Most women in Afghanistan give birth at home alone. If they are lucky they can get support from a mother or sister, but delivery is often considered a private, even shameful event.
Afghan women can only be helped by female health professionals because of the country's conservative Muslim culture. Since very few girls are educated in Afghanistan, these are scarce. As a result, the maternal mortality ratio in the country is one of the highest in the world.
Against this backdrop, the UK-based charity Merlin set up its midwife training programme in Taloqan, in the province of Takhar, in October 2004. Addie Koster, a maternal health consultant who worked on the project, says after initial uncertainty that rural communities welcomed the programme.
"It was hard to recruit students for our first programme because locals didn't know us. But our second training programme was heavily oversubscribed as word got out. These communities trusted the women who came to the programme and then returned to help their villages," she says.
Those studying in the programme find it empowering, says Koster. "The profession of a midwife enables girls to have independence, gain respect of others as well as earn their own money - which is not common in Afghanistan."
One graduate, Fauzia, is working in a clinic in her home town. She too has witnessed many changes in attitude. "I can now provide advice to pregnant women about healthy pregnancy and delivery," she says.
There are still challenges, says Sophia Craig Massey, country director for Merlin. "Finding funding is always tough despite the programme's popularity - the school costs about $120,000 (£60,000) to run annually. Most of the money comes from the two US health organisations Jhpiego and USAid."
The Afghan ministry of health says up to 8,000 trained midwives will be required to ensure adequate access to skilled care. The country currently has some 2,200 trained midwifes.
