Training Midwives in Afghanistan

by Action for Development (AfD)
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Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Training Midwives in Afghanistan
Mother & child after delivery by widwife at AfD
Mother & child after delivery by widwife at AfD

In our ‘2021 Annual Report’ on Training Midwives in Afghanistan, we expressed the delays and challenges that have been caused largely by the Taliban takeover, their limiting expectations, and the changes to a functioning administrative system. These factors have created barriers in accessing healthcare, especially for females, as well as a decline in the quality of healthcare and healthcare professionals including adequately trained midwives. 

We are happy to announce that our re-registration processes have been completed, the brand new MoUs established and signed with the current authorities of the Ministry of Health - allowing AfD to take the next steps in the implementation of its health projects, particularly in providing training to midwives. A total of 20 midwives from Logar province have been nominated to receive the ToT training, who will then train an additional 80 midwives in their respective locations. The training will contain 10 modules that AfD has established through its collaboration with the Midwifery School of Geneva. We will keep you posted with the new pictures and reports about the process of the training and its outcomes.

The re-registration process as well as the demanded changes have created administrative back-ups, and left many not feeling comfortable, or even allowed to leave their homes to seek healthcare, to study, or to work. The health systems are currently facing huge unpredictability for the future. Recent reports show that medical stores have supplies of essential medicine only for the next two months. Food prices are rising, and poor nutrition prevails over the entire country among children, pregnant and lactating women.   

In Afghanistan, thousands of women die from preventable pregnancy related deaths each year at an alarming rate. Historically during Taliban controlled regimes in Afghanistan, the number of midwives being trained decrease, and maternal and child mortality rates increase. A correlation can be seen between the rates of available, adequately trained midwives and the rates of mortality.

All of these factors result in a decline in the positive growth that the Nation and AfDs’ Training Midwives in Afghanistan project was achieving such as reducing child mortality. The steps towards progress, reduced child mortality, and overall well-being for women of reproductive age are to continue to train midwives in Afghanistan, have freedom of movement, and remove the barriers to 1. Accessing Healthcare and 2. Midwifery Training.

According to the United Nations National Survey, in 2000 at the end of a 4-year Taliban rule, 100 of every 1000 Afghan babies died before their 1st birthday. Between 2001-2015 the number of deaths fell dramatically to 66-45 per 1000. Today Afghanistan is still listed as having the highest infant mortality in the world, which concludes that it is even more important now to work towards training more midwives in Afghanistan so history will not repeat itself, which is highly likely unless intervention occurs, and programs like AfDs midwifery training continues to be supported.

Action for Development continues to move forward in unprecedented times, working for the lives of children, mothers, families, and for the benefit of the citizens of Afghanistan who need our support, and who should not be affected by the on-going conflict. AfDs project, Training Midwives in Afghanistan is a stable benchmark to progress in a country whose violence interrupts the very basic human needs of women and children. 

Woman & child receiving healthcare at AfD facility
Woman & child receiving healthcare at AfD facility
Local women discussing healthcare with AfD
Local women discussing healthcare with AfD
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A member of the clinic's medical staff
A member of the clinic's medical staff

In Afghanistan, the ongoing instability caused by the regime change is affecting every aspect of people's lives, down to their very first one. Indeed, it is estimated by UNICEF that infant mortality rate gravitates around 52 deaths per 1,000 births, and maternal mortality rate approximates 640 deaths per 100,000 live births, and these figures continue to rise as access to healthcare has become more challenging. As a result, only about half of all births in Afghanistan are attended by trained medical professionals, and rural areas have been facing a shortage of midwives and female health professionals, although they account for the majority of births and delivery supervisions. 

What are we doing to help?

Despite the complexity of the current political and social contact in Afghanistan, AFD is determined to continue supporting the training of medical personnel on the field to ensure a safe birthing experience for both mothers and infants.

