Maternal Health in Afghanistan

by World Vision
Tayibe Shafiq cares for a newborn
Tayibe Shafiq cares for a newborn

By Chris Weeks, World Vision United Kingdom

In Afghanistan, less than 40 percent of mothers are assisted in delivery by a doctor or midwife. World Vision has trained 200 midwives to work in hospitals across western Afghanistan, part of our efforts to end preventable child deaths through the Survive to Five Challenge.  

Working at the only neonatal unit in Herat province, Afghanistan, midwife Sudina Hossini is all too aware of her responsibilities. Before she has time to answer a reporter’s question, the 24-year-old breaks off the interview to resuscitate a baby who is suddenly rushed into the ward. The newborn is blue and not breathing, but Sudina works swiftly to ventilate the child’s lungs. In minutes, the baby is crying and regaining color, soon to be reunited with the mother in the next room. Without Sudina and her skills, the story might have ended differently. ‘If we weren't working here…more children would die’

Sudina is one among 200 midwives trained by World Vision who work in hospitals across western Afghanistan. Thirty community-level midwives will soon extend service to remote areas.  

This baby, not yet named, is one of about 15 whom Sudina saves from death every day. Since qualifying two years ago, she estimates that she has resuscitated 700 babies. “I became a midwife because I wanted to reduce the rate of death of mothers and children in Afghanistan,” Sudina says. “If we weren’t working here, of course it’s true that more children would die.” 

Afghanistan has one of the world’s highest mortality rates for children; more than one in 10 dies before age 5, according to a government survey  sponsored by UNICEF, the United Nations’ children’s agency.Less than 40 percent of Afghan mothers are assisted in delivery by a doctor or midwife. Women living in cities are twice as likely to deliver in a hospital, compared to women in rural areas.The risk of a woman dying from complications of pregnancy or childbirth is one in seven. 

Dr. Shahara Sarem, 32, duty doctor in charge of a maternity unit, explains that World Vision is addressing issues head-on. “Some mothers travel miles to get help from villages and districts around Herat,” she says. “There are some really complicated cases like pre-eclampsia and ruptured placentas. Women even come from much further away, like Badghis and Ghor provinces, because this is the only place they can get treated.”

The maternity unit in Herat is a constant hive of activity, seeing 150 to 200 patients in 24 hours. The caseload normally includes between 20 and 50 Caesarean deliveries, many of them extremely complicated. “The shifts are long, and we don’t always have the right medicines for all patients,” says 23-year-old Tayibe Shafiq, who has worked at the maternity unit for two years. “But the happiest moment for me is the moment they bring a baby to the hospital who is in a bad way. “I use the skills I have learned to take care of the baby, to give its life back, and I watch it get better,” she continues. “The mother is happy, the family is happy. That’s the best moment of my life.”

World Vision’s midwifery training program in Afghanistan is a component of our global Survive to Five™ Challenge, which seeks to end preventable child deaths through interventions like skilled birth attendants. For children in the developing world, the first five years of life are most deadly, and if a child lives to see his or her fifth birthday, chances of survival increase dramatically. There are a few basic reasons why children under the age of 5 die of preventable causes — and simple, inexpensive solutions can help them survive. In addition to providing training for midwives in Afghanistan, World Vision works to equip children and families in places of poverty with nutritious food, neonatal care, vaccinations, clean water, insecticide-treated bed nets, oral rehydration solutions, and other interventions.

Women participate in a training exercise
Women participate in a training exercise
Midwives Eclampsia Training
Midwives Eclampsia Training

Thank you for your gift to support critical healthcare for mothers and newborns in the Herat region of Afghanistan. As conservative Muslims, many Afghan women are not permitted or refuse to be attended by male healthcare professionals during delivery. This, coupled with the lack of female healthcare providers, results in only 14 percent of births in the country being attended by a skilled health professional.

Consequently, Afghanistan has one of the highest maternal mortality rates and the second highest under-5 mortality rate in the world according to UNICEF (2009 and 2010). Due to the scarcity of prenatal and postnatal care as well as unattended births, one-in-five children does not reach his or her fifth birthday. Furthermore, women stand a one-in-eleven lifetime risk of dying due to pregnancy-related causes.

