Pashtoon Azfar, head of the Afghan Midwives Association, says the number of trained midwives has grown nearly six-fold since rebuilding effort in Afghanistan began. "In 2002, we had 467 midwives, but no one knew how qualified they were; for years, they had received no access to training," says Ms. Azfar, also a midwifery specialist with the international nonprofit health organization Jhpiego, whose maternal health programs are funded by the US Agency for International Development (USAID). Today, there are more than 2,400 midwives around the country who have been trained in a standardized and accredited two-year program, she says.
"There are very good lessons to be learned from Afghanistan," says Bartlett. "The midwifery education program appears to be a real success story that could inform programs in other countries."
Certainly much remains to be done in a country where poverty and illiteracy run rampant and infrastructure in the most remote regions is still meager. Afghanistan's Ministry of Public Health is now launching a follow-up survey to assess the impact of recent maternal health efforts, seven years after the last round of research began.
Midwives see progress
Midwives working in the field say that they see signs of improvement every day in the communities they visit. This is thanks in large part to the growing role of skilled birth attendants whose services are now accessible to many women throughout the country, including those in hard-to-reach rural regions, where midwife use jumped from 6 percent in 2003 to 19 percent three years later, according to Johns Hopkins University research.
Dr. Noorkhanoom (some Afghans use only one name), has been making house calls to Kabul's poorest families since 1996, when she went to work for TDH. She joined TDH, a Swiss nongovernmental organization, after being barred by the Taliban from her university job teaching medicine.