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Young Afghan women train as midwives to serve in remote villages

The UN says an Afghan woman dies every two hours during pregnancy or childbirth – the highest maternal mortality rate in Asia.

A trainee midwife examines a woman at a hospital in Bamiyan, Afghanistan
A trainee midwife examines a woman at a hospital in Bamiyan, Afghanistan. [Ali Khara/Reuters]
Published On 8 Mar 2023

In a small village encircled by velvety white snow-topped mountains in Afghanistan’s Bamiyan province, Aziza Rahimi mourns the baby she lost last year after a harrowing birth with no medical care.

“It was too hard for me when I lost my baby. As a mother, I nurtured the baby in my womb for nine months but then I lost him. It is too painful,” said Rahimi, 35.

The village’s rugged and remote beauty in Bamiyan’s Foladi valley comes with deadly barriers for pregnant mothers.

However, a potentially lifesaving improvement is on the way. Rahimi’s village is one of several around Bamiyan that have sent 40 young women to train for two years as midwives in the provincial capital, after which they will return home.

Isolation can become a death sentence in any difficult birth, doctors and aid workers say, contributing to Afghanistan’s extremely high maternal and infant mortality rates, among the worst in the world.

The United Nations estimates an Afghan woman dies every two hours during pregnancy or childbirth, making Afghanistan’s maternal mortality rate the highest in Asia.

The trainee midwife programme has been spearheaded by the UN refugee agency (UNHCR) with the Watan Social and Technical Services Association, a local charity. They hope to expand the programme to other provinces.

Since taking over in 2021, Taliban authorities have barred women from universities and most charity jobs, but they have made exemptions in the healthcare sector and the UNHCR says local health authorities support the project.

Aziza Rahimi, 35, who lost her son at birth, talks to a trainee midwife in Foladi Valley in Bamiyan, Afghanistan
Aziza Rahimi, 35, who lost her son at birth, talks to a trainee midwife in Foladi valley in Bamiyan. [Ali Khara/Reuters]
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A vehicle drives along a road in Bamiyan, Afghanistan
A narrow road to the village with few vehicles is sometimes cut off by snow, severing a lifeline to hospitals, clinics and trained health workers. [Ali Khara/Reuters]
Trainee midwives attend a training class in Bamiyan, Afghanistan
Many of the trainee midwives, some with small children of their own, have faced logistical and financial challenges, often having to travel huge distances, or live far from home to attend the programme. [Ali Khara/Reuters]
A mother holds her child as she rests in her arms, while women line up outside of a doctor's room, at a hospital in Bamiyan, Afghanistan
A mother holds her child as she rests in her arms, while women line up outside a doctor's room at a hospital in Bamiyan. [Ali Khara/Reuters]
Children walk beside a donkey carrying goods in Bamiyan
'When the roads are blocked of course there is no means of transportation, people even use donkeys to move patients to the clinic centres, but sometimes there is not even the opportunity for that,' said Mohammad Ashraf Niazi, the head of the UNHCR's Bamiyan office. [Ali Khara/Reuters]
Aziza Rahimi, 35, who lost her son at birth, walks inside her house in Foladi Valley in Bamiyan, Afghanistan
Rahimi, who has five other children, said riding a donkey was out of the question when she was jolted by pain while nine months pregnant in the middle of the night four months ago. Stumbling, bleeding, for two hours to her in-laws' house after her husband was unable to find a car or ambulance to take them to hospital, she gave birth there. [Ali Khara/Reuters]
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A trainee midwife examines a woman and her newborn baby at a hospital in Bamiyan, Afghanistan
'We want to learn and serve the people of our village,' said one 23-year-old trainee, who walks two hours each day to the hospital. [Ali Khara/Reuters]
Snow covers the mountains surrounding Bamiyan, Afghanistan
Snow covers the mountains surrounding Bamiyan province in Afghanistan. [Ali Khara/Reuters]
People sit in a waiting room at a hospital in Bamiyan, Afghanistan
People sit in a waiting room at a hospital in Bamiyan. [Ali Khara/Reuters]
A woman dresses up her child at a hospital in Bamiyan, Afghanistan
A woman dresses up her child at a hospital in Bamiyan. [Ali Khara/Reuters]
A teacher gives a lecture to trainee midwives in Bamiyan, Afghanistan
'At first, I didn't want to study nursing or to be a midwife, but after I faced problems and pains during my pregnancy, I got a desire to study midwifery,' said a 20-year old trainee, the mother of an 18-month old son who struggled to access care in her village. [Ali Khara/Reuters]
A woman sits on a hospital bed in Bamiyan, Afghanistan
Women giving birth experience a very different situation in Bamiyan's main city hospital where the trainee midwives work alongside staff, and with the help of a trainer learn how to assess and guide pregnant women, deliver babies and provide post-partum care. [Ali Khara/Reuters]
A girl plays outside her house in Foladi Valley, Bamiyan, Afghanistan
A girl plays outside her house in Bamiyan's Foladi valley. [Ali Khara/Reuters]
A trainee midwife arranges her headscarf in front of a mirror, in a training center in Bamiyan, Afghanistan
'Many women and families in remote areas did not have the information and support they needed to prepare for a safe delivery. We have to change such kind of thoughts ... I want to go to remote areas to treat women who face problems,' said 20-year-old trainee. [Ali Khara/Reuters]