Worst place to be a mother, best place to be a midwife

Afghanistan is the most dangerous country in the world for pregnant women. But a rise in the number of community midwives is saving the lives of mothers and their newborn babies.

Story by Rebecca Lyman. Photos by Nila Akbari. Edited by Shawna Templeton.
Published January 2, 2012 at 12:00am PST

When Shukria, now 32, gave birth to her first child at age 15, she never dreamt she would become a midwife, or that her daughter would follow in her footsteps.

But Shukria and her daughter are part of a growing mother and child health movement in Afghanistan, the most dangerous place in the world to give birth.

Childbirth is dangerous business

Shukria’s inspiration to pursue midwifery stems from painful memories. Years ago, a close family member died in childbirth when an unskilled traditional birth attendant mistakenly removed her womb instead of her placenta.

Tragically, this story is all too common in Afghanistan. For every 43 births in Ghor and Badghis provinces, a woman dies in pregnancy, labor, or after childbirth. 

“So many women die needlessly through lack of any basic care during their pregnancy,” says Dr. Sarah Pickworth, a public health specialist who worked with World Vision in Afghanistan for several years. 

“Poor diets and working extremely hard physically in the fields right up to birth leave women in a poor state to go through childbirth, which is often only assisted by an unskilled neighbor or their mother-in-law at home,” explains Pickworth. 

Shukria (left, in lilac gown), a trainee midwife, cares for a newborn with Khadija Samet, the clinical supervisor for World Vision’s community midwife education project in Herat, Afghanistan.Cultural practices also put pregnant women at risk. “Women still need to get the permission from their husband or mother-in-law before they can go for help,” say Pickworth. “If there is no female health worker, rather than face the shame of seeing a male health worker, her family will not take her to get help.”

These women often bleed to death before they receive healthcare.

Midwives protect mothers

Before World Vision started the community midwife program in Ghor province, there were no midwives among a population of more than 800,000 people. Today, with 38 midwives in Ghor province, 85 percent of health facilities are staffed by a midwife.

In addition to assisting mothers in the birthing process to ensure a safe delivery, midwives educate women about the potential risks to mother and child, and how they can be avoided. 

For instance, midwives inform mothers about the risks of birthing several children in a short period of time. Shukria explains to mothers that if children are born too close together, the mother is more likely to become anemic, and the risk of death during childbirth increases. 

Awareness is also critical. Through the midwife program, community outreach teams comprised of men and women help raise awareness among both mothers and fathers to remove the barriers that prevent women from accessing care. “Early referral for complications and encouraging women to deliver in health facilities saves lives,” explains Pickworth.

Midwives prevent early childhood deaths

Midwifery is not just about a safe delivery for the mother and child, but also guaranteeing healthy first years of life for the child. 

This year in Afghanistan alone, more than 300,000 children died before their fifth birthday, with 38 percent not surviving their first four weeks. These deaths are caused by preventable pregnancy-related or neonatal complications, or preventable afflictions, such as diarrhea, pneumonia, and malnutrition.

Shukria and other World Vision-trained midwives help protect newborn babies and young children from preventable health threats. For instance, they teach mothers that breast milk is best for their babies — not oil from a sheep or sugared water, as some mothers have been led to believe. Midwives also train mothers how to clean and cook varieties of vegetables to nourish themselves and their children.

By introducing hygiene practices like hand-washing, separating water used for humans and livestock, and encouraging immunizations, midwives and community health promoters help reduce child mortality.

Shukria, a trainee midwife, cares for a newborn. Midwives help protect both mothers and their newborn children.

A community health chain

The hospital and community-trained midwives in Herat and Ghor provinces are important links in a developing health chain that is quickly gaining the support of community leaders.

In Ghor province, where many communities are cut off from health facilities during the winter months, World Vision is helping set up community growth monitoring groups. Group leaders are taught how to check the growth of children and refer those at risk to midwives or health facilities for further assessment.

Over the past year, with the help of a local aid agency, nearly 300 people have been trained in basic health, monitoring the nutrition of more than 20,000 mothers and children each month. More than 90,000 mothers and fathers currently attend these health groups across five districts.

While there are many more midwives than a decade ago and public awareness in Afghanistan has increased, still more needs to be done to protect mothers and children. 

A global movement to protect mothers and children

The challenges that pregnant women and mothers face in Afghanistan are reflective of a worldwide problem. Every day, more than 20,000 children die before their fifth birthdays, mostly from preventable and treatable causes.

World Vision’s Child Health Now campaign aims to ensure that children can grow up healthy with access to basic health services, adequate nutrition, and disease prevention. Through this campaign, we support communities in raising their voices about their right to quality healthcare and press national governments to meet their responsibilities to children, mothers, families, and communities.

Learn more

Read a Reuters article about the risks for mothers who give birth in Afghanistan.

Three ways you can help

Pray for mothers and children who do not have access to basic healthcare. Pray that countries and communities with the power to act and save lives would do so.

Donate now to help promote maternal health in Afghanistan. Your gift will help World Vision provide training for midwives like Shukria, as well as prenatal and ongoing healthcare for Afghan mothers and children.