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Afghan Midwives Association admitted to International Confederation of Midwives

Important step for improving health care system and reducing high maternal mortality rate in Afghanistan

09 March 2006

The International Confederation of Midwives (ICM) has approved the application of the Afghan Midwives Association (AMA) to become a member of the international midwifery body.

With technical support from Jhpiego and the American College of Nurse-Midwives (ACNM) through USAID's ACCESS Program, the AMA will serve as the professional organization for midwives in Afghanistan. In May 2005, the newly formed AMA held its first congress in Kabul, adopting a constitution and electing officers, and has been accepted by and registered with the Afghan Government.

With a growing membership of more than 400 Afghan midwives and midwifery students, five elected regional representatives, 11 provincial representatives, and a functioning Governing Body, AMA President and ACCESS midwifery advisor Pashtoon Azfar describes the organization as "one that aims to promote and strengthen the midwifery profession and the role of the midwife to ensure the well-being of the women and families in Afghanistan."

In his testimony to the Committee on Foreign Relations on 7 March 2006, Ambassador Randall Lee Tobias, President Bush’s nominee to serve as the fourteenth Administrator of the U.S. Agency for International Development (USAID), used Azfar and the AMA as an example of the transformational development in Afghanistan under USAID. "With its partners, the AMA has rehabilitated their schools of midwifery, implemented standardized midwifery curricula, and conducted clinical training courses for the staff of local organizations who, in turn, pass their expertise onto others. Under Pashtoon's leadership, the Afghan Midwives Association has tripled the number of trained nurse-midwives in Afghanistan, creating employment opportunities and strengthening the country's healthcare infrastructure," said Tobias.

Admission into the ICM is a vital step forward for the AMA and will link Afghan midwives with midwifery colleagues around the world. It also supports the current efforts to reform the midwifery profession and midwifery education in Afghanistan that suffered in the last 25 years of civil war, including the way midwives are selected, educated, deployed and supported as key players in maternal mortality reduction. Afghanistan has the second highest maternal mortality rate in the world, estimated at 1,600 maternal deaths for every 100,000 live births. Every 27 minutes a woman dies from complications attributed to pregnancy and childbirth, and 91 percent of women deliver without the presence of a skilled birth attendant. The use of midwives as skilled birth attendants is known to have an impact in reducing maternal mortality.

Each AMA member pays an annual fee, yet the association will require further funding to ensure its sustainability and its ability to adequately represent the midwifery profession in Afghanistan.

Access to Clinical and Community Maternal, Neonatal and Women’s Health Services Program (ACCESS) is a 5-year, U.S. Agency for International Development (USAID)-sponsored global program aimed at reducing maternal and newborn deaths and improving the health of mothers and their newborns. It is implemented by Jhpiego in partnership with Save the Children, Constella Futures, the Academy for Educational Development, the American College of Nurse-Midwives (ACNM), and IMA World Health. ACCESS/Afghanistan commenced April 2005.

ACCESS complements Jhpiego's efforts under USAID's Rural Expansion of Afghanistan's Community-based Health Care (REACH) Program, in which midwives are being trained with a new competency-based curriculum adopted by the Afghan Ministry of Public Health. REACH funds primary health care for women and children in underserved areas of the country and training for midwives, doctors and nurses. REACH is implemented by Management Sciences for Health, with technical assistance from Jhpiego experts in maternal and newborn health. This training program is creating a new cadre of midwifery professionals who can practice their midwifery skills in rural health facilities and hospitals as well as in the home, where most births occur. Already, 299 new midwives were trained in 2005—a 64 percent increase from the 467 trained midwives available in Afghanistan during the civil war. Afghanistan will eventually need 8,000 to 10,000 midwives to strengthen the overall quality of health care.

About ICM
The International Confederation of Midwives (ICM) is an international non-governmental organization that unites 85 national midwives’ associations from over 75 countries. It aims to promote and strengthen the midwifery profession, improve the status of women’s health globally and achieve a reduction in rates of maternal and neonatal mortality and morbidity.

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