Community midwifery education program in Afghanistan

Afghanistan's health services in the immediate post conflict period were in a deplorable and chaotic state. In 2002, its maternal mortality ratio was the second highest in the world, reflecting a lack of access and utilization of reproductive health services and skilled care during pregnancy, childbirth, and the first month after delivery. These services are key to saving women at risk of dying due to pregnancy and childbirth complications. In a society where women seek care only from female providers, one barrier to expansion of services was the lack of qualified female health workers to deploy to remote health facilities to make up for the shortfall of female staff. Some 77 percent of the population was living in rural areas, where women are usually excluded from access to skilled and emergency health care. In 2003 for example, most Afghan women delivered at home, and fewer than 10 percent of births were attended by a skilled provider. Very few midwives trained in Kabul or other big cities were willing to work in rural areas where the needs were much higher. Moreover, there were no education facilities and too few female school graduates who could be trained in the provinces. Given the dire situation, the shortage of midwives had to be remedied urgently. The community Midwifery Education (CME) Program was created.