Teenagers to midwives: How women are changing maternal and infant health
Dressed in scrubs and pink vinyl aprons, caps and the odd surgical mask, midwives hustle between beds in the delivery room at the Herat maternity hospital in western Afghanistan. In other countries, teens like these are attending high schools, watching movies, going on dates. But in Afghanistan, these young women are learning to save lives.In one corner of the delivery room, the air heavy with antiseptic, a young woman tries to catch her breath. Ramal, 16, stands gripping the arm of her mother-in-law, Bibijan. It is her first baby and her contractions are increasing, Bibijan says, but the girl is shy and fears being examined. Buckling in pain as another wave of contractions hits, midwife preceptor, Marzia Ahmadi, 22, calms her, then coaxes her onto the delivery bed, assuring her there is nothing to fear. All shall be well.
Some men want to bring their wives to the hospital, but they can’t reach the town. I can tell you about women dying, literally, at the hospital gates because they were too long on the road There are 11 beds in Herat’s delivery room and, by 10 am on this morning, they are all occupied. Opposite Ramal, on the other side of a long aisle is Zeinab, 25. Cringing in pain, her mother comforts her, while midwives prepare for her final stages of labour and the delivery of her third child. Her mother, Yagoneh, is in her forties, the mother of six children, the youngest of whom is only five.
“We always come to the maternity ward during labour,” she says. “Here, there are midwives and doctors, women who will care for both the mother and the baby. Before, many women did this at home, but only because there were no proper facilities, no women who were trained. Now we have the hospital with knowledgeable staff. There are some women who do not come, but only because they remain uneducated.”
Culture and tradition also stop women from going to hospital to deliver, shares Fatehma, 44, another midwife working in the programme. But the barriers don’t stop there. “We have a lack of clinics, a lack of facilities, education, and access. We don’t even have roads in much of this province. Some men want to bring their wives to the hospital, but they can’t reach the town. I can tell you about women dying, literally, at the hospital gates because they were too long on the road. It’s a problem of both economics and knowledge. They don’t have enough information to know better. “Those that know, she says, don’t have the economic means to get there.
Most of the infants here are delivered by midwives-in-training, students from the Institute for Health Sciences (IHS) at Herat Regional Hospital and the Community Midwifery Education (CME) programme in Ghor Province, both supported by World Vision. Practical training is a key component in preparing midwives for the rural communities they will return to following their graduation. In July 2009, the CME graduated 24 midwives, while the Herat programme, started in 2004, has already graduated and placed more than 140 midwives in rural clinics throughout western Afghanistan.
The first time I delivered an infant, I was so afraid...I was looking at the mother, feeling so sad for her and wondering, ‘Is it really possible that I can do this? Working alongside trained medical staff, the midwives gain invaluable experience in ante-, neo- and post-natal care. Assisting mothers through the labour process, they prepare hydration drips, monitor infant heartbeat and maternal blood pressure, carefully examining each woman for signs of complications such as obstructed births, and other potential causes of maternal death in Afghanistan.
Almost half of all deaths of women age 15-49 in Afghanistan result from complications during pregnancy and childbirth. Most of these deaths could be prevented with increased access to maternal health services. Competent midwives based in rural communities are beginning to make that difference.
At the far end of the delivery room, shouts burst like repetitious gun blasts, building into an eruption of excruciating pain. Anaesthesia is only administered for caesarean-sections and other surgery undertaken by doctors. Otherwise, only soothing words are offered as comfort against the searing pain that accompanies new life into this world. Labour is not for the faint of heart.
“Don’t push, not yet,” says the 18-year-old midwife-training, Suraya*. “Wait, wait…”
Married at 14, widowed at 16, Suraya understands more about motherhood than one might expect. She was 15 when she gave birth to a son, Razeq, now 3. Her mother cares for him at home while Suraya completes her practical training in Herat.
