Development and expansion of a professional association for midwives to strength midwifery Background The recognition that Afghanistan has

the second highest maternal mortality ratio in the world was the most significant data to impact health policy and planning in the early days of the reconstruction of health care, after the fall of the Taliban. The World Health Report 2005, illustrated that making the right technical and strategic choices is key to ensuring universal access to care as well as addressing the Millennium Development Goals, specifically reducing the number of maternal and newborn deaths. Strengthening and expanding midwifery services formed the platform for the Afghanistan Ministry of Public Healths comprehensive, multi-sectoral approach that improves access to and quality of services, and supports functional health systems. As timely access to skilled care at birth is the most crucial factor for the survival of pregnant women and their newborns, significant investment is being made in the training of midwives. Much has been achieved in human capacity development within midwifery, including revising preservice curricula, developing competency-based job descriptions and updating training programs. An accreditation system for midwifery education is in place to ensure quality. The Afghan Midwives Association (AMA) has contributed to improving the enabling environment for skilled attendance at birth. These early steps in the professionalization of midwifery were bold initiatives in a country where the status of midwives was reputedly low. Sustaining long-term commitment to saving the lives of women and newborns remains a challenge and no single intervention will address the many factors affecting maternal and neonatal health. However, much can be done in post-conflict settings to reduce maternal mortality with limited investment and effective strategic interventions. Aim The following presentations will highlight and justify the key role of Afghan Midwives Association in addressing the unacceptable levels of maternal and neonatal mortality in Afghanistan. PRESENTATION Summary: Post-conflict reconstruction should adopt a pragmatic approach that engages local people and encourages the expansion of their basic rights and freedoms. Establishing a professional association for midwives is a classic example of this conceptboth in ensuring women have access to skilled care at birth, a womans basic human

right, and through supporting and advocating for midwives in their work. The concept of an independent professional association for women is relatively novel in Afghanistan and to have this effort driven by the midwives was remarkable. The process of forming an association began in June 2004 and the AMA was accepted into the ICM in 2006. This presentation will focus on the role of the AMA in establishing alliances for advocacy in Safe Motherhood and newborn health by building a network of internal and external stakeholder support. Capacity-building activities to strengthen midwives will also be considered.