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.
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