“the midwife helped me. otherwise i could have lost my life ...“the midwife helped me. otherwise...

“Themidwifehelpedme.OtherwiseIcouldhavelostmylife”Women´sperception,utilizationandexperienceofaprofessional

midwiferyserviceinruralAfghanistan

BackgroundAfghanistanhasoneofthehighestmaternalmortalityratios(MMR)intheworld.Onlyaminorityofthewomenhaveaccesstoaskilledbirthattendantandmostwomenaregivingbirthattendedbyatraditionalbirthattendant. Since2012NorwegianorganizationshavesupportedtheeducationofcommunitymidwivesinAfghanistan.

Theaimofthisstudyistoexplorewomen´sperception,utilizationandexperienceofprofessionalmidwiferycareinthetimearoundchildbirthintwoprovincesofAfghanistan

TrudeThommesen1,2,,Hallgeir Kismul1, AbdulHabibWakilzad3, KhadijaSafi3, IanKaplan3, Terje M.Watterdal31.CentreforInternationalHealth,DepartmentforGlobalPublicHealthandPrimaryCare,UniversityofBergen,Norway2.DepartmentofObstetricsandGynaecology, Haukeland UniversityHospital,UniversityofBergen,Norway3.NorwegianAfghanistanCommittee,Kabul,Afghanistan

AcknowledgementsWewouldliketothankallthewomenandmidwives intheprovincesKunar andLaghman whoparticipatedinthisstudy,aswellastheirmothers,sistersandmothers-in-laws

MethodologyAnexplorativecasestudyapproachwasadopted.Inadditiontoparticipatoryobservation,14in-depthinterviewsandfourFocusGroupDiscussionswereperformedwithalltogether39womenwhohadgivenbirthduringthelastsixmonths,mothers-in-lawsaswellascommunitymidwivesintheprovincesKunar andLaghman.Datawereanalysedthroughathematiccontentanalysis

FindingsThewomenexpressedthatthemidwives´ levelofknowledge,care,skillsandabilitytosaveliveswereimportantreasonsforgivingbirthinaclinic.Theyappreciatedthemidwives’actionstopromoteimmediateskin-to-skincontactandearlybreastfeeding.Lackofpermissionfromtheirrelativestovisittheclinicsandproblemswithtransportweresomeoftheobstaclesforusingthehealthfacilities

ConclusionEducationanddeploymentofprofessionalmidwivesseemtoimpacttheuseofmidwiferyserviceandimprovementofmaternalandinfantmorbidityandmortalityinruralAfghanistan

“Ihadthreechildrenathomewithalotofproblems.Myneighbouradvisedmetogototheclinic[..].WhenIwenttherethemidwivesbehavedsowellandIwasveryhappyandsatisfied.AfterthedeliveryIhadaveryseriousbleeding.Howeverthemidwifehelpedmeandgavememedicine.OtherwiseIcouldhavelostmylife”(Khandan,30)