MY MIDWIVES ASSOCIATION: Afghanistan - Pashtoon Zyaee


Advocacy - The Game Changer

In the first of a series of blogs outlining the benefits of joining fellow midwives as part of a Midwifery Association to push for change, Pashtoon Zyaee tells how she influenced Afghanistan government policy on midwifery education in two hours of face to face advocacy. 


I believe advocacy is key in making sure we achieve the quality midwifery services women have a right to – wherever they live in the world.

In Afghanistan, despite years of war, we have seen rapid progress. Starting from a low point in 2002 when we had only 467 midwives for the whole of my country, we had a maternal death rate of 1,600 / 100,000 live births, one of the worst in the world.

Within ten years women had access to quality care by some  4,000 midwives, and this, together with the development of a functioning health system, reduced maternal deaths to 327 / 100,000 by 2012. This was a roughly 80 per cent reduction, a huge collective achievement!

At that point, as the founder and first elected President of the  3,000 strong Afghan Midwives Association, I asked for a meeting with the Minister of Higher Education to discuss how we could maintain the quality of care that midwives can provide to women and their families.

My main ask to the Minister was to approve a new bridging programme, (a post-Diploma BSc in Midwifery) in order to provide a career path for midwives. Our problem was that we were losing many midwives for lack of professional development opportunities. We also needed midwives to be managers, faculty members and supervisors, with the skills to lead on policy and to take midwifery forward. However, once we had exchanged greetings the Minister told me his view:

‘I totally disagree with this,’ he said, ‘but see if you can convince me!’

For the next two hours I put the case for this new programme, explaining the need for it, and gradually changing his view that midwives only had a presence by the bedside. With thousands of midwives now working in Afghanistan it was critical to ensure quality of care, and the best way to do this was via a new cadre of midwives who are skilled in leadership.

We had a frank and wide ranging discussion, based on my decades of experience as a midwife, during which we have rebuilt midwifery in Afghanistan. At the end of our conversation he was convinced.

He agreed and asked for the date of our first workshop so that he could attend and launch the new programme. 

Now midwifery is moving forward, offering a safer and healthier future for the mothers and newborns of Afghanistan.

Pashtoon Zayee now works for ICM at our office in The Hague.