Eighteen months earlier, Suraya had just completed grade nine, when she started the midwifery course in Chaghcharan, the provincial capital of Ghor. The training programme was 200 kilometres from her home – an unheard of distance for an Afghan woman to travel for education.
Her parents encouraged her. “They said, ‘This is good. You can help our community by assisting the women here. You can help save the lives of mothers and babies.’”
The United Nations estimates that Ghor has the highest rate of maternal deaths in all of Afghanistan, which holds the second highest rate in the world, after Niger. One in eight Afghan women dies in childbirth, according to UN figures. Last January, the agency said that Afghanistan needs to more than double the current number of midwives if mortality rates are to be seriously curbed.
According to the World Health Organization (WHO), in 2002 there were only 467 trained midwives in the country. By 2008, their numbers had increased to more than 2,100. Peter Graaff, WHO country representative for Afghanistan, has told media that the country needs far more, at least 4,500 midwives, if 90 percent of the population is to have access.
...I must do this. I must return home. It has been my dream to finish this programme and become a good midwife. This is my life’s purpose now In 2008, hoping to have a positive impact on maternal health, World Vision started the CME programme in cooperation with STARS, an Afghan non-governmental organization (NGO). Recruiting young women from rural communities across the province, the 18-month programme utilised classroom studies, skills labs, and practical on-the-job training to prepare students for careers in midwifery. Each student made a commitment to return to her community where she would serve as a new and much needed midwife.
It was a dream come true for Suraya. “When I was a small child, I hoped to be a doctor or a midwife in my community. When I heard about this programme, I had to apply,” she says, her shy demeanour giving way to the excitement she feels in finally fulfilling her vocation.
“The first time I delivered an infant, I was so afraid,” admits Suraya. “I was looking at the mother, feeling so sad for her and wondering, ‘Is it really possible that I can do this?’ I could only think how God must help me. Really, I was so afraid, feeling for the mother, and asking over and over, ‘Can I do this?’”
But she did it, and then she did it again and again, 43 more times in her final months of training.
“Now, I feel fully competent,” she says, relaxed and smiling broadly.
In one month, the midwives will graduate and return to their villages. Suraya has not been home since she began the programme in January 2008. She says she has missed her family, and especially her son, Razeq.
”…. I must do this. I must return home. It has been my dream to finish this programme and become a good midwife. This is my life’s purpose now.”
*Names changed to protect identity.
Some men want to bring their wives to the hospital, but they can’t reach the town. I can tell you about women dying, literally, at the hospital gates because they were too long on the road There are 11 beds in Herat’s delivery room and, by 10 am on this morning, they are all occupied. Opposite Ramal, on the other side of a long aisle is Zeinab, 25. Cringing in pain, her mother comforts her, while midwives prepare for her final stages of labour and the delivery of her third child. Her mother, Yagoneh, is in her forties, the mother of six children, the youngest of whom is only five.
“We always come to the maternity ward during labour,” she says. “Here, there are midwives and doctors, women who will care for both the mother and the baby. Before, many women did this at home, but only because there were no proper facilities, no women who were trained. Now we have the hospital with knowledgeable staff. There are some women who do not come, but only because they remain uneducated.”
Culture and tradition also stop women from going to hospital to deliver, shares Fatehma, 44, another midwife working in the programme. But the barriers don’t stop there. “We have a lack of clinics, a lack of facilities, education, and access. We don’t even have roads in much of this province. Some men want to bring their wives to the hospital, but they can’t reach the town. I can tell you about women dying, literally, at the hospital gates because they were too long on the road. It’s a problem of both economics and knowledge. They don’t have enough information to know better. “Those that know, she says, don’t have the economic means to get there.
Most of the infants here are delivered by midwives-in-training, students from the Institute for Health Sciences (IHS) at Herat Regional Hospital and the Community Midwifery Education (CME) programme in Ghor Province, both supported by World Vision. Practical training is a key component in preparing midwives for the rural communities they will return to following their graduation. In July 2009, the CME graduated 24 midwives, while the Herat programme, started in 2004, has already graduated and placed more than 140 midwives in rural clinics throughout western Afghanistan.
