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Response by Dr. Sakena Yacoobi, Executive Director, Afghan Institute of Learning (AIL)

Maternal mortality is still a huge problem in Afghanistan, where being pregnant and giving birth are a risky business. Where the national rate for stillbirths at 5.2% (Afghan government) and maternal death national rate at 1.4% (UNICEF). Only about 14% of women give birth with any skilled attendant to help. Many women just do not have the basic knowledge about pregnancy and birth to safeguard themselves and their babies. There are many small communities with limited access to trained healthcare staff and in consequence old wives tales about birthing practices are still followed. These practices are often unsanitary and unsafe and in certain situations downright dangerous. Pregnancy and childbirth take a tremendous toll on the health of mothers who are often dealing with other children and have children close together.

The Afghan Institute of Learning (AIL) has sought to address this major global health concern of maternal mortality in a number of ways. I founded AIL in 1996 to help with the lack of education, training and healthcare that I saw in Afghan society in refugee camps and then in my homeland. AIL has trained Traditional Birth Attendants, held multi day workshops about reproductive health and provided health education opportunities to patients seeking care including topics such as child spacing and contraceptives and more recently conducted mini workshops and gone into schools to talk about health to adolescents.

AIL is always creative and flexible in its approach and realized that some mothers were not able to attend its popular in depth reproductive health workshops because of time issues. In response, we launched our innovative Expectant Mother Workshops in 2010. In these workshops a mother, who would normally deliver at home, attends with her caregiver and, in a few hours on one day, receives the information she needs about safe pregnancy, problems during pregnancy and how to have a safe delivery. Most importantly, the participants are encouraged to deliver at a clinic or hospital rather than at home. The workshop is free and the mother receives a gift of baby clothes and the caregiver a scarf.

The workshops are very popular and hugely successful. The program continues to run in 2013 and so far the results through 2012 have been remarkable with 27 workshops now completed for 599 women. There have been 235 recorded births, of these 229 were at a clinic or hospital and only 6 women chose to give birth at home (2.55%). There have been no maternal deaths reported and only 1 stillborn and 1 complication (0.42%). The choice these women have made goes against the norm of thousands of years in Afghan culture, and they would have had to reason with husbands and mothers in laws to take the course of action of a clinic birth.

These workshops are giving women and babies a better chance of survival and wellness following birth. This innovative program shows that Afghan women are eager to learn and are open to change. Once they know what their options are, they choose a safer and healthier approach. The vast majority chose the clinic-based birth after learning what is offered and how it is much safer. This is encouraging and hopeful as it shows the situation within our culture is not intractable; change and improvement in outcome is possible. Afghan women just need the opportunity of education; they will seize the opportunity and then they will take responsibility to look after themselves and their children in the best way possible. There is no uphill battle to be fought in persuading a change in attitude; it is a question of access to knowledge which is the catalyst for a shift in what is normal behavior.

AIL has found that the Expectant Mother Workshop is a highly effective means to reach a lot of women in a short space of time. Women are ready for change and eager for knowledge. This workshop approach is easily replicated and could be used in many differing societies around the world to great effect.

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