A brief written by Sheena Currie, Jhpiego Midwifery
Advisor, will be published in an upcoming issue of International
Midwifery—the journal of the International Confederation of Midwives.
UPDATE: The article was
also published in the September 2005 issue of the journal Midwifery
(International News, p. 294).
In the brief, Afghanistan-based Currie describes the successful Inaugural Congress of
the Afghan Midwives Association, which was held from 4–5 May 2005 in
Kabul. The brief is included below, along with event photos taken by Mary Gibson,
Jhpiego Midwifery Consultant in Afghanistan:
First National Congress for Afghan Midwives
by Sheena Currie, Jhpiego Midwifery Advisor
The month of May held a special significance for midwives in
Afghanistan this year. Surrounded by snow-capped peaks, Afghanistan’s capital city,
Kabul, witnessed a gathering of more than 200 midwives from all over the country on
4–5 May for the Inaugural Congress of the Afghan Midwives Association (AMA).
Midwives from 15 other countries participated in the Congress to show
their support of and admiration for the Afghan midwives. Among the attendees was
Judi
Brown, Deputy Director of the International Confederation of Midwives (ICM), as well
as midwives from the American College of Nurse Midwives (ACNM) who provided technical
assistance to organize the event. On the day preceding the Congress, some 70 selected
midwives explored issues in the professionalization of midwifery in Afghanistan, which
included reviewing the ICM Code of Ethics, drafting an AMA Constitution and electing
the AMA’s new officers.
Pashtoon Azfar, the newly-elected AMA President, led the midwives as
they took a pledge to "work well and with the aim that all pregnant women have access
to quality midwifery care."
With an estimated 1,600 maternal deaths for every 100,000 live births,
Afghanistan currently has the second highest maternal mortality rate in the world. In
remote parts of the country, where there is virtually no access to health care, there
are nearly 6,500 deaths per 100,000 live births. One child in four will die before 5 years
of age, and the neonatal mortality rate is the highest in the world. A primary
reason for these staggering statistics is the lack of trained midwives due to a
weakened educational system, gender inequalities, and political instability
after years of war and conflict. New midwifery education programs have
increased the number of midwives in Afghanistan to approximately 680 as of
April 2005, but experts agree that nearly 5,000 midwives are required to meet
the health care needs of Afghanistan’s women and children.
United States Ambassador and Special Presidential Envoy to Afghanistan,
Zalmay Khalilzad, told the participants at the closing ceremony, "The reason we are
making health care and midwifery such a priority is clear: greater access to
midwives and improved quality in the education of midwives can have a dramatic
effect on the survival rate of newborns and mothers, and on the life chances of
Afghan children."
Mobilizing and strengthening human resources for health is central to
combating health crises and building sustainable health systems. The AMA will significantly
contribute to this process and, along with improvements in midwifery education, will
develop the capacity and strengthen the overall quality of the health care
system, particularly for women and their families.
In less than one year, the fledgling AMA has been established with the
assistance of various local and international supporters. The AMA is currently receiving
support from Jhpiego—an affiliate of Johns Hopkins University—and the ACNM through the
ACCESS Program, the U.S. Agency for International Development’s global program
to improve maternal and newborn health. Over the course of the coming year the AMA will
seek membership in the ICM, establish alliances for advocacy in Safe Motherhood
and newborn health, re-establish a Department of Nursing and Midwifery within
Afghanistan’s Ministry of Public Health and participate in international
midwifery activities including the ICM Triennial Congress in Brisbane.
Although the progress of health care change in Afghanistan continues at
a rapid pace in response to the appalling health statistics, donor and other international
support must continue to ensure sustained action in human capacity development and in
supporting midwives as they strive to bring health and peace to Afghan families.
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Dr. Zalmay Khalilzad, United States Ambassador and Special Presidential Envoy to
Afghanistan, with AMA President Pashtoon Azfar
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Azfar with ACNM representative Dr.
Gwen Brumbaugh Keeney and Jhpiego President and CEO Dr. Leslie Mancuso
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Newly-elected officers of the AMA
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Brumbaugh Keeney, Azfar, ICM Deputy Director Judi Brown, Mancuso,
Afghanistan's Minister
of Public Health Dr. Sayed Mohammed Amin Fatimi, and Khalilzad
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About REACH
The Rural Expansion of Afghanistan’s Community-based Health Care (REACH) Program supports
training centers for both the Midwifery Education Program and the Community Midwife Education
Program. REACH is implemented by Management Sciences for Health (MSH), and the program’s Safe
Motherhood Unit is staffed by Jhpiego experts in maternal and newborn health. The program is
funded by the U.S. Agency for International Development.
About ACCESS
The ACCESS Program is the U.S. Agency for International Development’s
global program to improve maternal and newborn health. The ACCESS Program works to expand
coverage, access and use of key maternal and newborn health services across a continuum
of care from the household to the hospital—with the aim of making quality health services
accessible for women and newborns.
Jhpiego implements the program in partnership with Save the
Children, Constella Futures, the Academy for Educational Development, the American
College of Nurse-Midwives and IMA World Health.
