As we come to the end of another successful year we wanted to take a moment to say THANK YOU to all of you who have helped us to save the lives of women and babies in Afghanistan through our project Educate a Midwife – Save Women in Afghanistan.
Because of donors like you, Jhpiego has supported midwifery training programs across Afghanistan and helped to ensure that more mothers are alive today caring for their children and families.
We also wanted to remind you of the many ways your donations have made an impact. Since Jhpiego began working in Afghanistan:
The percentage of women giving birth in health facilities has increased from 19% to 32.4%.
Community health workers have educated more than 1,000 pregnant women living in remote areas on how to use misoprostol – a lifesaving drug that prevents mothers from bleeding to death after birth.
Mothers are surviving! There has been a significant drop in maternal deaths across the country – from 1,400 for every 100,000 live births to 327 for every 100,000 live births.
And while there is still much work to be done, we have people like you to thank for the remarkable progress we have made so far.
So, again and with all our hearts, THANK YOU! You are helping to keep mothers and babies alive and families together through your kindness.
Mothers in Afghanistan are alive today because of women like Marzia Resolu…
Marzia is among the 3,000 midwives who have been educated and trained through the national midwifery education system established by the government of Afghanistan with support from U.S. Agency forInternational Development (USAID) and Jhpiego.
During the years of Taliban rule, maternal mortality in Afghanistan was the second highest in the world, and women routinely died in pregnancy and childbirth. Maternal and newborn services and skilled care were nearly non-existent. The consequences for the women of Afghanistan were significant. The presence of a skilled health careprovider during birth is the single most important intervention to keep a pregnant woman and her newborn alive and healthy.
With community midwifery schools re-established and skilled midwives returning to the workforce, Afghanistan’s maternal death rate has declined significantly.
“Previously there was no midwife in our village and women were suffering bleeding and their children were dying. Now, thanks to God, we have got a midwife and since have not seen a pregnancy death.”
A Jhpiego-supported study found that the numbers of women receiving prenatal care services was greater in provinces that had community midwifery schools than in those without them. In those same provinces, more women gave birth in a health facility where complications could be addressed swiftly and properly.
“People in the village are happy with them since they are female, because we cannot talk to male doctors about our problem. If we go and see a male doctor, our men will kill us. These midwives are everything for us.”
A teacher, Marzia returned to school at age 26 to become a skilled midwife. Marzia, and others like her, will go to great lengths to ensure their patients receive the care they need – these midwives often walk or travel by donkey for hours to make home visits, working nights and long hours.
“I know that there is a great need for midwives in the region as many women have problems in childbirth because there are very few facilities and the insecurity makes it very hard for people to travel to hospital when they need to,” said Marzia. “I am very happy that I will be able to go back to my community . . . and help my people.
The demand for skilled midwives, however, remains high. An additional 5,000 educated and trained midwives are needed to ensure women living across this mountainous and rugged country receive the skilled care they need to survive childbirth. As international funding has declined, community midwifery schools have closed. When the Jhpiego-led Health Services Support Project ended in the fall of 2012, there were 32 schools. That number has since dropped to 22.
Continued strengthening of midwifery education and training in Afghanistan is essential to saving the lives of women and newborns in this country. Your support has made a great impact on the lives of women and their babies throughout Afghanistan. Working together, we will save the lives of many, many more.
Source material: EVALUATION OFTHE PRE-SERVICE MIDWIFERY EDUCATION PROGRAM IN AFGHANISTAN, March 2011, Health Services Support Project (HSSP)
In the tiny village of Katasank in central Afghanistan, Ozara Husseini is a lifeline for pregnant women and mothers. She is neither a doctor nor a midwife. And yet, Ozara is often the first person to whom women turn when they have a question about their health. A community health worker who is studying to be a teacher, Ozara knows the importance of education and gives women in her village of 200 the information they need to safely space their pregnancies.
"I really believe in family planning,” says the 20-something who has been a community health worker since she was a young teen. “It is the only thing that is going to improve the economic situation of women throughout Afghanistan. Most women I visit in this community are very willing to accept family planning and want to use it -- either to not have any more children or to be able to have space between their children.”
