FARYAB, Afghanistan – Five years ago, midwife Laila Amini watched a girl die in childbirth from causes that were entirely preventable. That day, Ms. Amini resolved that no other women or girls in her community would die when they still had a fighting chance at life.
She worked with the small community, in Arkalik Village, to raise awareness about the importance of obstetric care. “As we worked together to ensure that no maternal deaths will happen again in the village, the community also found my work very critical and they value the services provided,” Ms. Amini said.
They have not had a maternal death since.
Ms. Amini remembers the case vividly. It was a cold winter day when a 17-year-old arrived at the local family health house – a community-based health facility managed by a midwife from the same community. These facilities provide essential reproductive, maternal, newborn and child health care in underserved areas.
The girl was in extreme labour pain, but her relatives did not have the means to bring her to the family health house in time. She arrived in a wheelbarrow, and died soon after.
By engaging in dialogues with the community, Ms. Amini inspired villagers to rally together to find emergency transport solutions. Together, the community identified two rental cars in the area whose owners agreed to mobilize immediately to transport pregnant women in need of urgent care. The villagers pool their money to pay for the rental fees. When necessary, the cars can take women to the nearest hospital, an hour’s drive away.
The system has worked for five years, and the family health house has become a sought-after service provider to the wider area. Originally intended to serve up to 300 patients per month, the Arkalik family health house has more than doubled its reach. Ms. Amini attends to about 700 patients per month, and is on call around the clock.
“This clinic may be small but it has a big contribution on the health of women in this village,” Ms. Amini said.
Women-staffed health facilities
There are 172 family health houses, supported by UNFPA, across the country. They have become an integral part of Afghanistan’s health system, particularly following the withdrawal of development assistance after the Taliban takeover of the country in August 2021.
Scaling up and strengthening these family health houses is a priority for UNFPA and partners working through the Special Trust Fund for Afghanistan, a multi-UN inter-agency funding mechanism working to meet basic survival needs in the country. Plans are underway to expand the number of family health houses to 1,500.
Not only will these facilities increase access to life-saving antenatal, maternal and newborn care, they will also provide much-needed employment opportunities for women at a time when women’s and girls’ rights are under increasing threat.
The last year has seen increasingly draconian rules on women and girls, including the discontinuation of girls’ education beyond sixth grade, restrictions on movement and a newly announced requirement that they cover their faces in public. Restrictions on women’s employment are expected to cost the country $1 billion in economic losses.
Under these circumstances, women health workers are more critical than ever, not only as life-saving health providers but also as breadwinners.
Women staffing the family health houses will be trained, and their skills will be invaluable. “My father feels honored every time people in our community approach him to express appreciation for his decision to support my education so I can be a midwife,” Ms. Amini shared.
She hopes her record of zero maternal deaths continues for as long as possible.
“We haven’t had maternal deaths here since that unfortunate day five years ago,” she said. “The zero maternal deaths represent the success of my work and this is an inspiration for me.”
Supporting family health houses is just one of UNFPA’s interventions in Afghanistan to ensure that the health and rights of women and girls are protected. In 2022, to scale up the delivery of life-saving reproductive health and protection services for 9.3 million people affected by the crisis, UNFPA requires $251.9 million. To date only 13 per cent of this appeal is funded.