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Viewing cable 09KABUL3098, USG-TRAINED MIDWIVES HELP COMBAT AFGHANISTAN'S APPALLING

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Reference ID Created Released Classification Origin
09KABUL3098 2009-10-05 10:47 2011-08-24 01:00 UNCLASSIFIED//FOR OFFICIAL USE ONLY Embassy Kabul
VZCZCXYZ0000
OO RUEHWEB

DE RUEHBUL #3098/01 2781047
ZNR UUUUU ZZH
O 051047Z OCT 09
FM AMEMBASSY KABUL
TO RUEHC/SECSTATE WASHDC IMMEDIATE 1831
RUCNAFG/AFGHANISTAN COLLECTIVE
UNCLAS KABUL 003098 
 
SENSITIVE 
SIPDIS 
 
DEPT FOR GWI, S/SRAP, SCA/FO, SCA/RA, SCA/A 
DEPT PASS AID/ANE 
 
E.O. 12958 N/A 
TAGS: ESTH SOCI AF
SUBJECT: USG-TRAINED MIDWIVES HELP COMBAT AFGHANISTAN'S APPALLING 
MATERNAL MORTALITY 
 
1. (U) Summary:  In a country with high birth rates and sparse 
medical assistance, one in eight Afghan women dies in childbirth. 
Afghanistan's maternal and infant health statistics are the second 
worst in the world, and it is one of few countries in which women 
have a lower life expectancy than men.  Doctors are rare in rural 
areas and most children are delivered at home.  USAID's Community 
Midwifery Education Program, in cooperation with the Ministry of 
Public Health (MoPH), is working to change these horrible 
statistics, training more than 2,000 rural women in maternal health, 
childbirth assistance and basic public health and providing 
graduates the critical skills they need to save women's and 
children's lives in their own remote villages.  Selected by their 
communities in conjunction with the MoPH, the midwives are the face 
of the delivery of critical life-saving services by the Afghan 
Government.  End summary. 
 
Afghan Women: Early Marriage, Many Children, Early Death 
- - - - - - - - - - - - - - - - - - - - - - - - - - - - - 
 
2. (U) Afghan women are 600 times more likely to die in childbirth 
than their North American counterparts - one Afghan mother dies for 
every 55 children born.  Fifty-seven percent of Afghan women marry 
before the legal age of 16, and the average Afghan woman has 6.75 
children in her lifetime before dying at age 44.  Most will never 
receive treatment from a medical doctor - in rural areas, where most 
Afghans live, mullahs are the sole medical providers.  Mullahs 
generally rely on advice passed down through generations, and they 
do not deliver children or conduct ob/gyn exams or treatments. 
Local midwives often assist births, but they too have no formal 
training. 
 
Community Midwifery Education Program 
- - - - - - - - - - - - - - - - - - - 
 
3. (U) Through the MoPH, USAID's Community Midwifery Education 
Program has trained more than 2,000 competent midwives through 12 in 
basic obstetrics and gynecology, as well as pre- and antenatal care. 
 The women are often the most educated person in their rural 
districts.  All three women who spoke with EconOff September 29 at a 
program graduation ceremony in Bamiyan had completed the 12th grade. 
 Since the program began in 2002, all but one of the two hundred 
graduates from the Bamiyan school has returned to her village to 
practice.  Participants in the Bamiyan program come from several 
surrounding provinces.  The 18 month program costs $16,000 per year, 
per student for trainers, room and board, transportation, child 
care, medical tools and follow up to make sure they have the proper 
working environment. 
 
4. (U) Most participants in the training program are married, and 
their families clearly support their ambition.  Each woman 
interviewed had her own personal story of maternal mortality - from 
lost mothers, sisters, and neighbors, the tragedy was universal.  As 
participants are in their 20s, many have their own infants who they 
can bring with them to the central training location and enroll in 
on-site childcare.  One graduate said her husband, a mullah, 
encouraged her to apply for the program, and added she hopes they 
can work together to promote maternal health in their community. 
 
Training Is Just One Challenge 
- - - - - - - - - - - - - - - - 
 
5. (U) While the training program has tremendous potential to save 
the lives of mothers and children, the challenges new midwives face 
when they return to their communities are great.  Depending on their 
location, some graduates work in clinics or local sub-centers of the 
Ministry of Health, but few are assigned to hospitals.  Several said 
the nearest hospital is more than a day's walk from their village, 
leaving them on their own in case of emergency.  Under Afghan law, 
midwives cannot perform cesarean sections. 
 
6. (U) Hemorrhage is the leading cause of maternal death in 
Afghanistan.  JPAIGO, a USAID implementing partner affiliated with 
Johns Hopkins University, conducted a study in which midwives and 
health workers provided expectant mothers with misoprostol, a drug 
that prevents hemorrhaging if taken immediately after delivery.  The 
Afghan Government is cautious about using the drug, since it can 
also be used to induce abortion, which is illegal in Afghanistan. 
However, the study found 45 percent of births result in 
hemorrhaging, and that misoprostol dramatically improves chances of 
maternal survival. 
 
7. (U) Concern about improper drug use is not unfounded.  One 
midwife graduate said that when she worked as a health educator in 
her village, an expectant mother came to the clinic with 
preeclampsia (the third leading cause of death for Afghan mothers 
behind obstructed labor).  The untrained midwife in the clinic gave 
the woman a high dose of labor-inducting drug oxytocin, killing the 
 
baby and almost killing the mother.  The graduate said she is glad 
she knows more about proper use of drugs after her training. 
 
Saving Lives and Promoting COIN 
- - - - - - - - - - - - - - - - 
 
8. (SBU) Trained midwives provide a local face to the delivery of 
critical governmental services.  Due to cultural considerations, 
most women do not travel outside of their community for childbirth - 
especially to see a male medical professional.  In addition to 
medical care, the program provides tangible evidence of Afghan 
Government support to its citizens. In a country where every woman 
knows she is at risk of dying in childbirth, Afghans are more likely 
to support a government that helps fight an all-too-personal cause 
of death. 
 
9. (SBU) At the September 29 graduation ceremony, both the Bamiyan 
Governor Habiba Sorabi and Deputy Minister of Health Faizullah Kakar 
thanked the USG for supporting one of the most important programs in 
Afghanistan and helping the Afghan Government meet the needs of its 
citizens.  As several recent polls indicate, Afghans list healthcare 
as one of the services they most demand from their government. 
 
10. (SBU) Comment:  Midwife education is a low-cost, high-impact 
program for Afghanistan's vulnerable rural population.  The program 
enables motivated women to further their education and support their 
families through their profession, creating jobs and opportunities 
in extremely poor communities.  The program also delivers 
much-needed life saving services through the MoPH - thus 
demonstrating the Afghan Government's ability to help its citizens. 
While Afghans may not see the link between healthcare and 
counterinsurgency, they definitely understand the importance of 
governmental provision of basic services.  The program's importance 
should not be overlooked. End comment. 
 
EIKENBERRY