24 August 2011 - Baskul Nasrati is one of 23 girls spending two years in Kabul to train as a midwife before returning to her home village in the Central Highlands, part of a national programme supported by the United Nations to knock Afghanistan from the top of the deadliest places to give birth.

“We are eight hours walking distance from the clinic and we have no roads in the winter,” Nasrati, a 20 year-old from Khwazari Nargis in Bamyan province, told UNAMA during a practice session of performing CPR on a plastic newborn.

“The reason I came to this place is to return home and bring down the mortality rate,” she said.

The Afghan maternal mortality ratio is 1,400 per 100,000 live births, according to national figures. About one-third of pregnant women receive pre-natal care, and only about 24 per cent give birth in a clinic or with a skilled attendant, according to UN Interagency estimates. As a result, one out of every 11 women risk dying from complications related to pregnancy, and an estimated one out of every 20 babies born dies within the first month.

With the average Afghan woman giving birth to more than six children, improving the health of new mothers and newborns is one of the five top priorities this year for the UN in Afghanistan.

The programme in Kabul is led by the Ministry of Public Health and the Agency for Assistance and Development of Afghanistan (AADA) with financial and technical support from the UN Population Fund (UNFPA). It trains young women from Bamyan, Daikundi and Faryab in basic community health and emergencies related to pregnancies, and provides them with resources to establish a health centre in their own homes - known as a Family Health Houses (FHH).

The midwife will be responsible for providing 24/7 services to neighbours living within a two hour walk from the FHH.

“The only clinic is 50 kilometers away. Even if we take the mothers to that clinic, the midwives work from 8AM to 4PM so after those hours there is nobody to attend to them,” said Gulchaman, 28, from Varas village in Daikundi.
“I have come here to this midwifery training centre to learn midwifery and to go back to my place and save the mothers and newborns,” she added.

The girls selected for the programme are at least 18 years old, married, and have completed at least six years of schooling. Eligible girls pass tests and interviews before being confirmed by provincial and district committees, with support from their communities.

“My family and our religious leaders were very happy and supported me when I passed the test because they realized I would return to the community and help” said Maryam, 19, from Charjoi village, Daikundi.

The students spend two days a week learning theory in classrooms and labs, then a week in hospitals practicing what they learn. The entire training takes two years.

In addition to the 23 students in Kabul, 40 in Faryab provice and 26 in Bamyan are undergoing similar trainings by AADA with funding from UNFPA.

“While Afghanistan has made some positive strides in improving maternal and newborn health, the advancement has been slow. We need to strengthen the health system in Afghanistan. A health system that can deliver for women when women are ready to deliver is a health system that will benefit all,” Babatunde Osotimehin, Executive Director of UNFPA, said during his visit to Afghanistan last week. Click here to read more about the visit.

In addition to UNFPA, midwifery training programmes in Afghanistan are also supported by the UN Children’s Fund (UNICEF), UN World Health Organization (WHO), UNAIDS, World Bank, USAID and the International Confederation of Midwives.

“I would like to request that husbands and fathers allow their wives and daughters to come to midwifery training centres,” Nasrati said.

Her peer Gulchaman agreed,” They can learn something so they can help their own people.”