All the news is bad, so I thought you might want some good news.

It’s getting safer to have a baby in Afghanistan.

BoingBoing (and Instapundit) today had posts telling of organizations training midwives to decrease the high mortality of childbearing in Afghanistan…LINK

I have worked in public health, so I can give some background.

During the Taliban years, a lot of people fled to refugee camps that had few medical facilities. Many lacked basic medicine, and even the traditional midwives of their villages, so as a result the number of women dying in childbirth soared.

But even those who lived under the Taliban, especially in rural areas, were worse off than in previous years, since the Taliban frowned upon women going to school or women working, so few professionally trained midwives were trained.

Two BBC links HERE and HERE are “ain’t it awful” posts documenting the problem but also giving a western “twist” to the problem, with it’s snide remarks about men not allowing women to be treated by male doctors, or lamenting the shortage of doctors in rural areas.

Hello. It’s not doctors you need, it’s “midlevel professionals”. And traditionally midwives are women. Preferably a woman from the village who gets to know everyone there and is trusted. (Villages tend to be slow in trusting outsiders: in places I have worked, the average was two years).

Doing public health also requires a comprehensive program, which is why I often write against HIV or Birth control programs that western organizations push without funding other basic needs. Want to implement a population program? Start by making it safe for moms to have babies, and a program of clinics to stop children from dying.

Mother and child health is often intertwined, and the lynchpin is making it safe to have a baby.

Here in the Philippines,  where there are many well trained nurses, there are programs where small towns in poorer areas get grants to hire a midwife to deliver the babies for free, and as a result the maternal mortality has gone down in these regions.

But what if you work in an area where women lack a high school diploma?

In Africa, we trained girls with a grade school education to be nursing assistants, and then allowed the best ones to take another year of midwife training.

But in some countries, even grade school education for women is rare. And in these countries, you have to be pragmatic. Women have babies, and in every culture there are local women who deliver babies with skill. The dirty little secret about midwifery is that you learn to deliver babies by…delivering babies.

So when there is not a high level of schooling in women, one alternative is to give extra training to traditional midwives,


This UN article is a good example of how one can improve health with limited resources, and it starts with the story of a traditional midwife:

“I am illiterate and I work as a local Daya (traditional birth attendant) in my village. One night people came and picked me up to deliver a baby in their home. The woman had very serious bleeding and I could not control it because I did not know how, so they brought a midwife. It was midnight and the case was very serious, but the delivery happened safely. Since I have received training from the Afghan Institute of Learning (AIL), I now understand many things. I can practice all the things that I learned from this workshop, and with this knowledge, I can help the women of my village better”, according to Seema.

Yes, even illiterate women can be part of your outreach to improve health.

One of the pioneering program was in the Sudan, (in the 1940’s, I believe) where two British midwives taught local midwives (who were illiterate) simple things like hygiene, examination, monitoring the position of the baby, and when to recognize problems so the woman could be sent to the hospital. Since they could not read, the medicines and cleaning fluids were labeled with various colors, and the students were taught to identify the liquids by smell.

And thirty years ago, a similar program was run by one of my friends in Monrovia’s JFK hospital, where local midwives received extra training. The result was to improve maternal mortality in rural villages.

Childbirth is natural, but can be risky. Most women can deliver in the middle of a forest alone and do well. But the ten percent who run into trouble with labor could die or end up with a sick or dead baby.

The first rule is to let nature take it’s course, and not use medicine to speed things along (in some African countries, herbs to speed delivery is a leading cause of dead babies and dead moms).

Midwives are also taught the importance of cleanliness to prevent childbirth fever in the mother and infections including neonatal tetanus from dirty herbs place on the umbilical cord. This is especially important if the delivery is at home.

A third thing taught to midwives is to recognize problems: twins, the baby lying sideways, or prolonged labor, all of which may need to be sent to deliver at a hospital.

Another big thing for midwives is to make sure the mom is healthy.

Vitamins, immunizations, and blood pressure checks during pregnancy can save a lot of lives. And midwives can advice in family spacing techniques including the importance of breast feeding to ensure a healthy baby and as nature’s way of spacing childbirth.

All cultures accept family planning, but you have to be sensitive to the local culture if you are to advise in this delicate area of life. Catholics here in the Philippines stress Natural family planning. And Islam allows family planning, including the IUD and Birth control pills, because the Koran stresses the importance of guarding the health of a mother. Indeed, the Iranian family planning program was encouraged by the Mullahs.

This BBC article tells of the government’s goal in training 1000 midwives in the next year. LINK2. Another link HERE.

It will be a slow improvement but things are changing in Afghanistan.

And for those of you who are interested, Hesperian Foundation has PDF files of a midwife manual, and the UN has a similar book HERE.
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Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes medical essays on HeyDoc Xanga Blog.

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