Imagine that you are nine months pregnant and have to drive seven hours to reach the nearest hospital. You have never seen an obstetrician or midwife for prenatal care and emergency health services are miles out of reach. This is the situation in parts of Afghanistan, where the maternal mortality rate is the highest in the world.

As of 2008, it was estimated that 1 in 11 Afghan women die in childbirth. (In Greece, the country with the lowest maternal mortality rate, the statistic is 1 in 31,800.) With a fertility rate of 6.62 children per mother, the life expectancy for women in Afghanistan—recently ranked “the most dangerous country for women” by the Thomson Reuters Foundation—is less than 48 years.

Now, a national midwifery program is one of several initiatives to drastically improve women’s maternal safety, report Isobel Coleman and Gayle Tzemach Lemmon in Ms. Magazine. Funded by organizations like the U.S. Agency for International Development, the United Nations, and the European Union, the program has trained more than 2,500 midwives. Coleman and Lemmon write:

For women in the country’s most remote provinces, who face the greatest challenge accessing health care in this overwhelmingly rural country, the midwives serve as a lifeline. Of the approximately 500 birth complications that occur daily in Afghanistan, 320 happen in those rural areas. Midwives are also active in cities, making home visits to women too poor or limited in mobility to seek help at clinics or hospitals.

The midwives can affect more than just the maternal mortality rate, they continue:

Along with saving mothers’ lives, the midwives serve as homegrown role models whose economic strength and earning power are changing their families’—and their communities’—views on women’s roles. Midwives can earn around $350 each month, a substantial salary in one of the world’s poorest countries and where per capita GDP is less than $500 per year. The money matters and is playing a role in shifting male attitudes toward women’s work outside the home…. When women begin contributing economically to the family, they also have a greater say in what happens to them and to their children.

 “Most people have a lot of respect for midwives because they need health care,” says Fatima, [a] student in the program. “Midwives save mothers’ lives and women’s lives.”

Source: Ms. Magazine (excerpt only available online)

Image by isafmedia, licensed under Creative Commons. 

A California hospital has banned midwives from delivering babies, saying they must deliver at a larger facility 11 miles away that has a neonatal intensive care unit. The Ventura County Star reports on the controversy and the midwives’ reaction to the decision in Camarillo, California:

The two midwives who deliver at least 60 babies a year at the Camarillo hospital said they don’t understand the reasoning because they rarely have complications. …

Midwives said they’re worried that patients who want to deliver their babies at a Camarillo obstetrics unit they described as quiet and homey may not want to go a busy, much larger hospital. They also questioned why hospital leaders decided midwives need immediate access to the intensive care unit but obstetricians-gynecologists who routinely handle high-risk births do not.

Feministing suggests an answer, writing, “It’s hard to view this decision as being motivated by anything but a distrust of midwives, especially when OB/GYNs who deal with higher-risk pregnancies are still able to use the smaller facility.”

The blog On Birthing pins the midwife ban on fallout from the hospital’s contentious relationship with a doctor who assists in home births and is affiliated with the midwives. He and the hospital have disagreed over some of his methods. “So for his non-compliance with such ‘suggestions’ on how he ought to practice, they now take it out on midwives?” writes On Birthing. “This is a travesty.”

Feministing reports that the advocacy group the Birth Action Coalition is protesting the hospital’s decision.

Source: Ventura County Star, Feministing, On Birthing