Marika Merits , Kaire Sildver, Irena Bartels and Sandra Tamme
Objective: The research is carried out in the framework of the development project “Improving Quality of Medical and Info-technological education in North and East Afghanistan in 2014-2016.” The Afghan midwives were educated about contemporary professional theoretical and practical skills within the training, whereas prior it was necessary to determine the existing knowledge and skills of the target group. It was possible to plan the content quality of the training with the support of the results of current research in accordance with the needs of the target group. The study’s aim is to describe contraceptive methods, maternal and neonatal mortality in Afghanistan and to analyses results of the interviews during professional training for Afghan midwives in Estonia, Tallinn Health Care College.
Methods: The research method is qualitative based on semi-structured interviews. The target group comprised nine Afghan midwives from North and East Afghanistan. The questionnaire consisted of questions, which were divided into three themes: contraceptive methods, maternal mortality and neonatal mortality.
Results: According to interviews, in Afghanistan, a variety of contraception is available: hormonal oral pills, birth control implants, and hormone injections, intra-uterine contraceptive and male condoms. Abortion is prohibited by law, but it is exercised in disguise. In rural areas, contraception is more difficult to access than in cities. There are several factors hindering the use of contraceptives and family planning in Afghanistan, such as family-related or societal religious standards and values, fear and ignorance of side effects, insufficient counseling skills of the midwives and lack of female doctors also high cost of contraceptives. There are many children in the families in Afghanistan. The birth of a baby boy is preferred because there is a widespread misconception that boys ensure the well-being of the family. Women from urban areas give birth in urban hospitals. Women from rural areas give birth at home, there is a high risk for the onset of complications and professional help is not available. The women are invited to the hospital for the midwife’s postpartum appointment but most women prefer not to go there, which increases the risk for the onset of postpartum complications. Newborn care consists of many different factors, which are hazards to the health of a newborn, such as not using colostrum, washing the newborn and several other inappropriate methods of care. Prematurity, low birth weight, infections etc. are highlighted as causes for neonatal mortality. Healthcare in Afghanistan as a whole is uneven, and needs systematic rearrangements. Midwifery care is not available in rural areas. Training of midwives should be supported and improved at the national level in order to provide even availability and quality of midwifery care. The measures listed help to alleviate problems related to family planning and to reduce the maternal mortality and neonatal mortality rates.
Conclusions: Afghan midwives require modern and evidence-based training what is based on accepted guidelines, medical and info-technological education. Tallinn Health Care College will continue to improve medical and info-technological education training of Afghan midwives. The target groups were educated about contemporary professional theoretical and practical skills, which covered pregnancy and delivery period and postpartum period, counseling in reproductive health, includes family planning, newborn care, women’s rights and digital technology.