I spent most of September in Pakistan, facilitating the midterm evaluation of our Chitral Child Survival Program. The first half of the project focused, primarily, on recruiting and training a group of 30 women to become community midwives. They were recently deployed into their home communities in July of this year, so this field visit was the first opportunity to observe their work as active midwives.

These women are truly remarkable. Most joined the midwifery program with a relatively basic level of education, and are now functioning as quality skilled providers, equipped to save lives in some of the most remote areas of northern Pakistan.

One of the midwives, Zainab, was particularly impressive. I remember meeting her several times during her training in the first Midwifery School in Chitral, developed by the project in partnership with the local government. She was a strong student. Compelled to learn how to save lives while making a living for her new family, she excelled in her studies and graduated at the top of her class.

I recognized her immediately as she ran up the hill to meet us. She was out of breath and apologized for being late—she had just delivered a healthy boy. This was her third delivery since July in a community of only 800 people. I was impressed by her confidence and commitment to her profession. As a certified midwife, Zainab can earn a good living through her midwifery services (approximately $19 for a ‘normal’ delivery). She has already purchased a white doctor coat with the funds earned from her first delivery and plans to purchase new equipment and medicine once she builds up her practice.

As part of the midterm evaluation, I asked Zainab to introduce me to one of the families who used her services for delivery. She knew just the person, who happened to live around the corner from our meeting spot. I had to walk carefully as we made our way down the steep cliff to meet Zeba who eagerly welcomed us into her home to tell her story.

Zeba sought out Zainab’s services when she was pregnant with her fifth child. She knew Zainab received quality training from the Aga Khan Health Services, so was confident she would provide good care. Plus, this was much more affordable. In the past, Zeba would spend at least Rs 5,000 (US $57) just to reach a health center, before having to pay for the delivery and medicine.

Zeba had progressed through labor well until discovering that her new baby was a girl. Then she started to panic. The disappointment and stress of not delivering a son was so severe that she began to hemorrhage—one of the leading causes of maternal death worldwide. Zainab quickly administered oxytocin (a lifesaving drug not previously available in these areas), which saved the mother’s life.

Zeba has come to terms with having five daughters, but the stigma is still severe. Nevertheless, Zeba desires to become a better mother and appreciates the health lessons she’s learned from Zainab. Zeba even stopped using cow dung as a local pamper since she learned it can cause infection. The mother and her baby girl are now both healthy and the mother is using the money she saved from not having to travel to the facility to pay for her oldest daughter’s education.

My trip to Pakistan was filled with stories like Zainab’s. I observed firsthand how these new community midwives are improving the health of their own communities with innovative, community-based solutions.

Andrea Wilson was the Health Program Officer at AKF USA. Chitral Child Survival Program (CCSP) is an initiative of the Aga Khan Foundation and the Aga Khan Health Service, Pakistan (AKHS,P) and made possible by the generous support of the American people through the United States Agency for International Development.