Afghanistan has one of the world’s highest maternal mortality ratios, with more than 60% of women having no access to a skilled birth attendant in some areas. The main challenges for childbearing Afghan women are access to skilled birth attendance, emergency obstetric care and reliable contraception. The NGO-based project Advancing Maternal and Newborn Health in Afghanistan has supported education of midwives since 2002, in accordance with the national plan for midwifery education. The aim of this study is to explore women’s experiences of professional midwifery care in four villages in Afghanistan covered by the project, so as to reveal challenges and improve services in rural and conflict-affected areas of the country. An exploratory case-study approach was adopted. Fourteen in-depth interviews and four focus-group discussions were conducted. A total of 39 women participated – 25 who had given birth during the last six months, 11 mothers-in-law and three community midwives in the provinces of Kunar and Laghman. Data generated by the interviews and observations was analysed using thematic content analysis. Many of the women greatly valued the trained midwives’ life-saving experience, skills and care, and the latter were important reasons for choosing to give birth in a clinic. Women further appreciated midwives’ promotion of immediate skin-to-skin contact and breastfeeding. However, some women experienced rudeness, discrimination and negligence on the part of the midwives. Moreover, relatives’ disapproval, shame and problems with transport and security were important obstacles to women giving birth in the clinics. Local recruitment and professional education of midwives as promoted by Afghan authorities and applied in the project seem successful in promoting utilisation and satisfaction with maternal and neonatal health services in rural Afghanistan. Nevertheless, the quality of the services is still lacking, with some women complaining of disrespectful care. There seems to be a need to focus more on communication issues during the education of midwives. An increased focus on in-service training and factors promoting quality care and respectful communication is necessary and should be prioritised.

中文翻译：

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“助产士帮助了我……否则我可能会死”：妇女在阿富汗农村地区从事专业助产服务的经历-对库纳尔省和拉格曼省的定性研究

阿富汗是世界上孕产妇死亡率最高的国家之一，在某些地区，超过60％的妇女无法获得熟练的接生服务。阿富汗育龄妇女面临的主要挑战是获得熟练的接生，紧急产科护理和可靠的避孕方法。根据国家助产士教育计划，自2002年以来，基于非政府组织的项目“促进阿富汗的孕产妇和新生儿健康”一直支持助产士的教育。这项研究的目的是探索该项目覆盖的阿富汗四个村庄中妇女的专业助产护理经验，以揭示挑战并改善该国农村和受冲突影响地区的服务。采用了探索性案例研究方法。进行了十四次深入访谈和四次焦点小组讨论。共有39名妇女参加了其中– 25名在过去六个月内分娩，11名婆婆和3名社区助产士在库纳尔省和拉格曼省参加了活动。访谈和观察产生的数据使用主题内容分析进行了分析。许多妇女非常重视受过训练的助产士的救生经验，技能和护理，而后者是选择在诊所分娩的重要原因。妇女进一步赞赏助产士促进立即皮肤接触和母乳喂养。但是，有些妇女在助产士方面表现出粗鲁，歧视和过失。此外，亲戚的不赞成，羞辱以及交通和安全问题是妇女在诊所分娩的重要障碍。在阿富汗当局的推动下并在该项目中应用的当地助产士招募和职业教育似乎成功地促进了阿富汗农村地区对孕产妇和新生儿保健服务的利用和满意度。但是，仍然缺乏服务质量，一些妇女抱怨不当的护理。在助产士的教育期间，似乎需要更多地关注交流问题。必须更加重视在职培训以及促进优质护理和尊重沟通的因素，因此应优先考虑。一些妇女抱怨不当照顾。在助产士的教育期间，似乎需要更多地关注交流问题。必须更加重视在职培训以及促进优质护理和尊重沟通的因素，因此应优先考虑。一些妇女抱怨不当照顾。在助产士的教育期间，似乎需要更多地关注交流问题。必须更加重视在职培训以及促进优质护理和尊重沟通的因素，因此应优先考虑。