gms | German Medical Science

Background: Afghanistan has one of the highest maternal mortality ratios (MMR) in the world, with a considerable variation between urban and rural areas [1], [2]. After more than 30 years of war the country is lacking resources in health care, particularly in maternal health. In some provinces of Afghanistan only 50.5 % of women have access to a skilled birth attendant [1], which is only half as many as the world average of 70.5%. About seven out of ten women are giving birth attended by a traditional birth attendant, a relative- or alone. Women in reproductive age between 15 and 49 account for 22% of the population and the main challenges for childbearing women in Afghanistan are access to a skilled birth attendant, to emergency obstetric care and to reliable contraception [3]. In order to reduce maternal morbidity and mortality these problems need to be resolved [4].

Traditions and rituals around pregnancy and childbirth are important and deeply rooted in the Afghan society [5]. Care of both mother and child in the time around pregnancy and childbirth depend on knowledge, attitudes and practice of health measures. Traditional measures are sought and preferred and professional health care providers are often first contacted when the problem is not solved by traditional measures. In addition are women often reluctant to seek professional help; they feel ashamed and embarrassed, particularly regarding questions about sexual and maternal health. The use of male health care providers is a problem and when the service is provided by a man the woman must be accompanied by the husband or another male relative [2].

The Afghan government and the international society are now paying more attention on the situation for Afghan women and maternal and child health in particularly. The national government as well as international organizations have established education of midwives both at community and hospital level. Since 2002 the Norwegian Afghanistan Committee (NAC) has supported education of midwives in Afghanistan through a project of education of Community based (CME) and Hospital based (HME) midwives with professional cooperation from The Norwegian Association of Midwives (DNJ) since 2009. Particularly following the implementation of a CME program the MMR in Afghanistan has been significantly reduced and the number of labouring women who are attended by a skilled birth attendant has increased by 28%.

Aims/research question: This study aims to better understand how women value current professional midwifery care and if the program has improved the use of midwives, particularly in rural areas.

Methodology: An explorative case study approach will be adopted for this research. Data will be collected through participatory observation, focus group discussions (FGDs) and individual interviews. Women in the provinces of Laghman and Kunar who have given birth during the last six months, mothers-in-laws and community midwives will be asked to participate. Data will be analysed through a thematic content analysis and presented as an article in a peer-reviewed journal.

Ethical criteria and conflict of interests: The research was submitted to an ethics committee. It was financed from own resources and by third party funds from donation of the Norwegian Association of Midwives/The Norwegian Afghanistan Committee. There is no conflict of interest.

The PDF file of the poster submitted for the meeting is available in English as Attachment 1 [Attach. 1].