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Women’s Empowerment in Afghanistan
Carl Taylor, MD, DrPH, MPH
Johns Hopkins University
Section A
Bamyan Valley
Divided Groups
Photo from Future Generations. www.future.org. Used with permission.
4
A Bombed-Out School
Photo from Future Generations. www.future.org. Used with permission.
5
Meeting
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6
Class of Village Midwives
Photo from Future Generations. www.future.org. Used with permission.
7
Clearing the Road
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8
Water System
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9
Started Future Generations Afghanistan
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Ghazni: mosque-based schools for literacy
Women’s education gap for whole generation
Three years later had 400 schools with 12,000 girls and young
women
2002 Bamyan: ex-Mujahedin formed pagals (crazy) association
-  Crazy enough to think you can help your neighborhood
Reforestation
-  Planted 150,000 poplars and willows in one season
-  Counted survivors; half had been eaten by wandering donkeys
Organized system for fines on any wandering domestic animals
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Central Theme
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The Future Generations 2005–2006 Operation Research project
demonstrated a successful model of CHW training that is
community-based and participatory
Changes in health practices showed almost complete coverage of
families in these villages
More important, the changes in behavior and social norms were
associated with locally adapted efforts to measure women’s
empowerment
The change process shows it is not just what is done, but more
important is how the change happened
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Women Village Volunteers
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A functional analysis of the potential capacity of village women
volunteers defined three groups who can contribute to communitybased care:
-  Shuras selected one mature and active women’s leader per
village to become CHWs (especially mothers-in-law)
-  Woman Action Groups are composed of mothers with young
children—who are the busiest of all but are motivated and able
cover all families in the village
-  Community statisticians—young, usually unmarried, and eager
to use newly acquired literacy and numeracy
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First Intervention: Women-Only Workshops
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Five, five-day workshops train twenty or more CHWs—covering all
topics in official training manual
Meet in secluded village house
-  Cooking and eating together
-  Sanitary and clean living (personal and home)
Acute care
-  Child diarrhea, pneumonia, malnutrition
Prevention
-  Immunizations, government programs, and referrals to facilities
when greater expertise is needed
Learning to communicate with neighbors, changing beliefs,
practices, and women’s empowerment
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Second Intervention: Pregnancy Histories
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Five women tell personal pregnancy stories for first four mornings in
the first five-day workshop
They bond as they share pregnancy stories and jointly realize
successes in raising families
Learning schedule is based on own experiences, priorities,
community practices, and culture
Intensive, continuing discussions according to season and real-life
experiences
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Third Interventions: Women’s Action Groups
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Each CHW organizes up to 10 neighborhood leaders of age cohort of
women with young children as a Women’s Action Group (WAG), who
work intensively with five or more families
Total village coverage with each CHW responsible for 50 or more
families, focused especially on most needy
Cascade learning from what CHW learns to WAG
Monthly meetings (depending on season); always working with shura
on annual work plans and iterative learning
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Fourth Intervention: Community Statisticians
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Third age cohort is young, literate, and eager women
Primary function is to ensure community’s ownership of its own
statistics for annual work plans
-  This ensures quality and completeness of data
Selective channeling of data to HMIS and district health system;
linkages to health facilities by community health supervisor at
health center
Potential being explored for vital statistics, selective surveillance
systems, and possible service statistics
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Fifth Intervention: Scaling Up Using Learning Centers
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Regional cluster of best performing villages linked into BPHS health
system with joint shura control
Transformation of cluster of villages into regional learning center as
responsibility of district governments and partner NGO with two
functions:
1. Action learning: CHW master trainers facilitate learning with
educational credibility because they still do health
development work in their own community
2. Experimentation: local experts trained to adapt to local
culture/needs for improved local solutions with guidance from
formal health system
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Midwives, Village Volunteers in Reproductive Health
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Health center midwives responsible for linkage between health
facilities and communities through community health supervisors
Every village has a community statistician (CS) who is responsible
for collecting data from the village CHWs
-  Each CHW focuses on:
  Early identification and preventive care of pregnancies
  Planning with shura for safe delivery
Community statisticians ensure:
-  Birth and death reports
-  Antenatal and postnatal visits
-  Immunization of children
-  Surveillance for special diseases with complete records reported
through community health supervisor (CHS) visiting from health
center
Trust created by comprehensive care leads to follow-up for possible
referral according to specific needs in each pregnancy
18
Women Only
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19
Skepticism?
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20
Cooking and Eating Together
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Children Involved
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22
Community Statistician
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23
Reviewing Documents
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24
Break into Groups
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25
Swaddled Baby
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Exhaustion
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27
Giving Presentations
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Practice Cutting Umbilical Cord
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