Because of on-going conflicts, the geographic isolation of some regions and poverty that is exacerbated because of Covid-19, Afghan women have difficult access to health services. This explains the high mortality rate at pregnancy and at childbirth. To improve mother and child health, prevent and better address complications, Terre des hommes (Tdh) has supported displaced populations who live in the most deprived areas of Kabul since 1996.

We currently operate in more than twenty displaced people’s camps and poor communities in Kabul, often located far from health services and very rarely connected to running water. Young children generally suffer from malnutrition and anaemia and mothers are exposed to early marriage and repeated pregnancies.

Giving birth under supervision

Our professional midwives reach the most vulnerable and displaced women and children through home visits. Women are assisted throughout the pregnancy and labour. Tdh midwives motivate them to give birth in health centres under the supervision of skilled birth attendants. If women prefer to deliver at home for cultural reasons or lack of money, Tdh midwives assist them and provide supportive care.

Being present in key moments

The initial hours, days and weeks after delivery are the most dangerous moments for both the mother and her child. Records have shown that most deaths occur during delivery and immediately after childbirth mainly due to complications of pregnancy. Trained midwives can identify risks early and can refer women to health centres if needed.

After birth, mothers and babies are examined clinically and the baby's growth and weight gain are monitored. In the follow-up visits, woman are also sensitised on danger signs of the postpartum period and on proper care-seeking. Moreover, they are counselled on the importance of handwashing and home hygiene, new-born care such as breast feeding to prevent malnutrition, and getting vaccinated. In addition, midwives treat ill children under the age of 5 and provide counselling to their mothers on homecare.

“Before, we didn't get vaccinated; we didn't go to the hospital to give birth. Once, a mother died during childbirth. Now, this doesn't happen anymore,” says Tashbibi*, a 22-year-old woman and mother of two children who was supported by Tdh.

Working with the families

Through the close relationship the midwives have with the families, they can advise them not only on family planning and child health, but also organise group sessions about violence against children and other issues arising for mothers and young women in their community. We train women to promote healthy practices with their neighbours and increase the awareness of families on the availability of services offered by Tdh midwives and health facilities. Health improvement is therefore combined with social work to give children a safe and healthy environment to grow up in.

Furthermore, children and family members at risk of or that are victims of violence are supported with psychosocial activities and followed up individually by our social workers. These collaborate closely with the midwives to identify children and mothers at risk, address urgent protection needs, support the victims, provide psychosocial support and mediation or refer children to specialised care if needed.

"Midwives play a very important role in the country. They have the knowledge of the socio-cultural determinants and epidemiological context of maternal and newborn health and ethics that form the basis of appropriate care. The midwives participate in the promotion of health and wellness in the community and serve as a link between the community and the health system. They provide high quality, culturally sensitive health education and family planning services and treat women before, during and after the child is born," concludes the health project manager.

*Name changed for protection reasons