The first time I delivered an infant, I was so afraid...I was looking at the mother, feeling so sad for her and wondering, ‘Is it really possible that I can do this? Working alongside trained medical staff, the midwives gain invaluable experience in ante-, neo- and post-natal care. Assisting mothers through the labour process, they prepare hydration drips, monitor infant heartbeat and maternal blood pressure, carefully examining each woman for signs of complications such as obstructed births, and other potential causes of maternal death in Afghanistan.
Almost half of all deaths of women age 15-49 in Afghanistan result from complications during pregnancy and childbirth. Most of these deaths could be prevented with increased access to maternal health services. Competent midwives based in rural communities are beginning to make that difference.
At the far end of the delivery room, shouts burst like repetitious gun blasts, building into an eruption of excruciating pain. Anaesthesia is only administered for caesarean-sections and other surgery undertaken by doctors. Otherwise, only soothing words are offered as comfort against the searing pain that accompanies new life into this world. Labour is not for the faint of heart.
“Don’t push, not yet,” says the 18-year-old midwife-training, Suraya*. “Wait, wait…”
Married at 14, widowed at 16, Suraya understands more about motherhood than one might expect. She was 15 when she gave birth to a son, Razeq, now 3. Her mother cares for him at home while Suraya completes her practical training in Herat.
Eighteen months earlier, Suraya had just completed grade nine, when she started the midwifery course in Chaghcharan, the provincial capital of Ghor. The training programme was 200 kilometres from her home – an unheard of distance for an Afghan woman to travel for education.
Her parents encouraged her. “They said, ‘This is good. You can help our community by assisting the women here. You can help save the lives of mothers and babies.’”
The United Nations estimates that Ghor has the highest rate of maternal deaths in all of Afghanistan, which holds the second highest rate in the world, after Niger. One in eight Afghan women dies in childbirth, according to UN figures. Last January, the agency said that Afghanistan needs to more than double the current number of midwives if mortality rates are to be seriously curbed.
According to the World Health Organization (WHO), in 2002 there were only 467 trained midwives in the country. By 2008, their numbers had increased to more than 2,100. Peter Graaff, WHO country representative for Afghanistan, has told media that the country needs far more, at least 4,500 midwives, if 90 percent of the population is to have access.
...I must do this. I must return home. It has been my dream to finish this programme and become a good midwife. This is my life’s purpose now In 2008, hoping to have a positive impact on maternal health, World Vision started the CME programme in cooperation with STARS, an Afghan non-governmental organization (NGO). Recruiting young women from rural communities across the province, the 18-month programme utilised classroom studies, skills labs, and practical on-the-job training to prepare students for careers in midwifery. Each student made a commitment to return to her community where she would serve as a new and much needed midwife.
It was a dream come true for Suraya. “When I was a small child, I hoped to be a doctor or a midwife in my community. When I heard about this programme, I had to apply,” she says, her shy demeanour giving way to the excitement she feels in finally fulfilling her vocation.
“The first time I delivered an infant, I was so afraid,” admits Suraya. “I was looking at the mother, feeling so sad for her and wondering, ‘Is it really possible that I can do this?’ I could only think how God must help me. Really, I was so afraid, feeling for the mother, and asking over and over, ‘Can I do this?’”
But she did it, and then she did it again and again, 43 more times in her final months of training.
“Now, I feel fully competent,” she says, relaxed and smiling broadly.
In one month, the midwives will graduate and return to their villages. Suraya has not been home since she began the programme in January 2008. She says she has missed her family, and especially her son, Razeq.
”…. I must do this. I must return home. It has been my dream to finish this programme and become a good midwife. This is my life’s purpose now.”
*Names changed to protect identity.
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