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Improving Midwifery Services in Tajikistan
– Reported, May 24, 2013
When midwives are educated, empowered, and informed of essential basic life-saving skills, they can avert the vast majority of maternal deaths. But in Tajikistan where two-thirds of the population reside in rural areas, there are only 4,000 midwives in the country to provide care to a population of 7 million.
The Government of Tajikistan has taken several steps to reduce maternal and infant deaths by adopting national and international legislative acts on maternal and reproductive health in compliance with the Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) and the Convention on the Rights of the Child (CRC). The Government, with UNFPA support, has also recently developed national strategies on reproductive health, safe motherhood, and family planning. Even though these strategies and many related measures have been approved, challenges to maternal health in the country remain significant.
Although the health status has improved for many people, there are still too many women in the region who cannot afford and access quality reproductive health care. There are women who die giving birth and young people who cannot access basic reproductive health services, said Thea Fierens, UNFPA Regional Director for Eastern Europe and Central Asia. Urgent action is needed to prevent the further growth of health disparities, she said.
Early bleeding is the most common cause of maternal deaths in Tajikistan. Due to interventions taken by the Ministry of Health, including the development of national standards for effective prenatal care, maternal deaths caused by early bleeding have significantly decreased.
In Tajikistan, the quality of midwifery services remains a challenge. Medical training facilities report problems including lack training materials, limited teaching equipment and scarce accommodation for out-of-town students. Public health facilities outside of urban areas have poor physical infrastructure; the overwhelming majority of rural health facilities in Tajikistan do not have access to sanitation facilities or clean water sources.
Although the recruitment of young specialists, including midwives into educational training programmes related to maternal health is not difficult, after the completion of compulsory service, retention is a problem due to low-paying salaries. Upon completion of training, there is no standard certification or licensing of midwives in the country which compromises the quality of midwifery services and overall maternal health care.
UNFPA in Tajikistan closely cooperates with the Ministry of Health and supports capacity strengthening of reproductive health workers, including midwives, through continuing education, capacity building and supply of medical equipment.
In Tajikistan, UNFPA implements the Beyond the Numbers Initiative of the World Health Organization which not only monitors maternal deaths but seeks to improve understanding of why they happened and how they can be averted. UNFPA supports the training of doctors and midwives on effective perinatal care at the at all levels of the health system. An advanced WHO training of trainers on Managing problems in Perinatal Care is also supported by UNFPA.
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