1. Lessons from the field: Using a women’s empowerment model to train midwives and doctors in Afghanistan Taraneh R. Salke, MPH Family Health Alliance (FHA) info@familyhealthalliance.org http://www.familyhealthalliance.org info@familyhealthalliance.org http://www.familyhealthalliance.org The program was evaluated using a pretest/posttest of trainees’ knowledge and a clinical skills test. A significant increase in trainee knowledge (from 53 to 89%) and average score of 86% in clinical skills test was achieved. Out of 47 participants, 45 completed the Lessons Learned and Recommendations : 1) The results indicate that the training program can effectively help providers to develop a high degree of competency in clinical skills and to be able to detect and treat STIs among family planning clinic clients. 2) Education in STIs and HIV/AIDS, especially clinical skills in detection and treatment of STIs/RTIs, should be increased and incorporated into family planning training programs. It is also recommended that prescription of medication to treat the infections be standardized and closely monitored. 3) Because women are at risk of cross infection, health providers should be trained to ask if the woman with infection is in a polygamous marriage and to persuade her to encourage her co-wife/wives to seek treatment. 4) If attention is paid to trainees’ individual obstacles, trainees become more able to actively participate in the training programs. Participants will feel more engaged and their level of participation and learning is increased. Abstract Background Evaluation Conclusion Why should we use a Women’s Empowerment Model in the context of Reproductive Health? In health training programs, a focus on women’s empowerment strategies has led to favorable outcomes. Using a women’s empowerment model in health intervention programs can lead to increased communication, changing gender norms, and changes in decision-making power. By helping women health providers to recognize their sense of agency, they can become valuable, contributing members of the healthcare system. Afghan women are among the world’s most disempowered due to multiple gender-based restrictions, and decades of war and oppression. Many Afghan health providers have never received basic training in contraception and STIs. To raise their knowledge/ clinical skills, we determined that their training should employ a women’s empowerment model of teaching. In 2006, we trained 47 female midwives/doctors in five clinics in Kabul and Mazar using women’s empowerment strategies. Our objectives were to improve knowledge/clinical skills in family planning (particularly IUD insertion), to reduce infections, to enhance detection/ treatment of STIs and their approach in educating client in STIs/HIV prevention. Our empowerment strategies included: (1) role modeling by using professional Muslim women trainers from neighboring Iran, who had overcome similar constraints; (2) developing critical thinking skills by focusing on the status of Afghan women and comparing them with other women in the region; (3) encouraging individual consultations between trainers and trainees to identify and overcome hurdles in completing the program, such as obtaining husbands’ permission; (4) fostering teamwork and personal responsibility by involving trainees in solving daily problems during the program; and (5) overcoming fatalism by promoting women as agents of change and a culture of “it can be done.” The Clinical skills results measure the percentage of the necessary skills demonstrated correctly by the trainee during monitored procedures Intrauterine Device (IUD) A long-term birth control method which is an appropriate method for fertility regulation in the context of Afghanistan. Incorrect 11% Correct 89% Incorrect 47% Correct 53% program and passed both the theoretical and clinical skills evaluations, and 2 passed only the theoretical and not the clinical part. Purpose and Objectives Pre-test results Post-test results To address the high maternal mortality rate in Afghanistan by preventing unwanted pregnancies and promoting birth spacing through the expansion of family planning services, Family Health Alliance implemented the program “Clinical Family Planning and STIs, HIV/AIDS Training for Midwives & Doctors” in summer 2006. The program was implemented in five family planning Afghanistan has undergone decades of war, displacement, and famine which have devastated infrastructure and professional capacity. The healthcare system has been heavily impacted. There is a shortage of medical facilities and health professionals and the vast majority of people in Afghanistan have no access to health services. This problem falls heavily on Afghan women who have the second highest maternal mortality in the world: 1,900 deaths per 100,000 live births. Data: “Maternal Mortality 2000” report by the WHO program was evaluated using a pretest/posttest of trainees’ knowledge and a clinical skills test. A significant increase in trainee knowledge (from 53% to 89%) and average score of 86% in clinical skills test was achieved. In this presentation, we will discuss the empowerment strategies used, lessons learned and our 2007 activities. planning clinics—three in Kabul and two in Mazar e Sharief. The program recruited health professionals from Iran, where family planning programs have been highly successful, to conduct the training program. FHA trained a total of 47 female family planning service providers from more than 10 provinces and provided services to 381 women. The training included theoretical and clinical components, with an emphasis on clinical skills and IUD insertion methods. Other topics covered were infection prevention, correct use of medical instruments, detection and treatment of sexually transmitted infections, and prevention and education about HIV/AIDS.