Afghan midwives: A lifeline for rural communities

In Badakhshan, a rural province in northeastern Afghanistan, rugged mountains and harsh winters shape daily life. For many families, reaching healthcare is not as simple as traveling to the nearest clinic. Distance, difficult terrain, and harsh weather can turn a routine visit into a long and challenging journey. As a result, many pregnant women lack access to essential maternal healthcare. Antenatal care coverage remains low, and many births take place at home, often without the assistance of a trained health worker.

Extending Healthcare Beyond Health Facilities

In Argo district, distance is measured not only in kilometers but also in time, cost, and terrain. Some villages can take hours to reach by road, while others are accessible only on foot or by donkey. In winter, snow and poor road conditions make journeys even harder. 

The consequences can be significant for both women and their children. For pregnant women, these barriers can make it difficult to access antenatal care, skilled birth attendance, and other critical health services. Across Afghanistan, only one in four women receives the recommended four or more antenatal care visits, while an estimated 1.27 million pregnant and breastfeeding women are expected to suffer acute malnutrition in 2027 (IPC, 2026). Afghanistan ranks seventh globally for maternal mortality, with preventable complications during pregnancy and childbirth continuing to claim the lives of women across the country (World Bank, 2023).

To help bridge this gap, Action Against Hunger has introduced mobile outreach services linked to its existing health facilities. Supported by the UK Foreign, Commonwealth and Development Office under the DAWAM project, outreach midwives travel directly to remote villages, providing maternal healthcare, nutrition screening, family planning services and referrals closer to where women live.

Rakia: The Daily Reality of Rural Midwives

For Rakia, an experienced outreach midwife, reaching Yaran Sha village is no easy task. The narrow, uneven mountain road is difficult to navigate, even by vehicle. Yet despite the challenging journey, Rakia and her team spend the day caring for patients in a small room adjoining the local mosque.

By midday, more than 50 women and children gather there, waiting their turn. Sitting on the floor with a medical kit beside her, Rakia moves from one patient to the next. Some women have come for pregnancy check-ups, others for nutrition screening, family planning services, or health advice.

Yaran Sha is one of several villages of Argo district she visits on a rotating schedule linked to the Ghozuk Dara Sub-Health Centre. Each day, she works from a different mosque, bringing basic healthcare services closer to women who might otherwise struggle to access them. Since the outreach activities began in August, the number of women attending has increased steadily. 

“At first, we informed people about the services,” she explains. “Now women are telling each other about them.” 

Among the women waiting to see Rakia is Zargul*, who is around eight months pregnant with her second child. Her first pregnancy ended in miscarriage after three months, leaving her anxious about possible complications.

Earlier in her pregnancy, she traveled with her husband to Faizabad, the provincial capital, to see a private doctor. For many women, seeking care outside the village requires a male relative to accompany them, adding transport costs and often costing the family a day’s income. Attending an outreach session in her own village is therefore a far more accessible option.

During the consultation, Rakia screens Zargul for malnutrition by measuring her mid-upper arm circumference (MUAC). A MUAC below 23 cm in pregnant women is associated with a higher risk of acute undernutrition and low birth weight. At 22 cm, Zargul’s result indicates that she is at nutritional risk and requires follow-up and support. Rakia provides supplements, discusses nutrition during pregnancy, and refers her to the Ghozuk Dara Sub-Health Centre for further follow-up. 

As the consultations continue, Rakia moves between different concerns and different patients. Since the outreach activities began, she has identified numerous cases of malnutrition among pregnant women and young children, referring those who need additional care to the Sub-Health Center. 

The consultations are brief, but for many women they provide a rare opportunity to speak with a qualified health professional without having to leave their community.

Tamana: Meeting women where they are 

A few hours away, in the Aq Kotal area of Argo district, midwife Tamana is providing the same service. Like Rakia, she spends her days traveling between villages and seeing patients in local mosques. The women who come to her consultations face many of the same challenges accessing healthcare, particularly during pregnancy. 

Among them is Fazela*, who is five months pregnant with her third child. Earlier in her pregnancy, she experienced stomach and kidney pain and traveled two hours by donkey to reach the Aq Kotal Sub-Health Centre. Her husband accompanied her, meaning he had to forgo a day’s work. The consultation helped, and she received treatment and nutritional supplements. But as her pregnancy advanced, repeating such a journey became increasingly challenging. Now, the midwife comes to her village instead. 

“I’m very happy that the midwife is here,” she says. “It is difficult for me to make the journey to the health centre, and I cannot afford private healthcare. Now that she is coming to our village, I plan to come every month so she can follow my pregnancy.” 

Midwives’ consultations cover far more than pregnancy follow-up. One woman receives counseling on tetanus and diphtheria vaccination and is referred to the health centre to complete her immunization schedule. Others come seeking family planning services, nutritional supplements, or guidance on caring for their children’s health.

Back in Yaran Sha, the line of women waiting to see Rakia is still stretching across the room. Mothers holding young children wait alongside pregnant women coming for a check-up or advice. Rakia continues working through the queue, one consultation after another. Tomorrow, she will do the same in another village.

Prevention and Continuity of Care

For some women, a health facility is within reach. For others, getting there may mean paying for costly transport, arranging for a male relative to accompany them, and spending several hours on the road. Bringing a midwife directly into the community helps remove some of those barriers and makes it easier for women to seek care when they need it. 

Since the outreach activities started in August 2026, over 400 women have received medical and nutritional support through mobile outreach visits conducted by midwives in rural areas of Badakhshan.

The outreach visits are not intended to replace the health centers. Women who need additional treatment, vaccinations, or follow-up care can still be referred to the nearest facility. But in a district like Argo, where villages are scattered across the mountains, and some journeys can take hours, healthcare cannot always be delivered in the same way everywhere.

*Names have been changed to protect the privacy of community members