As a maternal health issue, postpartum family planning is crucial because pregnancies during the first year after childbirth hold the greatest risk for the mother and her baby. Healthy birth spacing allows women to properly care for themselves, their babies and family, helping to reduce maternal and newborn deaths.
Community health workers are often the first contact for information on hygiene, nutrition, safe birthing practices and family planning methods. Ozara visits women in their homes, using illustrated flipcharts to educate women on family health issues. She explains that spacing pregnancies three years apart benefits both mother and newborn.
When patients are ill or in need of specialized maternal health services, she refers them to the Community Health Center in the nearby town of Foladi where two midwives work.
“Women get married very young here,” says Ozara. “Some women will have up to three children before they are 20 years old. There are a lot of cultural barriers here to using family planning - a lot of people believe that the birth of children is the will of God and we shouldn't interfere with this. Some decision makers of the family don't allow the women to use birth control - but often the women will do it in secret because they know that it is the only way that they are going to be able to look after their existing children properly. I explain all types of family planning - the (intrauterine device), pill, condoms and an injection that the women have to go to the health center for. It is up to families to decide for themselves.
“I have noticed,” she added, “an improvement in the economic situation of families who are able to decide when they will have their next child because they can plan for it.”
Community health workers are an integral part of the Afghan government’s community-based health system. In partnership with the Ministry of Public Health and with the support of U.S. Agnecy for International Development, Jhpiego has worked to ensure women and families gain access to quality health services.
A rebuilt midwifery education system has graduated 3,000 skilled midwives who are working in communities throughout the country. In addition, Jhpiego has helped educate and train community health workers like Ozara in delivering basic health information, family planning counseling, gender equity issues and prevention of postpartum hemorrhage in women who can’t reach a health facility and must give birth at home. Postpartum hemorrhage or severe bleeding after birth -- is leading cause of maternal deaths worldwide.
Community health workers like Ozara 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 when giving birth at home.
Shahrbanoo, a young midwife working in Bamyan Province in Afghanistan, is a graduate of the community midwifery education system, which was established by the Afghan government with support from USAID and Jhpiego. More than 3,000 skilled midwives have graduated from accredited schools in this system and are working today to save the lives of mothers and newborns. A significant reduction in maternal deaths in Afghanistan reported in 2010 has been attributed to these new midwives who bring skilled care to women where they live. Midwifery school graduates have an education and a job to help them provide for their families.
The number of midwives delivering skilled health care to women in Afghanistan has more than tripled under programs supported by Jhpiego and partners, leading to significantly more women surviving childbirth.Jhpiego, an international health non-profit 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.
At the time the USAID-funded work began in 2003, Afghanistan’s maternal death rate was the second highest in the world. There were only 467 midwives in a country of 20 million, less than 8 percent of pregnant women gave birth with a skilled provider at her side, and only one province offered midwifery education.
Today, as a result of the USAID-funded Health Services Support Project (HSSP) and prior programs, 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 curriculums 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 a health facility has increased from 19 percent in 2005 to 32.4 percent in 2011;• Midwifery programs have increased from 1 in 2002 to 30 today;• 86 percent of graduates of community midwifery schools received jobs;• A professional organization of midwives was organized and supported with the help of USAID; the association has more than 2,000 members across 33 out of 34 provinces; The Afghanistan Mortality Study (AMS), which was released last year by the government, showed a significant reduction in women dying in childbirth. The study found that 327 Afghan women die for every 100,000 births. That compares to the World Health Organization rate of 1,400 for 100,000 births in 2008.
Dr. Leslie Mancuso, Jhpiego President and Chief Executive Officer, said Jhpiego’s innovative strategies to build the capacity of Afghan midwives and strengthen health facilities throughout the country have resulted in improved health services for women.
“The fact that more Afghan women are surviving childbirth is a testament to the newly-educated midwives who are working in their communities to prevent the needless deaths of women and families,” said Dr. Mancuso. “Jhpiego’s focus on skilled care and innovative strategies to prevent the deaths of women shows that continued investment in strengthening the Afghan health system will save lives.”
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