Midwife Centre Breaks New Ground in Afghan Province

Officials hope pioneering scheme will help reduce high maternal mortality rate.

Two yellow buildings with neat lawns and a flower-filled garden lie next to the civilian hospital in Sharan, the administrative centre of Paktika province in southeast Afghanistan.

Although the premises look unassuming from the outside, local campaigners say that the potential impact of the Community Midwife Education Centre cannot be overstated. Right now, there is only one female doctor for the entire province plus a few nurses working in the countryside.

“I believe the construction of this centre is a blessing from God upon the women of Paktika,” said Zarmina, a 35-year-old from the Urgun district who has completed her first year of training as a midwife.

The province, 170 kilometres southeast of the capital Kabul, does not have a good record on women’s healthcare or rights. The lack of antenatal and neonatal care mean that maternal mortality rates are high. More generally, many women and girls are denied access to education, and customs like “baad”, where a dispute is resolved by handing over a girl in marriage to a family that has suffered an offence or crime, still persist.

“From an early age I heard about women dying in childbirth, and this really troubled me,” said student midwife Hamida, 18, from the Sar Hawza district. “Since childhood I have dreamt of being of service to women in this underdeveloped province, and now I’m fulfilling my dream.”

Hamida said she wanted to encourage more girls from her community to join her at the college.

“When I go back to my village, the people there, particularly the women, show me a lot of respect,” she continued. “They really need medical care and they ask me lots of questions and tell me all about their problems.”

The centre’s director Zuhra Mahmudzada said the training college was a major step forward for women in the province.

“It is a great opportunity for women in Paktika to be able to study at this modern centre and not only to provide health services for their sisters, but also to participate fully in changing public attitudes,”

Once the current intake of two dozen student midwives complete their training, each of them should be able to provide maternity services to around 3,000 women.

“The main aim of this centre is to reduce mother and child mortality rates in this province,” said the head of Paktika’s health department, Wali Gul. “We want to push forward with the process, because we have only one female doctor in Paktika and she alone is unable to meet the needs of even a single district.”

Completed last year, the centre is fully fitted out with facilities including laboratories, computers and conference facilities. Trainees live on the premises throughout the two-year course and have access to the internet as well as an opportunity to learn English.

Gul said the United States aid agency USAID covered the entire costs of the 830,000-dollar centre, which is run by the health ministry. The next step is to start a training programme for female nurses.

Bibi Hawa Khushiwal, the head of the women’s affairs department in the province, said the college was “a great achievement, the result of several years of effort by women in Paktika. Once the midwives graduate, women’s health problems will be cut in half”.

Khushiwal said that despite the progress made since the fall of the Taleban government in 2001, gender discrimination was still rife in the Paktika.

“The biggest problem is that women are deprived of an education,” she said. “People don’t allow their daughters to go to school. Even if they do let them go, they won’t allow them to continue beyond grade six. If the ground is laid for education in Paktika, all our other problems can be solved.”

Provincial council member Hanifa Katawazi insisted life had improved for women, although domestic abuse remained widespread.

“Women in Paktika now take part in meetings and seminars, something that was impossible a decade ago,” she said. “Women now study at school and take literacy classes. But that isn’t enough. These same opportunities should be available in all districts.”

Civil society activist Samar Gul Samar said progress on women’s rights had been negligible.

“How can you claim there has been a change in women’s lives in a province where they have no access to basic health services, and where there is no female doctor, nurse or midwife out in the districts?” he asked.

Samar recalled a tragic case 18 months ago in which a young woman from Urgun district became ill from complications during labour.

“Her family tried to bring her to Sharan. It was snowing heavily. The car got stuck in snowdrifts and the woman eventually died. The child she was carrying died as well,” he said. “These are the conditions in which women live in Paktika, where there isn’t even a single midwife in the districts.”

Samar expressed hope that the new college would improve healthcare.

“In my opinion, this centre is vital and it’s the most important achievement made by women in Paktika,” he said. “I am very optimistic about it.”

Akbar Rahel is an IWPR-trained reporter in Paktika.

This report was produced under IWPR’s Promoting Human Rights and Good Governance in Afghanistan initiativefunded by the European Union Delegation to Afghanistan.