USG-TRAINED MIDWIVES HELP COMBAT AFGHANISTAN'S APPALLING

UNCLAS KABUL 003098 SENSITIVE SIPDIS DEPT FOR GWI, S/SRAP, SCA/FO, SCA/RA, SCA/A DEPT PASS AID/ANE E.O. 12958 N/A TAGS: ESTH SOCI AF SUBJECT: USG-TRAINED MIDWIVES HELP COMBAT AFGHANISTAN'S APPALLING MATERNAL MORTALITY ¶1. (U) Summary: In a country with high birth rates and sparse medical assistance, one in eight Afghan women dies in childbirth. Afghanistan's maternal and infant health statistics are the second worst in the world, and it is one of few countries in which women have a lower life expectancy than men. Doctors are rare in rural areas and most children are delivered at home. USAID's Community Midwifery Education Program, in cooperation with the Ministry of Public Health (MoPH),is working to change these horrible statistics, training more than 2,000 rural women in maternal health, childbirth assistance and basic public health and providing graduates the critical skills they need to save women's and children's lives in their own remote villages. Selected by their communities in conjunction with the MoPH, the midwives are the face of the delivery of critical life-saving services by the Afghan Government. End summary. Afghan Women: Early Marriage, Many Children, Early Death - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ¶2. (U) Afghan women are 600 times more likely to die in childbirth than their North American counterparts - one Afghan mother dies for every 55 children born. Fifty-seven percent of Afghan women marry before the legal age of 16, and the average Afghan woman has 6.75 children in her lifetime before dying at age 44. Most will never receive treatment from a medical doctor - in rural areas, where most Afghans live, mullahs are the sole medical providers. Mullahs generally rely on advice passed down through generations, and they do not deliver children or conduct ob/gyn exams or treatments. Local midwives often assist births, but they too have no formal training. Community Midwifery Education Program - - - - - - - - - - - - - - - - - - - ¶3. (U) Through the MoPH, USAID's Community Midwifery Education Program has trained more than 2,000 competent midwives through 12 in basic obstetrics and gynecology, as well as pre- and antenatal care. The women are often the most educated person in their rural districts. All three women who spoke with EconOff September 29 at a program graduation ceremony in Bamiyan had completed the 12th grade. Since the program began in 2002, all but one of the two hundred graduates from the Bamiyan school has returned to her village to practice. Participants in the Bamiyan program come from several surrounding provinces. The 18 month program costs $16,000 per year, per student for trainers, room and board, transportation, child care, medical tools and follow up to make sure they have the proper working environment. ¶4. (U) Most participants in the training program are married, and their families clearly support their ambition. Each woman interviewed had her own personal story of maternal mortality - from lost mothers, sisters, and neighbors, the tragedy was universal. As participants are in their 20s, many have their own infants who they can bring with them to the central training location and enroll in on-site childcare. One graduate said her husband, a mullah, encouraged her to apply for the program, and added she hopes they can work together to promote maternal health in their community. Training Is Just One Challenge - - - - - - - - - - - - - - - - ¶5. (U) While the training program has tremendous potential to save the lives of mothers and children, the challenges new midwives face when they return to their communities are great. Depending on their location, some graduates work in clinics or local sub-centers of the Ministry of Health, but few are assigned to hospitals. Several said the nearest hospital is more than a day's walk from their village, leaving them on their own in case of emergency. Under Afghan law, midwives cannot perform cesarean sections. ¶6. (U) Hemorrhage is the leading cause of maternal death in Afghanistan. JPAIGO, a USAID implementing partner affiliated with Johns Hopkins University, conducted a study in which midwives and health workers provided expectant mothers with misoprostol, a drug that prevents hemorrhaging if taken immediately after delivery. The Afghan Government is cautious about using the drug, since it can also be used to induce abortion, which is illegal in Afghanistan. However, the study found 45 percent of births result in hemorrhaging, and that misoprostol dramatically improves chances of maternal survival. ¶7. (U) Concern about improper drug use is not unfounded. One midwife graduate said that when she worked as a health educator in her village, an expectant mother came to the clinic with preeclampsia (the third leading cause of death for Afghan mothers behind obstructed labor). The untrained midwife in the clinic gave the woman a high dose of labor-inducting drug oxytocin, killing the baby and almost killing the mother. The graduate said she is glad she knows more about proper use of drugs after her training. Saving Lives and Promoting COIN - - - - - - - - - - - - - - - - ¶8. (SBU) Trained midwives provide a local face to the delivery of critical governmental services. Due to cultural considerations, most women do not travel outside of their community for childbirth - especially to see a male medical professional. In addition to medical care, the program provides tangible evidence of Afghan Government support to its citizens. In a country where every woman knows she is at risk of dying in childbirth, Afghans are more likely to support a government that helps fight an all-too-personal cause of death. ¶9. (SBU) At the September 29 graduation ceremony, both the Bamiyan Governor Habiba Sorabi and Deputy Minister of Health Faizullah Kakar thanked the USG for supporting one of the most important programs in Afghanistan and helping the Afghan Government meet the needs of its citizens. As several recent polls indicate, Afghans list healthcare as one of the services they most demand from their government. ¶10. (SBU) Comment: Midwife education is a low-cost, high-impact program for Afghanistan's vulnerable rural population. The program enables motivated women to further their education and support their families through their profession, creating jobs and opportunities in extremely poor communities. The program also delivers much-needed life saving services through the MoPH - thus demonstrating the Afghan Government's ability to help its citizens. While Afghans may not see the link between healthcare and counterinsurgency, they definitely understand the importance of governmental provision of basic services. The program's importance should not be overlooked. End comment. EIKENBERRY