Learning to tackle malnutrition: Afghanistan’s silent child killer

On October 16, 2012, more than 70 school children in two Afghan provinces will join 20,000 children around the world taking part in Save the Children’s global “Race for Survival”. They will draw attention to Afghanistan’s frail progress in tackling one of the major remaining barriers to saving more children’s lives: Malnutrition. It is the underlying cause for one third of child deaths and in Afghanistan 55 per cent of children are stunted – not able to develop properly, both mentally and physically, because they don’t get the right kinds of foods.

Ten years ago, I took my first role as a midwife in a refugee camp in Iran. After the fall of the Taliban in 2003, when I returned to Afghanistan, there were only a few hundred midwives in the country. The situation for women and children was terrible – the maternal mortality rate was among the worst in the world. Most women gave birth at home in unsafe conditions with no support from anyone with the right skills, and women were afraid or unable to visit clinics. Pregnancy meant risking your life and the life of your unborn child.

Today, there are many more trained midwives in Afghanistan and the situation for mothers has improved. Recently, I met a mother in Badakhshan province who had given birth in a health clinic and was proudly explaining to me the value of seeking help from a midwife; she knew about newborn care and the importance of not washing her baby immediately after birth, as used to be done, but instead to keep him warm. Ten years ago, the facility, the health worker and the knowledge of the mother simply wouldn’t have been there. This is just one mother, one example, of the progress for women and children in Afghanistan.

Yet there is still a long way to go in providing mothers and babies with the support they need to save more lives. 

So what are the lessons learnt that could help Afghanistan tackle the malnutrition crisis?

Need political support

If the political will is there, everything else will follow. It was the government and international community that recognised and decided to address the high maternal mortality rate. By developing policies that have created an enabling environment, to providing funding to train more midwives in rural areas, with political will we have been able to mobilise communities to save more lives.

During this time of uncertainty and change, politicians will have many considerations, but children are the future of Afghanistan. If we don’t continue to save more lives and tackle malnutrition by putting the right policies and funding in place, we are putting Afghanistan’s future at risk.

Political support is needed, but change begins in communities. As with the mother from Badakhshan, more women are now able to understand the importance of giving birth in a clinic, or with a midwife, and can recognise danger signs during pregnancy or in their children, such as fever and fast breathing that might be a sign of pneumonia, and are able to seek help. Yet many communities are still struggling with traditional beliefs that can put lives at risk. More needs to be done to raise awareness of good nutrition.

Women are life-savers. Women are the centre of healthy lives for their families. My motivation as a midwife comes from the women that we support – the power of women working with women to save lives. It has pushed me to stay in this field and help women as much as I can, even beyond duty. When you feel you are helping women lead a healthy life, it feels like you have everything. It is mothers, and women like me, who with the right training, are changing the health of this country.

Training women to be health workers and midwives has been critical to improving health services, but it hasn’t been easy. As a midwife trainer, I had a challenge. How can you train women who are illiterate, or at best only have an elementary education? And on top of that women who are scared to work? But there are now around 3,500 midwives and around 10,000 female community health workers: Women given basic training to recognise and treat common illnesses. Now we need to train these women health workers to better be able to prevent and treat malnutrition and increase awareness.

There are many people like me in Afghanistan, driven by their relationships with communities, the ability of women to create change and the potential to save lives. Afghanistan is at a turning point. I hope we can harness this kind of motivation and belief that change is possible, and learn from the lessons so far to make Afghanistan a safer and better place for mothers and children. 

Sabera Turkmani is the President of Afghan Midwives Association.