This year, however, we have had to reckon with unprecedented difficulties. With the change of regime came new institutions, new ministries, and a new administrative context with which we have yet to find appropriate agreements to continue to provide quality trainings and promote the access of vulnerable populations to essential health services.

In these critical times the accessibility to health services is prohibited in some areas due to insecurity, however, some areas are still partially secure and there is a possibility to set up trainings for women, by women specialists, and we would like to use this momentum to safely train an additional 350 midwives to reach our initial goal. We have taken all the necessary measures to ensure the safety and well-being of our staff and the midwives we would like to train.

Until present, AfD received close to 25,000 USD through additional fundraising mechanisms and over 4,000 USD online through the GlobalGiving platform and generous donors like yourself.  However, we are urgently looking for additional funds to support the implementation of our midwifery training programme and other emergency services.

These sustained efforts and continuous support have enabled us to continue making a difference on the field, and to measure it, we've gathered testimonials from the midwives that we've helped train in Kabul to understand how this program helped them in their professional advancement and in making a difference in their community. 

The interview with Sherazade, who asked us to use this nickname instead of her real name amid concerns for her safety, can be found below: 

 

-    Hi Sherazade, thank you so much for being with us today for this interview. Could you maybe start by summarizing the role you took into this program, and for how long?

“Good morning from Kabul, I’m happy to be here! I am actually a trained midwife here at the Health Center, I started working around spring last year, so I joined about eight months ago”

 

-    When did you start?

 

“I actually started overall about a year and a half ago, as I initially joined the center as a volunteer for an entire year before being offered this position”

 

-    What was your first appointment? Did you get any promotion, since you started? Why? How? When?  

“I have been a midwife since the first day I joined this clinic, and I still am, but now I specialize in juvenile care and in family planning”

-    Are you happy with your job? what makes you feel happy when you attend your job? or which part of your job do you like to most?

 

“I adore my job! I would say the part I like the most about it is to be able to have a special relationship with my patients, which you could perhaps not have in other medical professions”.

 

-    Why did you join the program? What did you think it could do for you?

 

“I joined this health center because I wanted to specialize myself in family planning from early on, and improve my skills, learn more things, and increase the arsenal of methods I knew so I could better care for my patients.”

 

-    How did you learn about this Health Facility? Why did you choose this clinic specifically?

 

“I joined this health center specifically because it was the one providing me with the exact training that I wanted, it was a unique opportunity for me in that regard!”

 

-    So, which are the training have you received so far?

 

“I learn new things every day here, but the two main trainings I’ve received have been in certain surgical interventions, IV drip placing for instance, juvenile care in general, and as I mentioned, in family planning.”

 

-    What was your first day feeling when they offered you the job? Did you experience overwhelm, joy, serenity?

“I was very overwhelmed, mostly with joy! I remember exactly when they called me to offer me this position at the Health Center, I was so happy! I knew it would be a challenge, but I also knew that I was going to be helpful to my community, that meant the world to me!”

 

-    After you got the training, which areas do you feel you improved the most?  

 

“I feel that I’ve learned to use many more different methods that what I knew when I joined the facility. I've improved a lot in small surgical interventions too, especially on mothers and infants, and I can offer a more adapted care to my patients”.

 

-    Tell us about a day from your life that you were proud to be a midwife? 

 

“Honestly, I am proud to be a midwife every single day, it’s a rewarding job in itself, but being able to place and IV drip for the first time was definitely a moment to remember! It was so intimidating, and I was proud to have managed that on my own.”

 

-    What do you want to achieve in the future? 

 

“The goal for me is to help my people and my community, and to continue specializing in midwifery, improve my skillset, and make a difference in the lives of my patients, one at the time, especially in the lives of my female patients, mothers, infants and girls”.

 

-    Is there any moment you regretted your choice to become a midwife, did you ever experience any doubts?

 

“I absolutely experienced challenges, but I never regretted my choice to become a midwife, not even for a second. It is definitely challenging, it is not an easy job, but I enjoy it and I wake up every day knowing that I love it, and that I am being helpful in the community.”