The Midwifery Extension Project at Herat Maternity Hospital is helping to save the lives of mothers and newborns by providing skilled midwives to safely deliver babies and care for newborns. Because of generous donors like you, midwives were able to help deliver 20,450 babies at Herat Maternity Hospital during fiscal year 2011 (October 2010 through September 2011).



June 2012 Update - Covering activities from October 2011-March 2012

24 qualified female midwives delivered quality midwifery services through their direct employment at Herat Hospital - All 24 female midwives are in full time employment at the Herat Hospital. During the January 2012 joint supportive supervision session conducted by the World Vision midwifery education program, midwives working at the hospital achieved 34 out of a potential 36 standards.

Herat Maternity Hospital provided with essential supplies and equipment to ensure a high quality of patient care - This project has provided essential medical supplies such as gloves, protective goggles, masks, and containers for sharps, povidone iodine, antiseptic solutions, portable lights, delivery kits, trolleys, fetoscope, newborn kits, clothes and aprons on a quarterly basis to improve the quality of services and facilitation of care and reduce the risk of infections.

Delivery of home-based visitation services (post natal care within three days after delivery) - During this period of reporting, midwives conducted 115 home services visits for women who had complicated deliveries within two weeks of delivery who live within at least a 30 kilometer radius of Herat city.

Improved employment opportunities for 24 qualified midwives in Herat - During this reporting period, World Vision Afghanistan midwives attend the training:

  • Provide facilitation for three midwives to attend Helping Baby Breathing (HBB) training..
  • Provide facilitation for all World Vision Afghanistan midwives to attend Eclampsia training for 4 days. 

Capacity of midwives built - To improve the midwives’ knowledge and capacity, scientific conferences are held for midwives at the hospital every week. The midwives have learned more about shock, newborn care, and vacuum delivery.




A midwife during the Health Education Session
A midwife during the Health Education Session

 A story of success

Across Afghanistan, premature babies are regularly sent home with their mothers just hours after birth and often die within a short time. The Midwifery Extension Project is helping more newborns survive by providing specialized care to premature babies and those who are born with complications.

Mrs. Sharifa’s first four pregnancies did not end well. She delivered each of her babies at home, premature (between 28 and 32 weeks), and without the presence of a skilled birth attendant. Determined to have a more positive experience with her fifth pregnancy, Mrs. Sharifa rushed to Herat Maternity Hospital at the first signs of labor. She was 30 weeks pregnant.

After six hours of labor Mrs. Sharifa gave birth to a healthy baby boy weighing only two pounds. He was transferred immediately to the special care neonatal unit where he received around-the-clock care by midwives and remained in an incubator for three weeks. After 40 days, his weight had nearly doubled and he was released to go home. Mrs. Sharifa is just one of many women whose families are benefiting from the Midwifery Extension Project at Herat Maternity Hospital.

More project stats and photos will be in our next update. Stay tuned!

Ultimately the goal is to reduce maternal and infant morbidity and mortality rates in Herat, by improving the quality of care to babies and mothers at Herat Maternity hospital

The maternity unit of Herat hospital is a 100 bed facility serving a patient population of nearly 2 million people.  It is a major regional referral hospital serving patients from all of the surrounding rural areas as well as Herat city itself.   Approximately 1,600 babies are delivered in the hospital in a typical month.  Of these, about 10% will have birth complications and need to spend some time in the neonatal care unit.

 The Maternity Hospital has recently moved into a new, modern building that is a vast improvement over its previous location, but the improvement in physical infrastructure does not in itself lead to improved health outcomes or enhanced quality of care. Afghanistan is a conservative Muslim country in which most women are unwilling to be treated by male healthcare providers.  The number of skilled providers at the Herat Maternity Hospital is still not sufficient to ensure that all mothers and babies receive quality care and the Ministry of Public Health does not have sufficient resources to increase the number of staff. 

This project addresses these identified needs by employing midwives at the hospital for three years. 24 midwives have been hired to train and work full-time. They are receiving on the job training, supportive supervision and capacity building to support their development. This project improves the level of service delivery at the hospital and also home deliveries in the surrounding area.

 Stay tuned for more details in our next report!


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Organization Information

World Vision

Location: Federal Way, WA - USA
Website: http:/​/​
Project Leader:
Rachel Wolff
Senior director, World Vision news burea
Federal Way, WA United States

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