Midwives on the front lines working to reverse Afghanistan’s high maternal death rate

SHAHRISTAN, Afghanistan – “It was midnight on 6 August when there was a loud knocking at my front door. My husband answered. A person stood in the dark, asking for my help. “A baby was being born,” Shirin described to UNFPA.

It was the start of Shirin’s greatest challenge as a midwife.

Shirin, 31, manages a family health house in Usho Golaka Village, in Daikundi Province. Family health houses are community-based facilities that provide a host of basic reproductive health services in remote communities. These services include family planning, antenatal care, safe delivery services, newborn care and immunizations.

She knew the man. He was a relative of Fatima, one of her patients. “Tonight her situation was critical,” Shirin said.

Fatima, already a mother of six children, was in labor with her seventh. Immediately, alarm bells went off. An earlier examination had shown that the delivery would be dangerous.

“Fatima’s baby was found to be in the wrong position and the delivery was to be a breach birth,” Shirin explained. “I’d provided information and counselling on her condition, but advised her to refer the case to the provincial hospital in Nili, the center of Daikundi, for further management of her delivery.”

But Fatima’s family couldn’t afford to seek care so far from home. “We’re a poor family and the cost and unavailability of transport was a big problem for us,” Fatima said. “We would have had to pay 13,000 afghanis [$170] for transport to reach the provincial hospital in Nili. This was not possible.”

UNFPA midwives to the rescue in Afghanistan

Afghanistan has one of the highest maternal mortality rates in the world, according to United Nations data. Some 638 women die per 100,000 live births. Poverty, lack of access to health services and gender inequality all contribute to these tragically high numbers; health professionals attend fewer than 60 per cent of births.

To address these concerns, UNFPA supports Afghanistan’s community midwifery education program, a training program funded by the Canadian Government, which equips midwives to provide essential basic maternal health services and other midwifery care. These midwives then operate from UNFPA-established family health houses, which provide the only medical services available in Afghanistan’s remotest and most difficult-to-reach areas. 

Shirin graduated from the community midwifery education program in 2015. She has since worked in the family health house in Usho Gholaka, where she has served hundreds of women.

Her husband is supportive of her work. That night, he took her by motorbike to the village where Fatima and her family live.

“The intent was to save a mother and her baby,” her husband said. “I’ve pledged to support my wife in this work, even if it’s midnight.”

Thinking on her feet

Shirin found Fatima suffering in terrible pain, shouting for help. She urged the family to transport Fatima to a hospital, but it was impossible.

Although Shirin is an experienced midwife, she didn’t have the equipment for serious complications like breach delivery. But in that situation, she had to improvise.

“I called an expert gynecologist who was working in the provincial hospital and asked for instructions. This was the only solution I could come up with that might save their lives. They instructed me to use different maneuvers to shift the position of the baby in the womb. I followed the gynecologist’s guidance carefully.”

It was a tense labour – but in the end, her efforts paid off.

“Finally, the uterine contraction began and a baby boy was born after one hour and 45 minutes of labor. He was safe and healthy,” Shirin recalled.

Relief washed over Fatima’s family.

“When I heard that Fatima and her baby were alive, I can’t tell you how happy I was,” Fatima’s mother-in-law told UNFPA. “I am so grateful to Shirin for being there and helping women in need.”

Fatima later brought her newborn to the family health house for postnatal services. “I’m grateful to Shirin,” she said. “She saved not only my life but also the life of my child.”

And Shirin, too, is grateful. Though the experience was harrowing, she feels she has grown as a midwife.

“I was very proud of what I did,” she said.