 

-    How do you see your role as a midwife - now, under the new regime? are you able to work? are you able to move freely? What changes have you experienced since the change of regime? 

 

“Professionally, not so much. The job and the clinic are able to function almost normally on a daily basis. But we are people also, and we had to make a lot of personal changes since the new regime, even in a big city like Kabul, there’s a huge difference. Especially in the medical profession, face coverings are mandatory for women for example, they [The Taliban] are in the street permanently, revving their engines, driving by fast, we feel their presence constantly.”

 

-    How do patients experience the difference since the new regime? Has it changed your professional relationship with your patients? 

 

“The change has been drastic in my relationship with my patients. They are a lot more reluctant to seek our help, most of the time because they are concerned that they will not have enough money to both eat and get medicine, and they feel they might have to choose. The influx of patients that have to be treated at the clinic has also increased significantly under the new regime, even as some people and even doctors are displaced from Kabul to the countryside.

 

-    Thank you so much for your time Sherazade, is there anything else you’d like to share with the world? A special message? 

 

“Thank you for having me!

I guess if I had a message to share with the world, it would be to keep fighting. Keep fighting for us, keep fighting for the women and girls in Afghanistan and for their future. The new regime is making their lives particularly restrictive and dangerous. It is truly heartbreaking to witness on a daily basis these women and girls who cannot go to school, get an education, contribute to their community the way they feel is right or at their full potential. I’d say that now more than ever, we need your support and we need you not to give up.

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The current crisis in Afghanistan is affecting the lives and the security of many people in Afghanistan, particularly women and girls. Access to many essential health and social services has been disturbed due to the control of Taliban and their imposed restrictions. Women and girls have been banned from receiving education, freedom of speech, freedom of activity and movement. Humanitarian aid services have also been reduced or have been suspended in certain provinces, with many aid workers having left the country. Main donors including the World Bank have also halted their support to health programmes.  This has caused a serious problem in the operations of clinics and hospitals, lack of medicine, lack of staff and can eventually even result in the collapse of Basic Package and Essential Package of Health Services (BPHS and EPHS).

What is Action for Development doing to help?

Despite the current situation in Afghanistan and the ongoing conflict, AfD is determined to continue its support to vulnerable populations, especially women, and adapt its projects to the ongoing emergency context, to make sure that women and children are still prioritized and get access to essential health services despite the crisis. We do so because we cannot leave behind those we have worked with and for over the last 10 years.

Action for development (AfD) has been working over the years in supporting the capacity-building of midwives in rural zones in Afghanistan and by promoting healthy messages.  For the years 2021 and 2022, and as part of the Basic Package of Essential Health Services (BPHS and EPHS), AfD has developed a midwifery gap-training project in four provinces in Afghanistan, with the aim of improving quality of maternal and neonatal health services in rural areas. Previously, AfD’s overall mission was to train 1,000 midwives across the country. So far our count has reached 650 midwives in 7 provinces.

In these critical times the accessibility to health services is prohibited in some areas due to insecurity, however, some areas are still partially secure and there is a possibility to set up trainings for women, by women specialists, and we would like to use this momentum to safely train an additional 350 midwives to reach our initial goal. We have taken all the necessary measures to ensure the safety and well-being of our staff and the midwives we would like to train.

Until present,  AfD received close to 25,000 USD through additional fundraising mechanisms and over 4,000 USD online through the GlobalGiving platform and generous donors like yourself.  However, we are urgently looking for additional funds to support the implementation of our midwifery training programme and other emergency services.

Please help us support these women, please help our midwifery training programme. Your help can make a huge difference, especially where it is needed most.

Every donation counts!

Thank you for your generous support,

The Team at AfD

 

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Since 2014, Action for Development (AfD) has been providing training to midwives in Afghanistan. According to UNICEF and global research, high rates of maternal death reflect several factors, including limited access to quality maternal health care, particularly in rural parts of Afghanistan; a lack of knowledge of maternal health and safe delivery; and the scarcity of qualified female health providers, since there is a strong cultural preference for women to be cared for by other women.

