From 4-6 May, the Asia Regional Meeting on Interventions for Impact in Essential Obstetric and Newborn Care is being held in Dhaka, Bangladesh, with an opening ceremony and optional supplementary sessions on 3 May 2012. Organized by the Government of Bangladesh, MCHIP, and the Bill & Melinda Gates Foundation-supported Oxytocin Initiative, in collaboration with Women Deliver, VSI, FIGO, and ICM, this three-day meeting will focus on postpartum hemorrhage (PPH), pre-eclampsia/ eclampsia (PE/E) and other aspects of maternal and newborn health.

For more information on the conference, click here. A live webcast begins May 4th, and related resources -- included presentations -- can be found here. Please also connect with the conference via Facebook and Twitter!

Below is the first of a series of blogs from conference attendees. Please find other blogs in the series by:
Ms. Alice Levisay on expectations of the conference,
Dr. Jeffrey Smith on a decade of maternal health successes and the challenges ahead, Rae Galloway and Dr. Justine Kavle on introducing and implementing calcium supplementation to prevent pre-eclampsia, and
Dr. Nuriye Hodoglugil on misoprostol use and acceptance.

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On International Day of the Midwife, May 5th, conference attendees will hear from Ms. Pashtoon Azfar, the Asia Regional Midwife Advisor for the International Confederation of Midwives (ICM). Growing up in Afghanistan, Ms. Azfar knew from a young age that she wanted to be a midwife. “Women in my country are suffering from different miseries such as illiteracy, isolation and domestic violence,” she says, “which consequently and directly contribute to their health problems.”

Ms. Azfar completed her midwifery education before the Communist regime in Afghanistan, when midwifery training in the country followed global standards. But after the late 1970s, she says, nursing and midwifery education—like many other aspects of Afghan society—deteriorated quickly. And during the Taliban regime, they completely collapsed.

In 2002, the Ministry of Public Health in Afghanistan, with the support of its development partners such as USAID, the United Nations and many others identified strategies to address the alarmingly high maternal mortality rate in the country. These strategies included strengthening the midwifery education program and establishing a community midwifery education program. As a result, a competency based community midwifery education program was started that includes a unique feature—a pre-planned deployment plan in which students are selected and deployed back to the communities where they live and where their help is needed most.

This program has proved to be one of the most successful initiatives of the Ministry of Public Health. Afghanistan now has more than 3,000 midwives and a very strong Afghanistan Midwives Association. Ms. Azfar established the Association with only 15 midwives; now the membership has grown more than 2,000 and is now considered to be one of the strongest associations in the region.

Below, Ms. Azfar talks about the role and importance of midwifery in maternal health today, and the challenges they face going forward.

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Midwives are important and valued caregivers. They work hand-in-hand with mothers, considering their needs and practicing in a birth setting that meets mothers’ needs – whether in a hospital, birth center, or their home. Midwives also act as the only bridge between the community and the facility, serving as a kind of emotional support for mothers and their families. They are a main source of maternal and child health at the community level, and are also the ones who approach mothers to seek health care services at the facility.

In Afghanistan, midwives provide high-quality midwifery care and play the leading role in maternal health. Their services are cost effective and, because they live in the communities they serve, are also accessible and accepted by the entire community.

Midwives not only save lives, they also provide routine care to keep women and their babies healthy. To ensure that every woman has a qualified and competent provider by her side when she gives birth, we must continue to improve midwifery education and the enabling environment, create mentorship programs for new graduates, and provide supportive supervision. These efforts will help us to increase the number of midwives and guarantee their retention the health system.

Preventing the needless deaths of women is complex and involves a number of factors—security, poverty, illiteracy and inaccessibility to the health care services among them. We must address financial and cultural barriers, and increase awareness related to pregnancy complications.

But we must also recognize midwifery as an autonomous profession, not just one overshadowed by nursing. ICM and the United Nations Population Fund are working toward  this goal by strengthening all three pillars of the profession: education, regulation and professional association. Midwives also need policy support, the authority to prescribe essential medicine according to their competencies, opportunities for professional development, and the right to be involved at decision-making forums/levels.

By providing continued education, equipment, and a safe work and enabling environment, we will not only improve the quality of our midwives, but also the quality of maternal health.


Pashtoon Azfar,
International Confederation of Midwives
Regional Midwife Advisor/Asia