Investment in Midwifery Workforce: Little Steps, Big Outcomes

Afghanistan has experienced one of the longest internal war conflicts. People in this country suffer from protracted insecurity for almost four decades. Women and children are much more vulnerable in this regard. Shreds of evidence show that within the war and when men control to access health services, women and children are affected by unequal access to health services and health care.

Women and children’s health is among the top priorities in the world society. Enhancement of maternal and children health is still an open book and an unfinished agenda. Goal 3, out of 17 sustainable development goals, has been allocated to health and well-being, including maternal and new-born health. Studies show that educated and competent midwives can provide nearly 80 percent of the essential care needed for mother’s as well as new-born’s health. In a traditional and war-torn country like Afghanistan, midwives can play a critical role more than in the frame of maternal and new-borns’ health. Afghanistan's society is pretty conservative. The “female only” nature of midwifery helps it to be accepted easily among the people. Well- trained midwives can improve family health including men's health also. So investment in midwifery is an investment in population health. Using the midwifery health workforce is especially critical in the limited resources countries. World Health Organization (WHO), United Nations Children's Fund (UNICEF) and United Nations Population Fund (UNFPA) have accepted strengthening the capacity of midwifery as an effective method for improving maternal and new-born health care services. The more efficient midwives, the more improved outcomes, and this depends on well-trained, skilled, licensed and sufficient midwives.

In 2002 Afghanistan had the highest maternal mortality rate in the world (1600 death per 100,000 live birth). Over the past 20 years, thanks to the support of the international community, the maternal mortality rate has almost dropped to 60 percent. According to WHO, UNICEF, UNFPA, World Bank Group, and the United Nations population division maternal mortality rate in Afghanistan was 638 Per 100,000 live birth in 2017. The infant mortality rate was also 50 per 1000 in 2017. It is estimated that this tableau has been worsened by changing the political system and imposing the Covid-19 pandemic. Maternal health experts believe that, the lack of trained and skilled birth attendants who can deliver antenatal and postnatal care is one of the main factors in the high prevalence of maternal mortality rate in this country. The country faces a shortage of female health workers. Midwives are critical to provide reproductive, maternal, new-born child and adolescent health. Other than maternity services, midwives can provide other care including, essential newborn care, immunization, screening postpartum depression, screening sexually transmitted diseases, comprehensive abortion care, contraceptive services, support of gender-based violence and primary care following rape. While all of the midwifery health workforce in Afghanistan are female, they need to be protected in order to work in a fragile and an insecure environment. Providing a support system in remote and conflicted zone to deliver midwifery services is necessary for this country. Midwives need continuous, pre and in-service education in concordance with global standards. Providing timely paid systems and job opportunities in middle and high levels of health care management is essential. We should remember that an efficient midwifery system can have more effect beyond maternal and new-born health. Midwives can have an important role in the improvement of population health.