Kabul, Afghanistan – Midwife Naseema Qochi is easily recognized when she walks into the small, spare health clinic nestled beside a rose garden in the dusty warrens of Qlia Bakhtyar. The health officer greets her warmly, Salaam alaikum (Peace). Qochi has helped three generations of women in this community give birth. “Naseema is the doctor,” a visiting midwife says in explaining Naseema’s primary role here and the respect she commands.
In conservative areas of Afghanistan, families are often reluctant to have their women give birth in a health facility, where birth complications can be handled by skilled providers and lives can be saved. It’s a reality that Naseema deals with daily, even as the number of educated and skilled midwives has increased across Afghanistan through the work of Jhpiego.
“I encourage them to go to the clinic. I talk to their husbands. I tell them about the risk of pregnancy…but they refuse,” says the veteran midwife and member of the Jhpiego-supported Afghan Midwives Association. “In one case, a lady fell down from the top of the roof; even in that case they didn’t bring her to the health clinic.”
So Naseema goes to the women. She educates them on nutrition, breastfeeding, the danger signs of pregnancy and how to care for a newborn. She also provides skilled care in the months before birth.
In her visits to women’s homes, Naseema carries a leather case filled with the tools of their profession: blood pressure cuff, fetoscope, iron pills to prevent anemia, syringes, scissors, clamp, chlorine, clean cords, emergency drugs and other supplies.
On this particular day, Naseema meets with a married teenager who lives with her mother, younger brother and husband in a spare room of a neighbor’s house. The girl is seven months pregnant and this is Naseema’s third visit to the family. In addition to examining her, she will explain to the teenager’s mother what to do in case the baby comes unexpectedly or the mother-to-be can’t get to a health facility in time.
With deliberation, Naseema unfolds a gray plastic sheet and places it on the floor. She ties a clean white scarf around her head and prepares to show the mother how to properly wash her hands, lathering soap between her fingers and scrubbing up to her elbows. She opens her black bag and pulls out several props: a baby doll and small box covered in material that resembles a split curtain. Talking to the mother, Naseema begins a simulation of birth, proper cord clamping, care of the newborn and delivery of the placenta.
“If you are facing challenges, if there is no midwife or the baby comes in the middle of the night, you have to know [how to do this],” she says to the pregnant wife’s mother.
In the district she covers, Naseema may have as many as 500 pregnant women and new mothers as clients. For a woman whose baby is in the breech position, Naseema will pay for a car to take her to the nearest hospital to give birth. After a birth, Naseema will return to check on the mother and child.
In her 30 years as a midwife, Naseema says has delivered as many as 50,000 babies. But since the fall of the Taliban in 2001, she has seen more women choose to give birth in a hospital or health clinic, a shift she attributes to education and the growing number of midwives who have received training through programs supported by the U.S. Agency for International Development and Jhpiego. That shift is important because research has shown that a skilled health provider at birth is key to reducing maternal deaths.
“Before, I had 60 deliveries a month. Now I have 20 deliveries at home. That’s a big difference,” she says.
And yet the pregnant girl’s mother insists she will call Naseema when her grandchild is ready to be born. The 57-year-old midwife smiles, knowing what she will say, “I will encourage her to go to the hospital for delivery. This is my responsibility.”