Army of Angels

Afghanistan’s community midwives

- Sophie Ibbotson

In Afghanistan, a woman dies every 27 minutes from pregnancy-related complications. At 6.5 percent (6,500 maternal deaths per 100,000 live births), the maternal mortality rate in Badakhshan Province is the highest in the world. Over the course of her lifetime, an Afghan woman’s chance of dying in childbirth or from pregnancy complications is one in eight, compared to one in 8,000 in the developed world. There is nothing poetic about these deaths; the birth of any child is a miracle, but in Afghanistan, it often comes at too high a price.

With a nominal per-capita GDP of just US$585 (International Monetary Fund, April 2012), Afghanistan is one of the poorest countries on Earth. More than three decades of conflict with forces both external and internal have ravaged what infrastructure there was, and the much-advertised influx of foreign aid rarely reaches the people that need it most: the rural poor in Afghanistan’s remote, mountainous regions, as well as women in conservative communities who rarely, if ever, leave their homes and can have no contact with men outside their immediate family.

One of the most cost-effective ways of reaching out to these isolated populations, and an invaluable weapon in the war against infant and maternal mortality, is Afghanistan’s growing army of trained midwives. In 2002, Afghanistan had just 467 trained midwives, and less than half of all healthcare facilities had any female staff. In Nuristan – albeit an extreme case – male healthcare workers outnumbered female staff43 to 1. Refusing to be seen by men, even women that could physically reach medical services could not then be treated, contributing significantly to the death rate. The World Health Organization (WHO) recommends one midwife be available for every 175 women of childbearing age. To reach this goal, Afghanistan requires almost 5,000 midwives, and for cultural reasons, the vast majority of them need to be women.