Jeffrey M. Smith, MD, MPH, JHPIEGO/Afghanistan, House #24 Darulaman, Kabul, Afghanistan and Anne Pfitzer, MHS, ANE office, JHPIEGO, 1615 Thames Street, Baltimore, MD 20912, 410 537 1840, apfitzer@jhpiego.net.

Afghanistan has one of the world’s highest maternal mortality ratios. Its geographic terrain, cultural factors and high poverty levels contribute to the dismal statistics. In addition, the Taliban regime severely restricted all female education. A key priority for the Ministry of Health is to produce and deploy large numbers of skilled providers who can manage normal and complicated pregnancies. JHPIEGO, with funding from UNICEF and USAID is working to rapidly expand the number and skills of midwives in Afghanistan. Initial efforts focused on preparing a 1-year competency-based clinical program for midwifery students who had their education interrupted by the Taliban. A class has graduated and now a comprehensive midwifery curriculum is being implemented across the country. To support appropriate recruitment, training and deployment of these midwives, certain initiatives to promote appropriate national policies were also necessary. The authors will describe the cadres, educational programs and technical inputs to support the education of different types of midwives. They will review efforts to develop standardized national curricula and teaching approaches as well as service quality improvement efforts in hospitals where students train. They will also describe community-based interventions to recruit literate women from rural, remote communities to enroll into these educational programs, since one of the challenges is finding women who have the requisite years of education. A related adult literacy program seeks to prepare women for health-related training programs, such as community health worker or community midwife. Finally, the authors will describe ongoing efforts to establish standards for accreditation of midwifery education programs.

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