Reducing maternal mortality in Afghanistan: A pilot study of midwives and mothers

Background:  In 2005 according to the Afghan Health Ministry in rural regions of Afghanistan maternal mortality rate were 6,000 per 100,000 women. Although these figures have improved substantially since 2005, the current rates are alarming.  According to the WHO the maternal mortality ratio in 2010 was 460 per 100,000.  Afghanistan has been in conflict for the past 35 years.  However, for many Afghan women the greatest threat is not bombs or bullets, but the mere task of giving birth. Methods: With the assistance of the Afghan Midwives Association we gained access to conduct by telephone in-depth interviews with 6 Afghan midwives and 4 Afghan mothers. The interviews were conducted by a public health education masters student, a native speaker of Dari, the predominant language (50%) of Afghanistan.  Results: According to the midwives, implementation of educational programs and training for midwives, pregnant women and their families (husbands and mother-in-laws) has made a major change in the past 10 years. All the mothers stated that the midwife was the most helpful person through their pregnancy.  They said that the midwives provided them with critical health education lessons and demonstrations on nutrition, hygiene, vaccinations and exercise. However, barriers to decreasing maternal mortality still exist, such as, transportation, access to care and the influence of the husband and mother-in-law in preventing access to midwives. Conclusions:  Any programs to decrease maternal mortality need to address socio-cultural factors (including husbands and mother-in-laws in maternal health education) and infrastructure issues (making healthcare more accessible).