnership with the Afghan government, and funded by the U.S. Agency for International Development, Jhpiego helped revitalize the Afghan midwifery workforce by developing a national education system to train midwives to provide competent, skilled care to women during childbirth.

In 2003, Afghanistan's maternal death rate was the second highest in the world. With only 467 midwives in a country of 20 million, less than 8 percent of pregnant women gave birth with skilled providers at their sides, and only one province offered midwifery education. Today, as the USAID-funded Health Services Support Project concludes, the state of midwifery in Afghanistan is vastly improved:

• More than 3,000 new midwives have graduated from a network of government-accredited schools, whose curricula and competency-based training were developed by Jhpiego in collaboration with the Afghan Ministry of Public Health and other partners.

• The percentage of women giving birth in health facilities has increased from 19 percent in 2005 to 32.4 percent in 2011.

• Midwifery programs have increased from one in 2002 to 30 in 2012.

• Eighty-six percent of graduates of community midwifery schools obtained jobs.

• A professional organization of midwives was started and supported with the help of USAID and now has more than 2,000 members across 33 of 34 provinces.

• More than 17,000 health care workers, supervisors, faculty, and health ministry staff have been trained in 28 areas of care, from emergency obstetric and newborn care to family planning and mental health.

• Across 21 provinces, 505 health facilities are using a new quality improvement and assurance system to provide better services.

• Community health workers have educated more than 10,000 pregnant women living in remote areas on self-administration of misoprostol, a potentially lifesaving drug to prevent postpartum hemorrhage, which is taken if women can't reach health facilities to give birth.

The Afghanistan Mortality Survey released last year by the government showed a significant reduction in the number of women dying in childbirth. The study found that 327 Afghan women die for every 100,000 births, in contrast to the 1,400 per 100,000 births reported in 2008 by the World Health Organization.