Midwives in Afghanistan defy constraints and crises to save lives of women and newborns

PAKTIKA, Afghanistan – “There was a woman who was heavily pregnant. She was injured and had lost family members in the earthquake… She was in a state of shock,” said Minaz Bibi, a newly-trained midwife in Afghanistan’s Paktika province. 

Moments later, the woman went into premature labour. This was the first delivery that Ms. Bibi had assisted alone, without the support of a mentor – and in the midst of a humanitarian emergency. 

She had been looking forward to helping pregnant women give birth in the safety of a community health centre: She hadn’t expected to receive the phone call that meant the first life she would welcome into the world would be in one of the worst-affected areas at the centre of a natural disaster. 

On the night of 21 June 2022, an earthquake struck Afghanistan’s south-eastern Khost and Paktika provinces, bringing already fragile homes and health centres crumbling down on top of thousands of people, cracking open unpaved roads and all but obliterating communications infrastructure. The mountainous area made it even more treacherous to reach those in danger, while heavy rain and strong winds rendered search and rescue attempts with helicopters almost impossible.

The earthquake killed over one thousand people and destroyed some 10,000 homes. Of more than 360,000 people in need of assistance following the disaster, UNFPA estimates that around 87,000 are women of childbearing age, of whom some 8,400 are pregnant and have little to no access to any reproductive health care: The health system is barely functioning and women and girls’ freedom of movement and access to essential services has been severely restricted, jeopardizing the lives of those in need living in remote and affected areas. 

On the frontline of a growing crisis

Ms. Bibi is among 12 female midwives recently trained by UNFPA in Afghanistan, who will later be sent to provide maternal and newborn health services in UNFPA-supported family health houses currently under construction. She and another newly qualified midwife were immediately deployed to a temporary clinic to support the emergency response in Paktika. Both women were anxious but dedicated to ensuring mothers and babies were safe. 

A few weeks on, Ms. Bibi remembers the first birth she assisted as the one that put her skills as a midwife to the ultimate test. Describing their working conditions, she said, “We used a tent for maternal health services and had up to 15 patients arriving daily.” 

She added that there was at least one baby born every day during the first 10 days after the earthquake. “Other women, many of them pregnant, were also in shock from the sight of dead bodies – including those of their loved ones – being pulled from under the rubble.”

Having seen first-hand how important it is to have midwives providing delivery, antenatal and postnatal assistance, she said, “Trained midwives offering maternal health and psychosocial support are crucial in such emergencies: Midwives can save mothers’ and babies’ lives.”

When giving birth means risking your life 

As a deep economic, food security and political crisis was already roiling in Afghanistan following the Taliban takeover on 15 August last year, the suffering of thousands of vulnerable people only intensified with the earthquake’s impact.  UNFPA and partners deployed five mobile health teams, including female health workers, to reach those in the least accessible parts of the country with reproductive health and psychosocial support services. 

In the past year, over 12,000 deliveries in Afghanistan were attended by UNFPA-trained health-care providers like Ms. Bibi, while almost 200 UNFPA-supported family health houses as well as mobile and static clinics ensured immediate reproductive and maternal health support to more than 4.3 million people.

Every two hours, a woman in Afghanistan dies from preventable pregnancy and childbirth complications – the highest maternal mortality ratio in the Asia and Pacific region. UNFPA Executive Director, Dr. Natalia Kanem, said of the crisis, “​​For the estimated 24,000 women who give birth each month in hard-to-reach areas, childbirth can, in effect, be a death sentence.” 

The earthquake response follows UNFPA’s continuing support to the overall humanitarian crisis in Afghanistan. Earlier this year, UNFPA appealed for $251.9 million funding to respond to the reproductive health and psychosocial needs of 9.2 million people.  To date, just over 10 per cent of the appeal has been funded.