Afghanistan: midwives save lives and change dangerous practices

At Istaqlal Hospital in Kabul, the capital of Afghanistan, a tiny body wrapped in a yellow blanket is rushed into the emergency neonatal room. It’s a little boy, born minutes earlier. But he’s not breathing.

I watch as a midwife dressed in purple scrubs lays him on a table and  tries to clear his airway, then hurridly rubs his back. A second midwife arrives and repeats the routine as a third hovers behind ready to move the oxygen tank in.

Just yesterday I had watched another newborn boy die on this table. His mother had tried to give birth at home without anybody to help her, but the birth had been breach and when she finally came to the hospital it was too late.

As the seconds pass, terrible anxiety wells up in me that the same thing is about to happen. But suddenly, with oxygen being pumped into his lungs, the baby’s chest starts jerking up and down and his head starts to move. Finally there is the cry the midwives have been waiting for. Minutes later he is bundled into a tight cloth package and carried out, and the midwives return to the busy delivery wards across the corridor.

This little boy was lucky. Istaqlal Hospital has one of Kabul’s best equipped and biggest maternity wards. 50 trained midwives are on hand 24 hours a day to deliver the hundreds of mums who arrive here to give birth every week.

Most dangerous place to be a mum

But this is an incredibly unusual set up in Afghanistan. The country is one of the most dangerous countries in the world for pregnant mums and newborns. Every year more than 85,000 babies and 17,000 mums die due to pregnancy or childbirth complications.

Most of these deaths would be entirely preventable. But the chronic shortage of midwives and health clinics here means the vast majority of mothers – more than 80% – still give birth at home without any skilled help.  And the consequences are frequently devastating.

At Guldara clinic, a small health centre on the corner of a winding dirt road that leads up into the Hindu Kush mountains near Kabul, I follow 35-year-old Rogul into one of the consulting rooms.  She has recently been trained by Save the Children as a community midwife, and now spends time with pregnant mums and families in her village, making sure they know the dangers involved in giving birth, that they go for check-ups at the clinic, and know how to look after themselves properly to give both them and their unborn children the best chance of survival.

“I gave birth to my first eight children prematurely, and they all died,” she tells me. “Every time I would start bleeding and suffering from a severe pain in my waist and my mum would go to an illiterate woman in our neighbourhood for help. She would ask my mum to do some strange things like shaking seven metal chains into a glass of water and then giving it to me so that my bleeding would stop. But by the time my mum was back with the glass of water I already had lost the baby.”

Her ninth baby boy was born at term, but he died within the first 24 hours. “After I delivered him, his legs and arms turned green and he passed away. Now that I have been trained, I know that he died from tetanus, as I hadn’t got the tetanus vaccine when I was pregnant.”

Rogul tells me how proud she is now she is helping to save babies lives in her village. “You can’t imagine how happy people are with the kind of help I am providing for them. A lot of people do things that are totally wrong due to lack of awareness. Before I was helping them, mums were giving babies food and butter instead of breastfeeding them. They would start washing the newly born baby with soap and thick cloths right after the birth. Now they know what to do. Because of us community midwives, fewer mums and babies are dying. It’s so important to save a life.”

But the impact of women like Rogul goes even deeper than simply helping mums deliver safely. Later I pass through the guarded gates of a house into the home of Fawzia Koofi, Afghanistan’s most prominent female MP.

Changing dangerous cultures

Her constituency in Afghanistan has the worst rates of maternal mortality not only in the country, but in the world. As we drink tea in her sitting room, she explains how community midwives have unique potential to change the culture in Afghanistan that often prevents pregnant women from seeking help.

“Here women are often prevented from getting trained help, either because their husbands are worried that they will see a male doctor, or because their own mothers gave birth at home and believe their daughters should follow the old traditions – however dangerous they are.

“If a girl is trained from a village as a midwife, she is respected when she returns. She can start to change not only the beliefs of pregnant women, but of their families, their husbands, and of traditional people in the community.

“Afghanistan has a critical shortage of midwives. Of course they are not the only solution — we need more health clinics and better equipment so even the poorest families in the most remote areas can get help. But with more trained midwives, we can start to create real change and save lives. Their practices can reach everybody.”

As part of our No Child Born To Die campaign we’re calling for world leaders to help recruit and train 3.5 million vital midwives and healthworkers. Take action today