Developing Afghan Women as Leaders to Improve Maternal Health
Improving the health of women requires addressing the gender inequities and barriers that keep them from accessing health services. This is particularly true in Afghanistan. Despite having one of the highest maternal mortality rates in the world, women are not encouraged by their families or by society to deliver their babies in health facilities with skilled attendants. MSH's Technical Support to the Central and Provincial Ministry of Public Health (Tech-Serve) project, funded by USAID, has been working with Afghanistan's health leaders for five years to help combat maternal mortality.
The following story was written by Madina, a trained midwife in Afghanistan and a participant in MSH's Leadership Development Program, about how the program empowered her to address gender and health challenges in her community.
I live in Afghanistan's Gurbaz district, which has a population of about 25,000 people. It is located in the southern part of Khost Province and shares a border with Pakistan. We are surrounded by mountains and have only a few roads, most of which are in poor shape. There are few children that go to school, especially girls. As a result many adults are uneducated. Women generally know little about maternal and child health and the services that midwives and community health workers can provide to them. As a result, few families seek care from skilled health workers like me. Aside from the shame that is attached to being seen by a health care worker, when women do go to a health facility, the unfamiliarity of the place and the difficulty of getting the services they need leaves them disappointed and they return home. Every day we hear announcements in the mosque of women who have died in childbirth. This is very sad as I know that the health services we provide could have saved their lives.
I had the good fortune to be part of a team from Gurbaz Comprehensive Health Center that was invited to participate in MSH's Leadership Development Program (LDP). During the LDP we learned to work as a team, to take on a challenge, and use root cause analysis techniques to identify how best to achieve a measurable result. We realized that educating the community was something we had to focus on. We started to hold meetings with the Community Health Shura, the local traditional council, as well as with community elders and religious leaders, to educate them about the importance of ante- and postnatal care and family planning. We also explained how having a skilled health worker's presence during labor and delivery can prevent unnecessary deaths. We convinced these influential members of the community to talk with others and share what we had been telling them. We also persuaded female community health workers to talk with women and refer them to the health facilities when they needed to see a skilled health care worker.
One day, a woman named Jamila arrived at our health facility after a complicated delivery at home. She was bleeding severely. While still at home, her family had worried as her condition deteriorated rapidly. Fortunately, her neighbor Marjana had recently met with a female community health worker and had learned about the services at the Gurbaz Comprehensive Health Center. Marjana convinced Jamila's husband to take her there.
Immediately upon arrival Jamila was seen by me, the midwife, and I realized she was already in a state of hemorrhagic shock and at death's door. Our team of skilled health workers quickly stepped in and used manual vacuum aspiration to remove parts of the placenta that had remained in her uterus. The bleeding stopped and Jamila recovered, to the great joy of everyone. The family realized that if they had not brought Jamila to the health center, she would have died. They agreed to tell the families in their valley about the good services at the Gurbaz Comprehensive Health Center and remind them to go there quickly in case of an emergency. This incident has greatly strengthened the relationship between the health center and the community and removed the barrier that existed before.