The Road To Midwifery In Afghanistan: Training Duration And Challenges

Afghanistan has one of the highest maternal mortality rates in the world, with an estimated 396 deaths per 100,000 live births. In addition, thousands of Afghan women die each year from preventable pregnancy-related causes. The situation is particularly dire in rural and hard-to-reach areas, where only 3% of deliveries are attended by a skilled professional.

To address this issue, the Afghan government has implemented the Community Midwifery Education Program, which has reduced the training period from 4 years to 18 months. This has led to an increase in the number of midwives; however, the depth of their skills and knowledge has been compromised. Other organisations, such as Relief International and the Afghanistan Midwifery Project, are also working to train midwives and improve maternal healthcare in Afghanistan.

The duration of midwife training in Afghanistan varies depending on the program. The Community Midwifery Education Program offered by the Afghan government lasts for 18 months. Diploma-level midwifery programs, which are the minimum requirement to work as a midwife in the country, typically require at least 10 years of secondary education. Bachelor's degree programs in midwifery, on the other hand, usually take 4 years to complete.

Despite the challenges, organisations and individuals are working tirelessly to improve maternal healthcare in Afghanistan by training a new generation of midwives.

Midwife training in Afghanistan was reduced from 4 years to 18 months to increase the number of midwives

Afghanistan has one of the highest maternal mortality rates in the world, with 396 maternal deaths per 100,000 births. The country also has one of the highest infant mortality rates, with estimates ranging from 52 to 110 deaths per 1,000 live births in 2017. In addition, thousands of Afghan women die each year from preventable pregnancy-related causes. These issues are particularly prominent in rural and hard-to-reach areas, where only 3% of deliveries are attended by skilled professionals.

The shortage of midwives in Afghanistan can be attributed to several factors, including the Taliban rule from 1996 to 2001, during which women were banned from working and studying. The ongoing conflict, internal displacement, and difficulties in accessing education and employment have further exacerbated the shortage. To address this issue, the Afghan government reduced the midwifery training period from four years to 18 months in the Community Midwifery Education Program. This policy decision led to an increase in the overall number of midwives but came at the cost of compromising the breadth and depth of their skills and knowledge.

The reduction in training duration was a strategic move by the government to rapidly expand the midwife workforce and address the critical shortage. However, it is important to acknowledge that this shorter training period may have resulted in a trade-off between quantity and quality. The skills and knowledge of midwives are of utmost importance in ensuring safe and effective maternity care.

While the reduced training duration achieved the goal of increasing the number of midwives, it is crucial to continuously evaluate and improve the training programs to ensure that midwives are well-equipped with the necessary skills and knowledge to provide quality care. This may include extending the duration of training, expanding the range of topics covered, and providing ongoing professional development opportunities for midwives to enhance their competencies.

Despite the challenges, the Community Midwifery Education Program has been successful in increasing the number of midwives in Afghanistan, which is a positive step towards improving maternal and infant health outcomes in the country. However, it is important to continuously invest in the development and support of midwives to ensure they have the necessary skills, knowledge, and resources to provide quality care to pregnant women and newborns.

The Community Midwifery Education Program trains midwives to work in rural health centres

Afghanistan has one of the highest infant mortality rates in the world, with estimations of between 52 and 110 deaths per 1,000 live births in 2017. In addition, thousands of Afghan women die each year from preventable pregnancy-related causes, with 396 maternal deaths per 100,000 births. The situation is particularly dire in rural and hard-to-reach areas, where only 3% of deliveries are attended by a skilled professional.

The Community Midwifery Education Program (CMEP) is one initiative that aims to address this issue by training midwives to work in rural health centres. The Afghan government has reduced the training period from 4 years to 18 months under the CMEP. While this has led to an increase in the number of midwives, it has also compromised the depth and breadth of their skills and knowledge.

Action for Development (AfD), in partnership with the Geneva Health School and the University of Applied Sciences Western Switzerland (HEdS), has developed a training program to address these skill gaps. The program covers five key areas: eclampsia, pre-eclampsia, management of the third stage of labour, post-partum haemorrhage, and newborn care. Since 2014, AfD has trained 490 midwives in seven provinces. These midwives then go on to train an average of five other midwives each, under the supervision of the Ministry of Public Health.

Another initiative aimed at improving access to healthcare in remote areas is Relief International's Community Midwife Training Program. This 26-month program accepts 24 female high school graduates who are 18 years or older and prioritises students from remote areas with low or no midwife coverage. The curriculum covers basic anatomy and physiology, as well as maternal, newborn, and antenatal care.

