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06.09.2017 - News

Kabul: Mobile midwives reach the most vulnerable at home

War-torn since more than 30 years, Afghanistan remains one of the most dangerous and most violent countries in the world. Health workers continue to be victims of the conflict. Families are the first to live the consequences of this insecurity. To provide a solution, Terre des hommes has put in place a house visit concept of midwives who assist families in need.

The mother mortality rate in Afghanistan is one of the highest in the world. Even though clear statistics are difficult to obtain, it is said that around 8 children and 4 mothers out of 1000 die when giving birth. Due to the tense security context in Afghanistan, health facilities are still targets of the conflict and over 9 million people have limited or no access to healthcare.

Tdh midwives are where families need them most: at home

Guaranteeing the health of mothers and children remains a challenge: 25% of the hospitals do not have a midwife or skilled birth attendant. Additionally, the Afghan cultural context prevents many women from getting medical care. Without the agreement of her family or her husband, the woman is not allowed to go to a hospital and therefore, many give birth at home. Living in isolation - without any contact to the society - they are not sensitized on the health issues small children can have.

To face the acute need of health services, Tdh has established a door to door concept of professional midwives. Our mobile midwives carry out house visits in order to provide care to women who cannot access public services.

"The house to house concept is extremely important in Afghanistan. The midwives know the socio-cultural and epidemiological context of maternal and newborn health and ethics that form the basis of appropriate care."

Doctor Noor Khanum, manager of the Kabul health project


When two Tdh midwives visit the 22-year old Qandi in an informal settlement of displaced families just outside of Kabul, she is struggling with her life. Unconscious and  pale, she just gave birth to her fifth baby with a retained placenta. Many women and children surround her in the dark tent, which has almost no light and very poor hygiene conditions. Midwife Simeen and Nooria, who both have worked with Tdh for more than 15 years, don’t waste a second; they quickly do a physical examination, check Qandi’s blood pressure and treat her adequately to stop the severe bleeding. As soon as the mother regains her consciousness, the midwives provide her with necessary medicines. One day later, in the morning, the two midwives visit the mother and the baby and are happy to see that both of them are in a good state.

Supporting the most vulnerable: internally displaced families and returnees

Our mobile midwives focus on providing outreach assistance for  displaced and ‘returnee’ families in 26 areas of Kabul, who are not covered by the governmental health programme. With more than 600,000 returnees from Pakistan – former Afghan refugees coming back to their country - joining more than one million internally displaced people because of the violence and on-going war in Afghanistan, displaced people face especially vulnerable conditions. Mostly living in temporary shelters or informal settlements in urban areas, they lack the most basic needs.

Innovating our response: a mobile unit

“Mothers are greatly affected and come under extreme stress when their children are unable to get education, are faced with violence, not aware of their basic rights and earning money for their families in the streets”, explains Dr. Noor. To better support children and mothers, an innovative mobile unit composed of a social worker and a midwife has been set up. This is a step forward towards not just helping mothers and children survive, but providing protection activities to improve their wellbeing and respect their rights. Dr. Noor adds: “The mobile units will improve the work of the midwives, because mothers and children are not separable from each other. To conclude, health and protection are closely interrelated and health is incomplete without protection.”

Our mobile outreach in the peri-urban areas of Kabul brings assistance to pregnant and lactating women and their babies and shows the mothers how to adopt healthy behaviours. Our Afghan midwives carry out continuous health education sessions within the communities; in 2016 alone, they have raised awareness amongst more than 50,000 women and adolescents about the importance of breastfeeding, hygiene promotion, vaccination, self-care, and access to health facilities.

Tdh is currently the only organisation working on the mobile community approach in Afghanistan. Our door to door concept of midwives who live in the community is an essential element of access to healthcare for the local people, and brings behavioural change about the importance of professional care for pregnant women and their newborn babies. So far, our team has managed to provide assistance to over 60% of the registered internally displaced population in Kabul. The link with child protection reinforces the impact for children’s well-being and gives them the possibility to live a healthy life.

Photo credit: ©Fabrice Pedrono

The protection and counselling support Heela and her family got from the social worker is priceless, as they now live together peacefully and she has developed a life more in line with the one of a little girl’s.

Heela, 'returnee', got back her childhood