Teen Midwives in Afghanistan Help Save Lives

Teen midwives in Afghanistan help save lives
A bored teen at the mall? Hardly. This 18-year-old widow and mother works courageously to curb Afghanistan’s staggering infant and maternal mortality rates, thanks to a training program supported by World Vision.

September 2009

By Mary Kate MacIsaac, World Vision Afghanistan, and Rachael Boyer, World Vision U.S.


As part of her practical training, this 18-year-old midwife-in-training administers a vaccination to a newborn at Herat Regional Hospital in Afghanistan. World Vision is training young women here to become midwives in an effort to reduce the region's high maternal- and infant-mortality rates.
Photo ©2009 Mary Kate MacIssac/World Vision
Dressed in scrubs, pink vinyl aprons, caps, and the occasional surgical mask, midwives-in-training hustle between beds in the delivery room at the Herat maternity hospital in western Afghanistan.

In other countries, teens like these are attending high school, watching movies, or going on dates. But in Afghanistan, these young women are learning to save lives.

Almost half of all deaths of women age 15-49 in Afghanistan result from complications during pregnancy and childbirth. Most of these deaths could be prevented with increased access to maternal health services. Competent midwives based in rural communities are beginning to make that difference.

A midwife named Suraya
It is May 2009. A young woman cries, “God, God, God…” from behind a portable turquoise curtain. Leaning over her, an Afghan teen dressed in hospital scrubs speaks calmly, encouraging her to take quick, short breaths. The laboring woman’s toes grip the mattress edge, and her hand presses against the green tiled wall next to the bed. “Don’t push. Not yet,” says the midwife, “Wait, wait…”




Make a donation to World Vision’s Mother and Girls Health Fund. Your gift will help provide maternal health care in areas where the need is great.
The midwife is Suraya,* an 18-year-old midwife-in-training from a remote village in the mountainous province of Ghor. Married at just 14, and widowed at 16, Suraya is more grown up than one might expect. She was 15 when she gave birth to her son, Razeq, who is now 3. Her mother cares for the boy at home while Suraya completes her practical training in Herat.

When her parents heard about the program, they encouraged Suraya to become a midwife. “They said, ‘This is good. You can help our community by assisting the women here. You can help save the lives of mothers and babies,’” recalls Suraya.

Eighteen months ago, Suraya had just completed the ninth grade. Then she heard about and applied to the midwifery training program, supported by World Vision. The program is about 125 miles from her home — an unheard-of distance for an Afghan woman to travel through rocky terrain and bad roads for an education.

Midwives-in-training, like Suraya, deliver most of the infants at the Herat maternity hospital. They work alongside trained medical staff, gaining invaluable experience assisting mothers in labor by preparing hydration drips, and monitoring infant heartbeats and maternal blood pressures. They also carefully examine each woman for signs of complications such as obstructed births, and other potential causes of maternal death in Afghanistan.

Some staggering figures
The United Nations estimates that Ghor has the highest rate of maternal deaths in all of Afghanistan, which holds the second-highest rate in the world, after Niger. According to the UN, one in eight Afghan women die in childbirth.

In 2002, the World Health Organization (WHO) found that there were only 467 trained midwives in the country. By 2008, that number had increased to more than 2,100. However, Peter Graaff, a WHO representative for Afghanistan, says that the country needs far more — at least 4,500 midwives.

In 2008, World Vision started a program in coordination with an Afghan humanitarian organization. The 18-month program, which aims to improve maternal health, recruits young women from rural communities across the province. Each student makes a commitment to return to her community after she completes the training, to increase women’s access to care in remote areas.

On a mission to save their friends


A 17-year-old midwife-in-training is supervised as she dresses a newborn child at Afghanistan's Ghor Regional Hospital.
Photo ©2009 Mary Kate MacIssac/World VisionThe training program was a dream come true for Suraya. “When I was a small child, I hoped to be a doctor or a midwife in my community. When I heard about this program, I had to apply,” she says.

Suraya, like many of the student midwives, joined the program motivated by personal experiences from their own communities.

“Back home, in our village, my friend was in labor for more than four days…she lost so much blood, but they would not take her to the hospital. The baby finally came out dead and my friend, the mother, was in a terrible situation. It was her first child, an awful experience, but she survived, barely. They didn’t consult anyone.”

Every student has a story like this. Every student’s family has been affected or knows a family that has endured such a loss. Among these young midwives, there is a sense of urgency that something must be done to reverse the trends in maternal and infant health. These students see themselves as part of a new future for their country and their people.

‘Now I feel fully competent’

A 20-year-old mother lies with her newborn son after receiving care from midwives-in-training at Ghor Regional Hospital.
Photo ©2009 Mary Kate MacIssac/World Vision“The first time I delivered an infant, I was so afraid,” admits Suraya. “I was looking at the mother, feeling so sad for her and wondering, ‘Is it really possible that I can do this?’ I could only think how God must help me.’”
But she did it, and then she did it again and again, 43 more times in her final months of training.

“Now, I feel fully competent,” she says with a confident smile.

In one month, Suraya and her classmates will graduate and return to their villages. Suraya has not been home since she began the program in January 2008. She has missed her family, and especially her son.

“But I’ll miss all the friends I’ve made in this program, too,” says Suraya. “Already, every day we are missing each other,” she laughs, but then grows more thoughtful and serious: “But I must do this. I must return home. It has been my dream to finish this program and become a good midwife. This is my life’s purpose now.”

*Name has been changed.