In 6 years of existence, AfD's program has made it possible to train 650 midwives, including 113 who then qualified to become trainers themselves thanks to the so-called «cascade» approach. In total, 6 provinces of Afghanistan have already benefited from this program. 

Sediqa is 31 and she works at the Shadeed Abdul Health Center. She beneficiated from the AfD Midwifery Training Program in the past as well. She is now training 6 other midwives:“I have very good memories of my training with AfD because when I first came, I did not know about some topics. Thanks to the cascade approach, I later became myself a trainer. Taking a step back, I realize as our knowledge of the profession grows, so does our will to learn."

Despite these improvements over the past years, Afghanistan has one of the highest maternal and newborn mortality rates in the world, and the need for specialised care is more important than ever. Moreover, COVID-19 has exacerbated the difficulties faced by many and has pushed women and children's health outcomes to devastating levels, which also has implications for peace.

"Besides, the corona virus has had a huge impact on our practice, as our patients were afraid of getting infected.One of our patients, who came from Dehsabz, reported that she had given birth at home. Sadly, she was not able to give birth in a healthy and professional context and manner which caused her to bleed extensively and to suffer from anemia. She then came frequently to visit the clinic and was able to recover."

Improving the survival rates of mothers in Afghanistan is an issue of immense importance for women, children and the country as a whole. Midwives are the key to providing the crucial care necessary - but they need your help!

We aim to train 400 new midwives across 4 provinces of Afghanistan: Takhar, Logar, Wardak and Badakhshan. One Day Wages foundation has agreed to provide us a total of 11,000USD with a condition to raise another 11,000USD. With a total of 22,000USD we will be able to train 100 midwives; which would include: 

- Travel cost and accomodation charges for two Master trainers (a male and a female) who would travel to the rural province
- Travel cost and accomodation costs of the 20 midwives who will receive ToT lessons
- Cost of preparation of material and training dossie for 100 midwives 
- Travel cost to the monitor who would collect information on actual cascade training from the midwives who received training via cascade method.
Not only is our project impactful, it is also super cost-efficient, costing just 220USD for a 12 day training per midwife (18USD per day, in the very rural province). In return, each of these 100 midwives will be able to serve between 150 to 360 women per month, assisting them with post-partum and ante-natal care. 
Support us, and help improve the health outcomes for vulnerable women and children!
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In Afghanistan, maternal and infant mortality rates are among the highest in the world. Between 2014 and 2019, Action for Development (AfD) has trained more than 600 midwives in 6 provinces of Afghanistan. The 2021 program aims at training 400 midwives across 4 provinces of Afghanistan: Kabul, Logar, Wardak and Badakhshan.

Following a “skills-gap protocol”, AfD delivers training to 80 government-trained community midwives, who will then become midwife trainers. The training for the 80 midwives will be run over 12 days in a secure rented venue, sourced with the help of local provincial public health officials and local community. Midwives then return to their communities and deliver the training to an additional 4 midwives each through a cascade-model approach. This method of training has proven more effective, less expensive, more sustainable and community-based than traditional training methods. 

Upon completion of the training, the midwives will be able to better perform their roles in the healthcare system, contribute to the prevention of unnecessary maternal/infant mortality, and improve women’s participation in the workforce.

Join us in improving women and children’s lives in Afghanistan by empowering midwives with qualified training! In order for the program to be implemented, it needs to be funded. We have set the total budget at $11.000. We count on the generosity of our donor community, supporters and friends to make this possible!

Every donation counts!

Sincerely,

The Team at AfD

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Organization Information

Action for Development (AfD)

Location: Geneva - Switzerland
Website:
Facebook: Facebook Page
Twitter: @afd_swiss
Project Leader:
Zuhra Dadgar-Shafiq
Geneva, Geneva Switzerland
$5,190 raised of $22,000 goal
 
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