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ARO Midwife Team Establishes Midwife Training and Infant Care Program

In traditional Afghan culture, families and children are the core of society. Becoming a mother is central to the life of every woman. Raising healthy children to continue your family is of unquestionable importance and joy. However, in Afghanistan today, the lives of women and children are jeopardized by extremely poor health conditions.

“…a recent study undertaken in four Afghan provinces indicates that the country still has one of the highest maternal mortality ratios in the world, estimated at 1,600 deaths per 100,000 live births…”

“…the proportion of women who died of maternal causes ranged from 16 percent in Kabul, where at least one maternity hospital was functional, to 64 percent in Badakshan, where healthcare access was profoundly limited…(also) the highest proportion of deaths due to maternal mortality reported in the world .”
Maternal Mortality in Afghanistan: Magnitude, Causes, Risk Factors and Preventability
Afghan Ministry for Public Health, U.S. Centers for Disease Control and Prevention, UNICEF

The government of Afghanistan has a 30-year plan to rebuild community hospitals, with a goal to increase hospital-based births. However, a doctor interviewed in the spring of 2004 by the ARO midwife team in Afghanistan, believes “women are just going to die” in the gap years until hospital births are achievable. These alarming public health conditions are the result of more than two and a half decades of continual war, exacerbated in the 1990s, when women were not permitted to train in any medical or care-giving capacity (nor indeed allowed access to medical care). Before the 1979 Soviet invasion and the ensuing civil war, most Afghan physicians and nurses were women. The years of war dismantled the country’s health care structure, most facilities destroyed, and it is projected to take years before a working national healthcare system is reinstated. Currently, men, who customarily are not permitted to attend women in childbirth, perform most of the nursing care. During prior years, skilled midwives fled the country, went into hiding, or risked being killed. The result is that there are few trained women to attend childbirth.

While there is a program to rebuild a working national healthcare system, it will take years to achieve. ARO assisted with the early development of the International Midwife Assistance program in 2004 and 2005, in an effort to meet immediate healthcare needs.

International Midwife Assistance
ARO partnered with American mid wives and acted as the fiscal agency to create a mobile healthcare outreach project. The primary focus of the then Afghan Midwife Project (re-named International Midwife Assistance) is to train Afghan women about healthy prenatal care and safe childbirth. Their training involves attendance at births, and the program is sensitive to and suitable for Afghan urban and rural culture, living conditions and traditional modes of child delivery. As witnessed by ARO relief teams and midwives, Afghan women are desperate for medical care and training so they may help one another.

Phase One – Accomplished!
In April 2004, Certified Professional Midwives from Colorado joined the ARO relief trip to implement their grassroots initiative to train Afghan women as midwives, and to conduct more research into the needs and methods for assistance.

The midwife team was able to make contacts, locate local Afghan midwives and create a viable curriculum – based on realistic needs and customs. The instructors were assisted by ARO members, fluent in Dari and Pashto. This unique team assisted with numerous births and provided instruction to many women and girls about their personal health practices. Please see more about the Spring 2004 Relief Trip.

In particular, the relief and mid wife team visit to Bamiyan was particularly touching and enlightening. In addition to helping with actual births, the midwives were able to provide instruction to local women regarding their health and hygiene. The midwife team plans to revisit Bamiyan to provide more training and medical assistance.

Phase Two – A Unique and Visionary Program
As a result of the Spring 2004 Relief Trip investigation, the midwife team developed a model for the International Midwife Assistance (IMA).

Developed collaboratively by midwives, mothers and healthcare professionals in Boulder and Denver, Colorado, in conjunction with ARO members in Southern California, IMA is truly visionary. Unlike current non-governmental organization’s (NGO) medical programs in Afghanistan, IMA will combine traditional Afghan Midwife with aspects of modern medical practice to re-invigorate and re-establish women as primary-care providers in the long-term and saving lives in the short-term.

There is no other program like this in Afghanistan. It achieves many goals at once

  • Afghan women are enabled better control over childbirth/women’s healthcare
    conditions (they will be trained to be primary-care providers who must deal with emergencies in the home, often far from medical assistance).
  • With respect to deep and ancient cultural concerns, midwife training will offer tangible and needed community skills to Afghan women.
  • A prototype or replicable model of an apprenticeship-type program will be created.
  • The lives of women and children will be saved.

Medical Realities
Afghanistan is a largely rural and rugged country. Ninety-three percent of Afghan births take place at home within women’s compounds, and today are attended primarily by elder women in the family.

Certified Professional Midwives who are trained for homebirths are prepared for what may actually happen in rural Afghanistan, as they are less dependent on modern facilities, methods, and medications than modern doctors. They must be able to manage without the support of a hospital, without electricity, and with herbal medicines, if necessary. The educational models and actual experiences of homebirth midwives are profoundly relevant to the reality in Afghanistan.

IMA is now functioning successfully as a separate, independent non profit organization, working internationally.  ARO is proud to have assisted with IMA’s initial development.

For information and an introduction to the IMA, please contact

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