Last week, I wrote a post suggesting that the lives of mothers and babies in Afghanistan are showing signs of improvement. That was prior to the launch of the second State of the World’s Midwifery (SoWMy) report at the International Confederation of Midwives (ICM) 30th Triennial Congress. The report, coordinated by UNFPA, ICM and WHO but involving stakeholders from around the world, is a response to Millennium Development Goal 5 and provides an evidence base for the state of midwifery in 73 low- and middle-income countries.


Included in the report is a two-page country profile for each of the 73 ‘Countdown to 2015’ countries included in the report. The country profiles are data rich – the first half deals with ‘where are we now?’ and the second half looks at ‘what might 2030 look like?’.

Based on the available data, the report shows that:-

  • the maternal and newborn health workforce is able to meet 23% of the need in Afghanistan
  • this could decline to a shocking 8% by 2030 if the status quo remains
  • even if by 2030, the number of pregnancies were reduced by 20%, the number of midwife, nurse and physician graduates doubled, efficiency improved by 2% each year and attrition was halved in the next 5 years, the maternal and newborn health workforce is predicted to still only be able to meet 31% of the country’s need.

Anecdotal evidence from my experience living and working in Afghanistan suggests that a significant proportion of Afghan midwives have qualified in the past 5 years, are under the age of 25 and are as yet unmarried. In a few years’ time, those midwives will be married and be having their own children to care for, which may well mean for many of them, an end to work, thus negatively impacting attrition rates of the midwifery workforce.

Although this sounds rather bleak, it is important to remember that Afghanistan has just been through a period of decades of war and significant progress is being made. However, given the potential period of instability that the country may well be entering with the forthcoming elections and withdrawal of foreign troops, there will need to be an enormous and concerted effort on all levels to maintain the progress that has been made.  It was truly wonderful to see Afghan midwife Sabera Turkmani receive the Dorethea Lang Leadership Award at the ICM Congress on the same day that the SoWMy 2014 report was launched.

Midwives in Afghanistan are also women and mothers, and find themselves facing the same pressures as the women for whom they are providing care. Girls need to be free to attend school in order to train as midwives, young women need to be free to work once qualified and midwives need to be free to travel to and from their place of work safely. That’s a lot of freedom needed for Afghan midwives in a country that has a history of oppressing the freedom of women.

Fundamentally, the state of midwifery in Afghanistan rests delicately with the freedom and security that the country will provide for women over the coming years.

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Cover image courtesy of Flickr Creative Commons

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