With her constant threat to midwives

"Taliban" hinders the midwifery profession after Afghanistan became a leading regional model

• Afghan refugee women demonstrate in the British Parliament Square, demanding their rights.

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• A midwife supervises a woman prior to delivery.

  From the source

• A midwife holds a baby she helped deliver.

  From the source

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After years of saving the lives of Afghan mothers and their newborn babies, a veteran midwife was shocked this week when a Taliban commander and two other fighters walked into the clinic where she was working in a remote corner of southeast Afghanistan.

The Taliban men insulted the staff, saying that women "have absolutely no right to go out or work" and that they have had their freedoms over the past 20 years, "attending meetings with men" and going out without a male guardian "ruined Afghanistan."

Such insults are just a challenge many Afghan midwives have faced since the Taliban took control of Afghanistan in mid-August.

The work of midwives presents a dilemma for the Taliban, as modern midwifery requires educated women to do life-saving work.

However, this necessity contradicts many of the Taliban's rules, which are applied arbitrarily from one region to another, and which are currently restricted to women's education and movement.

A challenge to the Taliban

There are some successes in the continuity of midwifery services, especially with the UNFPA program in remote areas.

But the Afghan midwife profession poses a major challenge to the Taliban, and determines the Taliban's acceptance of the expanded role of women in society since their ouster from power in 2001.

At the time, there were only 467 trained midwives across the country, according to United Nations figures, a number that has risen to more than 15,000 today.

Midwives are widely respected in their communities for their life-saving service, and have helped drastic reductions in maternal and infant mortality rates, once Afghanistan was one of the most dangerous countries in the world for childbirth.

Another Afghan midwife says she has received death threats and has not returned to the country, but is still in daily contact with her colleagues at home. From stress, when one of them leaves the house, she thinks: What will happen to me on the way?

What will happen to my family?

What will happen to me in the hospital?” “They are now losing everything they accomplished,” she says. “I am sure that if things continue like this, Afghanistan will become the worst country in the world in terms of maternal mortality.”

Gleam of hope

There is still some glimmer of hope in those units of the UN Reproductive Health Agency, which operates 172 family health facilities in 10 of Afghanistan's most remote provinces.

In 2020 alone, these community facilities performed more than 11,000 safe deliveries, and another 9,500 in the first six months of 2021.

Their numbers increased in the blink of an eye, despite the Taliban's control.

This is because access to health care homes - and even the women who will be selected for two years of training to become certified midwives - have been negotiated within remote communities by senior men from those areas who have spoken to local Afghan NGOs, says a UN fund representative For the population of Afghanistan, Dr. Alexander Boderosa.

The representative says that most of the female midwifery school students are now back in their classrooms, after staying at home during the first weeks of Taliban rule.

The closed health facilities were reopened.

Many of these facilities have already operated under Taliban control for years.

“I think it is all about evaluating the consequences of preventing midwives from providing these services,” says Bodiroza, who is based in Kabul.

He says: “Every day we hear news of the closure of educational institutions for girls.

We are able to mobilize the community and send women to get education in midwifery schools that are delivered in urban areas.”

A humanitarian catastrophe looms

One reason was clear when Dr. Bodiroza recently visited a village high in the mountains of the central Daikundi province.

The head of the local council, a senior religious figure, said that before 2016, women were dying “weekly.”

But after the United Nations Population Fund opened the local health home, "no woman died in childbirth."

UNFPA's family health program serves four million Afghans, or just 10% of the population.

It has plans to expand ninefold, to open a total of 1,500 family health centers to better serve remote areas.

But even the current level is at risk, because the World Bank and Western donors have stopped providing aid since the Taliban seized power.

With chronic poverty and widespread hunger and at a time when the health system is on the verge of collapse with the approach of winter, the United Nations warns of a looming humanitarian "disaster".

It has launched an emergency appeal for $606 million through the end of 2021.

And the United Nations Population Fund warns of a worst-case scenario, if the health system is completely shut down, which will lead to tens of thousands of additional maternal deaths by 2025.

regional model

In 2009, for example, the United Nations Children's Fund reported that Afghan women face a 1 in 8 lifetime risk of dying from childbirth, the second highest rate in the world. But by 2014, the United Nations said Afghanistan had become "a regional leader in the midwifery profession and a model for reducing maternal mortality". The maternal mortality rate dropped dramatically from 1,600 per 100,000 live births in 2002 to 638 in 2017.

Using these milestones to gain universal acceptance from the Taliban may not be easy, says Heather Barr, associate director of women's rights and former Afghanistan researcher at Human Rights Watch. to midwives.

“The Taliban seem to have a high degree of willingness to make their own people suffer,” says Bar, who was contacted in Islamabad, Pakistan. “I think they are quite capable of saying that implementing rules that limit women's freedom is more important than reducing deaths Mothers and children.

• The Taliban says that “the midwife is not necessary in society, because death is in the hands of God, and only God saves the lives of mothers.” This is what the midwife in Paktika state told about the allegations of these two men, and requested anonymity in order to preserve her safety.

• The United Nations said that Afghanistan has become “a regional leader in the midwifery profession, and a model for reducing maternal mortality.”

The maternal mortality rate dropped dramatically from 1,600 per 100,000 live births in 2002 to 638 in 2017.

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