Development of the Community Midwifery Education initiative and its influence on women's health and empowerment in Afghanistan: A case study

TY - JOUR

T1 - Development of the Community Midwifery Education initiative and its influence on women's health and empowerment in Afghanistan

T2 - A case study

AU - Speakman, Elizabeth M.

AU - Shafi, Ahmad

AU - Sondorp, Egbert

AU - Atta, Nooria

AU - Howard, Natasha

N1 - Funding Information: In late 2001, Afghanistan emerged from decades of war with ruined infrastructure and a non-functioning health system [1]. Transition brought national commitment to improving Afghan lives. Crucially, this commitment was supported by the international community with a strong political imperative, technical assistance, and substantial funding [1]. Copyright: © 2014 Speakman et al.; licensee BioMed Central Ltd.

PY - 2014/9/15

Y1 - 2014/9/15

N2 - Background: Political transition in Afghanistan enabled reconstruction of the destroyed health system. Maternal health was prioritised due to political will and historically high mortality. However, severe shortages of skilled birth attendants - particularly in rural areas - hampered safe motherhood initiatives. The Community Midwifery Education (CME) programme began training rural midwives in 2002, scaling-up nationally in 2005.Methods: This case study analyses CME development and implementation to help determine successes and challenges. Data were collected through documentary review and key informant interviews. Content analysis was informed by Walt and Gilson's policy triangle framework.Results: The CME programme has contributed to consistently positive indicators, including up to a 1273/100,000 reduction in maternal mortality ratios, up to a 28% increase in skilled deliveries, and a six-fold increase in qualified midwives since 2002. Begun as a small pilot, CME has gained support of international donors, the Afghan government, and civil society.Conclusion: CME is considered by stakeholders to be a positive model for promoting women's education, employment, and health. However, its future is threatened by insecurity, corruption, lack of regulation, and funding uncertainties. Strategic planning and resource mobilisation are required for it to achieve its potential of transforming maternal healthcare in Afghanistan.

AB - Background: Political transition in Afghanistan enabled reconstruction of the destroyed health system. Maternal health was prioritised due to political will and historically high mortality. However, severe shortages of skilled birth attendants - particularly in rural areas - hampered safe motherhood initiatives. The Community Midwifery Education (CME) programme began training rural midwives in 2002, scaling-up nationally in 2005.Methods: This case study analyses CME development and implementation to help determine successes and challenges. Data were collected through documentary review and key informant interviews. Content analysis was informed by Walt and Gilson's policy triangle framework.Results: The CME programme has contributed to consistently positive indicators, including up to a 1273/100,000 reduction in maternal mortality ratios, up to a 28% increase in skilled deliveries, and a six-fold increase in qualified midwives since 2002. Begun as a small pilot, CME has gained support of international donors, the Afghan government, and civil society.Conclusion: CME is considered by stakeholders to be a positive model for promoting women's education, employment, and health. However, its future is threatened by insecurity, corruption, lack of regulation, and funding uncertainties. Strategic planning and resource mobilisation are required for it to achieve its potential of transforming maternal healthcare in Afghanistan.

KW - Afghanistan

KW - Maternal health

KW - Midwifery

KW - Policy analysis

UR - https://www.scopus.com/pages/publications/84907911494

U2 - 10.1186/1472-6874-14-111

DO - 10.1186/1472-6874-14-111

M3 - Article

C2 - 25220577

AN - SCOPUS:84907911494

SN - 1472-6874

VL - 14

JO - BMC Women's Health

JF - BMC Women's Health

M1 - 111

ER -