The Norwegian Afghanistan Committee (NAC) has also been supporting the education of midwives in Afghanistan since 2002, with a focus on deploying them in rural communities. The NAC's Advancing Maternal and Newborn Health in Afghanistan project has educated approximately 1000 midwives since its inception.

Midwifery training covers basic anatomy, physiology, and pharmacology

Midwifery training in Afghanistan covers basic anatomy, physiology, and pharmacology. This training is essential for midwives to provide safe and effective care to pregnant women and their babies.

Basic Anatomy and Physiology

Basic anatomy and physiology are fundamental components of midwifery training. This includes understanding the structural organization of the human body and how it functions. Midwives need to know the different body systems, such as the cardiovascular, nervous, respiratory, digestive, and reproductive systems, and how they work together to maintain homeostasis. They also learn about the specific anatomy and physiology of pregnancy, childbirth, and the postpartum period. This knowledge helps them identify normal and abnormal developments and provide appropriate care.

Pharmacology

Pharmacology is another critical aspect of midwifery training. Midwives must understand the legal basis for medication use, prescription requirements, and drug testing. They learn about different types of medications, including analgesics, anaesthetics, antibiotics, and medications used during pregnancy and childbirth. This knowledge equips them to administer medications safely and effectively, following legal regulations, to manage pain, treat infections, and address various health conditions.

Training Programs

Midwifery training programs in Afghanistan vary in duration and structure. Some programs offer a Community Midwifery Education Program, which was shortened from four years to 18 months to address the shortage of midwives. There are also longer programs, such as a 26-month Community Midwifery Training Program offered by Relief International. This program covers basic anatomy, physiology, infection prevention, and pharmacology, ensuring graduates are well-prepared to handle pregnancy, delivery, and postpartum care.

Benefits of Training

The inclusion of basic anatomy, physiology, and pharmacology in midwifery training has multiple benefits. It empowers midwives with the knowledge and skills to provide competent care, handle complications, and improve maternal and infant health outcomes. By understanding the underlying physiological processes, midwives can better monitor pregnant women, recognize deviations from normal, and provide timely interventions. Additionally, pharmacology training enables midwives to safely administer medications, ensuring the well-being of both mother and child.

Midwifery training has been supported by the US Agency for International Development since 1974

Midwifery training in Afghanistan has been supported by the US Agency for International Development (USAID) since 1974. USAID has played a leading role in decreasing maternal and child deaths in Afghanistan, with a focus on providing life-saving care to women and children.

In the early 2000s, USAID supported the Community Midwifery Education (CME) programme, which aimed to train rural midwives. CME was considered a positive model for promoting women's education, employment, and health. The programme was scaled up nationally in 2005 and has contributed to positive indicators, including a reduction in maternal mortality ratios and an increase in skilled deliveries and qualified midwives.

USAID has also supported the delivery of basic health services to over 2,300 health facilities across Afghanistan and has engaged the private sector to promote and distribute essential health products to vulnerable populations. Their efforts have helped increase the percentage of pregnant women receiving antenatal care and full immunisation coverage, while also reducing child mortality rates.

However, midwifery education in Afghanistan continues to face challenges, including insecurity, corruption, lack of regulation, and funding uncertainties. There is also a need for greater investment in building the skills and confidence of midwives and providing higher education opportunities. Despite these challenges, the support from USAID and other organisations has been instrumental in improving maternal and child health outcomes in Afghanistan.

Midwives in Afghanistan face challenges such as long working hours and a lack of job security

Midwives in Afghanistan face many challenges, including long working hours and a lack of job security.

Long working hours

Midwives in Afghanistan often work long hours, with some working 24 or 32 hours consecutively. This can lead to exhaustion and an increased risk of mistakes. In some cases, midwives have to work in multiple clinical areas in which they do not feel competent, further adding to their workload.

Lack of job security

Job security is a significant concern for midwives in Afghanistan, especially in rural areas. The Taliban's restrictions on women's education and employment have made it difficult for midwives to continue their jobs. They face challenges such as a lack of pay, difficulty in safely getting to work, and uncertainty about whether the Taliban will accept their profession. The Taliban's requirement for a male guardian has also made it challenging for midwives to work, especially those who do not have a close male relative.

In addition to these challenges, midwives in Afghanistan also face issues such as a lack of infrastructure and supplies, cultural and gender norms that impede their work, and security concerns. Despite these obstacles, midwives remain committed to their profession and play a crucial role in improving maternal and infant health outcomes in the country.

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