Midwives Risk Death to Help Bring Birth

The Chicago Tribune reports on the high maternal death rate for women in Afghanistan and training programs for midwives. To put it in perspective: “Almost every 26 minutes here, a woman dies giving birth. Only Sierra Leone’s rate is worse. In her lifetime, an Afghan woman has a 1 in 8 chance of dying in labor.”

As Rachel previously wrote, there has been a push in recent years by Afghan health officials and Western aid groups to train midwives, whose skills are desperately needed in remote villages. Only 14 out of 100 births are attended to by skilled health workers. Midwives were not allowed to be trained under Taliban rule, so as of 2001 there were only 537 skilled nurse-midwives in the entire country. The number has since increased, but as the Trib’s Kim Barker writes, deadly threats still remain:

[I]n a country where government employees are attacked constantly by Taliban-led insurgents, being a midwife is a risky political statement.

In Nuristan province, a midwife was kidnapped by the Taliban four months ago. In a rural part of Kandahar province, militants shot and killed a midwife about two months ago, allegedly because she was handing out condoms and birth control.

The Ghani Khel program is supposed to train students from neighboring Kunar province, a militant haven, but no students from Kunar are enrolled. A clinic that opened in the dangerous Pech Valley of Kunar has almost no patients because it is close to a U.S. base, and Afghans there do not want to associate — or be seen associating — with Americans. That clinic is being moved.

“People didn’t want to send their women there because it was near the Americans,” said Toorpekay Nawab, 51, the midwife who runs the Ghani Khel school. “The war affects everything. Of course it hurts our program.”

The Trib has also published a series of photos of a midwife training session.

This story reminded me to check in on the failings of a maternity hospital in Kabul that receives funding from the U.S. Department of Health and Human Services (previous posts here, here and here). Alison Young of the Atlanta Journal Constitution did some great reporting on conditions at Rabia Balkhi Hospital, which features the “Laura Bush Maternity Ward.”

To re-cap, officials at both the CDC and the Afghan Ministry of Public Health questioned whether U.S.-led medical training “pushed Afghan doctors to perform more c-sections before they were ready and before the hospital had the necessary anesthesia, sanitation and blood supply.” Health experts criticized the rate of neonatal and maternal deaths, high post-operative infection rates, lack of medical supplies, and misguided spending priorities.

In a letter to HHS Secretary Michael Leavitt delivered almost exactly one year ago, U.S. Rep. Henry Waxman expressed his concern and requested HHS to turn over correspondence and other documents related to contracts and agreements, including the $1.3 million on computerized LeapFrog talking books, despite the fact that 90 percent of Afghan women who used the books in a pilot program did not find them useful.

In January 2008, new U.S.-led initiatives to improve care at the facility were announced. I haven’t come across any other news on hospital conditions. Over at the HHS Afghanistan website, the last Rabia Balkhi hospital project report is from July 2007. Anyone have anything to add?