Amid War in U.S. Health Care and in Afghanistan: Midwifing Life

I received two emails in my inbox today. One was from The Big Push for Midwives, asking for help in advocating for greater access to Certified Professional Midwifery (CPM) nationally. The group is basically petitioning Congress to add CPMs to the Medicaid provider list in order to make midwifery an actual option for more women in the United States. Why?

I’ve written extensively about all of the reasons why access to out-of-hospital birth is critical for women in the United States but if you want the quick run-down, check out this synopsis from The Big Push (and sign the petition if you’re so inclined, while you’re there!).

Why is this an uphill battle? Part of the problem is that professional organizations like the AMA and ACOG, while quite supportive of safe abortion care, are not keen on expanding childbirth options to include out-of-hospital settings and use of CPMs, for healthy, low-risk pregnant women. As well, in this country, we’re still enmeshed in seeing childbirth as a medical condition – a condition that must be treated clinically by a physician – regardless of whether or not there are any "medical conditions" present. Culturally we have strayed (if we were ever there) from women experiencing childbirth as normal and healthy, providing opportunities to bond with other women, and receiving support from a midwife and a community of other women.

This is not to say that CPMs do not care for the health of pregnant and birthing women but more that the medical establishment has succeeded in over-medicalizing birth to the point where, ironically, women’s health and lives (as well as the health and lives of the fetuses’ and newborns’) are placed at greater risk through unnecessary interventions. Jennifer Block has written an entire book on the subject! 

Please don’t misunderstand. I’m not saying that prenatal care and childbirth care is not critical. As I’ve referenced in the past, the United States’ maternal mortality rates are dismal for an industrialized nation. African American women are four times as likely to die during childbirth as white women are, in this country. This dire situation is precisely why we need to expand options to a range of care for all women – not limit them. 

So, I know you’re probably wondering at this point what that other email was? The New York Times has an excellent article on the critical role midwives can play in rebuilding Afghanistan, specifically addressing maternal health.  The country is second only to Sierra Leone, in the entire world, in its numbers of women dying directly as a result of pregnancy and childbirth.  

Amid war, after suffering for years under the Taliban, Afghan women are truly in trouble:

The main causes of these deaths are hemorrhage and obstructed labor, which can be fatal if a woman cannot obtain a Caesarean section.
Even if the mother survives, obstructed labor without a Caesarean
usually kills the baby. Most of the maternal deaths — 78 percent,
according to the Lancet report — could be prevented
. [emphasis mine].

But there is one woman under whose leadership Afghanistan is beginning to rebuild its midwifery battalion, literally saving women’s lives. 

Her name is Pashtoon Azfar and she works for Johns Hopkins University but also heads up the Afghan Midwives Association. Her mission? It is to remedy the Afghan women’s death rate from pregnancy and childbirth by training and disbursing the next generation of midwives in Afghanistan. 

The article notes that there is a long way to go. Apparently 80% of women in Afghanistan birth alone or without the help of a skilled birth attendant. And cultural issues plague Afghan women as well:

Afghanistan’s problems mirror those of many other poor countries:
shortages of personnel, supplies and transportation to clinics or hospitals,
especially in remote regions and mountainous areas that are snowbound
half the year. The deeper problems are cultural, rooted in the low
status of women and the misperception that deaths in childbirth are
inevitable — part of the natural order, women’s lot in life.

As we all know, Afghanistan wasn’t always mired in these battles. Before the Taliban women enjoyed equality similar to that of women in the West. After years of war, however, it is certainly women and girls who have suffered unimaginably, without choice or options, surrendering their bodies and babies to a militant power. 

But Azfar calls the midwives she trains "champions" and has great faith that they will help turn things around. 

The link between these two stories? It’s not just that midwives can provide critical assistance, support and care to pregnant and laboring women around the world. It’s that women around the world must demand the right to life – the right not to "surrender our bodies and babies" to powers that tell us we are not worthy of care; and that whether we’re talking about safe abortion care, access to contraception, HIV protection or bringing new life into this world safely, we’re talking about reproductive and sexual health and rights. 

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  • alison-cole

    Again, Amy, thank you for this piece. Midwives empower and support the health of women, in the US and around the world. It’s so important for folks in the US to remember that midwifery care is not just beneficial in situations where medical care is unavailable — it is the most appropriate care for healthy birthing women in all circumstances. The low-tech care midwives can provide out of the hospital saves money and promotes maternal health in all contexts.

  • invalid-0

    I fully agree with Alison in that midwives empower and support women’s health care; personally, I don’t know what I would have done without mine when I had my daughter. Thanx for the great post!