Farangis Sultani had her hands full. A woman in labor had just arrived by way of a donkey to the clinic in Badakhshan province where Sultani works as a midwife. Sultani went to work delivering the baby, then learned the woman was pregnant with twins—and the sibling of that first arrival was not in the correct position to exit the birth canal safely.
As she relayed the story to a National Public Radio reporter in September, Sultani suggested a higher power may have had a hand in the baby turning on its own and being delivered successfully, as she had to turn her attention to the twins' mother. The woman was bleeding and in distress.
"After injecting some drugs and medicines, I finally managed to stop the bleeding," Sultani told NPR. "And at the end of the two days, she was completely healthy and she went home."
Happy endings like this are not the norm for Afghanistan, which has some of the highest infant and maternal mortality rates in the world. Approximately one out of every 60 women dies giving birth in Afghanistan, and 129 infants out of every 1,000 die in their first year of life.
But a concerted effort to train women as midwives is making progress in this war-ravaged country to extend the lives of some of its most vulnerable citizens.
USAID began working to cut the numbers of deaths of mothers and infants by providing some very basic services that Afghans lacked, but that are key to healthy deliveries: skilled midwives, well-equipped health centers that take the place of at-home deliveries, and community health workers who educate mothers on preparing for birth and proper infant care. The program also sought and received buy-in from Afghan women and men. All of these appear to be making an impact.
This year, the country's infant mortality rate has dropped by an estimated 22 percent since 2003, thanks in part to better midwifery.
"We've trained over 2,500 midwives since 2002 with support from donors like USAID, the Word Bank, U.N. agencies, and the European Commission. Mobilizing over 1,600 Afghan Midwives Association members contributes to a reduction in infant and maternal mortality," said Feroza Mushtari, acting president of the Afghan Midwives Association.
Statistics also show that 77 percent of maternal deaths in Afghanistan can be avoided with proper health care. However, particularly in the most remote parts of the country, access to reliable health services is limited due to a lack of infrastructure, education, and professional health providers.
USAID has worked with the country's Ministry of Public Health for eight years to support midwifery training for women across Afghanistan. Classes last 24 months and cover a range of both clinical and practical trainings, including in antenatal, natal, and postnatal care.
Dr. Nasratullah Ansari is an obstetrician and the technical director of the nationwide midwife project. He sees first-hand the difference this project makes to the women trained, the women treated, and beneficiary communities. "They are so proud to be a midwife. You are taking care of the whole village. And the … other thing is they are so proud they can receive salary. It's a sort of empowerment of women."
As a result of multi-donor support—including the European Commission, the World Bank, and the Global Alliance for Vaccines and Immunizations—the number of midwives in Afghanistan has increased from 467 in 2002 to more than 2,500 in 2010.
USAID has helped train more than half that number, and developed a midwifery education program that is used in 34 specialty schools in 32 provinces. In addition, the Agency helped establish a National Midwifery Education Accreditation Board to authorize, supervise, and monitor all midwifery and community midwife education programs in the country.
USAID also supported establish- ment of the Afghan Midwives Association (AMA) in 2005. The organization has more than 1,600 current members and works to promote and strengthen the midwifery profession.
"Since I became a member of AMA, I have had the opportunity to improve my leadership by attendance in international events, sharing experiences, and participating in leadership and management trainings. Because the AMA is a well reputed association at both the national and international levels, as an AMA representative, I am benefiting from the respect of my management team in Cure Hospital," said Victoria Parsa, an AMA representative at Cure International Hospital in Kabul.
For new mothers, proof of the program's success is often laying quietly in their arms. "For the first time in my lifetime, I have seen a woman doctor [midwife] that has treated me with such tenderness and care," said a 35-year-old mother in Dahana-e-Sabzak, a remote village in Bamyan province.
Though it appears there has been progress, U.S. and Afghan officials will get a better understanding of the country's health gains when the USAID-supported Afghanistan Mortality Survey now underway is completed in summer 2011. The survey report will provide data on the magnitude of maternal mortality, the main causes of death, risk factors, and barriers that affect women's access to care.
Last updated: September 19, 2016