Reducing maternal mortality and improving maternal health in a rural, remote area of Afghanistan

The Birth and Life Saving Skills (BLiSS) course is a series of participatory training sessions delivered in the beneficiaries’ villages, teaching topics of birth preparedness, complication readiness and safer birthing practices. The courses have been specifically designed to be culturally and context relevant for Afghanistan and appropriated according to gender and low literacy levels. Working within a paternalistic and hierarchical society, the BLiSS course is delivered to women of child-bearing age, men and older women, as it is often the mothers-in-law along with the husbands who are responsible for making decisions about the care and treatment of pregnant woman, particularly should any difficulties arise. It is therefore important to include men and older women for women of child bearing age to experience improved outcomes in their maternal health. The project also improves the collective knowledge of the community, as people often discuss together, in informal settings, what to do, both in preparing and if problems arise. The project seeks to increase knowledge, leading to improved practice in the following areas: • Birth preparedness: Basic good maternal health practice such as the importance of regular antenatal care visits, good nutrition, taking vitamins, drinking 6-8 cups of water a day. For men, this helps to improve their awareness, so they are more accepting, supportive and can make safer choices on behalf of their wife. A key action is for men to save money so the wife can afford to travel to the clinic for check-ups, if there are complications prior to or during birth, and for necessary medications. • Complication readiness: Recognising the distance and difficulty in accessing health clinics, it is important to recognise the warning signs of complication so they can be ready to seek professional medical help. The course teaches the importance for high-risk pregnancies to travel ahead of time to the clinic, the importance of saving money to pay for transport or medical bills, and what can be done in the home if they are unable to travel to the clinic. • Safer birthing practices: Due to the prevalence of unchallenged and unsafe traditional birthing practices, the BLiSS course teaches why these practices are potentially harmful to mother and baby, and replaces these with knowledge of good practice. The safer practices can be applied at home, often with the support of local women and traditional birth attendants, such as using the Birth Kit and breastfeeding within the first hour. Meetings are held with village leaders before any courses start, to gain permission for courses to be hosted locally, for local women to be identified as local trainers, and for courses to be promoted (often by word of mouth).