Skip to main content

Research Repository

Advanced Search

Development of the Community Midwifery Education initiative and its influence on women’s health and empowerment in Afghanistan: a case study

Speakman, Elizabeth M.; Shafi, Ahmad; Sondorp, Egbert; Atta, Nooria; Howard, Natasha


Elizabeth M. Speakman

Ahmad Shafi

Egbert Sondorp

Nooria Atta

Natasha Howard


Political transition in Afghanistan enabled reconstruction of the destroyed health system. Maternal health was prioritised due to political will and historically high mortality. However, severe shortages of skilled birth attendants - particularly in rural areas - hampered safe motherhood initiatives. The Community Midwifery Education (CME) programme began training rural midwives in 2002, scaling-up nationally in 2005.

This case study analyses CME development and implementation to help determine successes and challenges. Data were collected through documentary review and key informant interviews. Content analysis was informed by Walt and Gilson’s policy triangle framework.

The CME programme has contributed to consistently positive indicators, including up to a 1273/100,000 reduction in maternal mortality ratios, up to a 28% increase in skilled deliveries, and a six-fold increase in qualified midwives since 2002. Begun as a small pilot, CME has gained support of international donors, the Afghan government, and civil society.

CME is considered by stakeholders to be a positive model for promoting women’s education, employment, and health. However, its future is threatened by insecurity, corruption, lack of regulation, and funding uncertainties. Strategic planning and resource mobilisation are required for it to achieve its potential of transforming maternal healthcare in Afghanistan.

Journal Article Type Article
Acceptance Date Aug 29, 2014
Online Publication Date Sep 15, 2014
Publication Date 2014-12
Deposit Date Jan 23, 2020
Publicly Available Date Jan 23, 2020
Journal BMC Women's Health
Publisher BMC
Peer Reviewed Peer Reviewed
Volume 14
Article Number 111 (2014)
Keywords Policy analysis, Midwifery, Maternal health, Afghanistan
Public URL


Downloadable Citations