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"Several hours after giving birth at home to a healthy baby, my daughter-in-law began bleeding heavily. Remembering what I had learned in the Birth Life Saving Skills (BLiSS) lessons, I asked the traditional birth attendant to check the placenta. "What?" she replied, "I have never done this before. Why should we do this?" I told her that in the BLiSS lessons we learned that if a piece of the placenta remains in the woman?s body she would bleed a lot. We checked and found out that a piece had remained. I quickly asked [my son] for money and a car to take [my daughter-in-law] to the hospital. The doctor told us that we did a good job bringing her to the hospital since a piece of placenta was still in the uterus. At the hospital, doctors helped her and she got better and then we took her back home. We all are thankful for these lessons and are so happy that we have my daughter-in-law and my grandchild with us." " Birth Life Saving Skills participant

BLiSS update Jan 17

Since 2005, Operation Mercy, in cooperation with Afghanistan's Ministry of Public Health, has enabled thousands of Afghans to obtain invaluable practical birth lifesaving skills through a series of learner-centred, participatory lessons. Specifically directed at improving the situation for women during their child-bearing years, two thirds of those trained are women, resulting in increased pregnancy and birth-related knowledge amongst this largely illiterate group. In addition to equipping women to advocate for their own needs as well as the needs of their female family members, BLiSS also trains men, the primary decision makers in the home. With greater understanding of the needs of pregnant women and new-borns, male heads of households are more likely to make informed decisions that support the health of their family members.

Here's another person that BLiSS has helped. *The name is changed to protect her identity.

Shirin Gul* has received many good things in her life. She has given birth to many babies, which is a big blessing in Afghanistan. Because of her life experience, women from her village ask her to help when they give birth. Even though she has never received professional training as a midwife, she helps as well as she can, as there is no midwife to find in reachable time.

Shirin Gul was very excited when she received an invitation from an organization to attend training in Birth Life Saving Skills. A group of Afghan trainers travelled from the capital to a remote location, close where she lives. Shirin Gul listened carefully what was taught and watched with excitement the role plays which tell about problems and solutions. The lessons talked about exactly what she experienced in her work as traditional birth attendant: A woman who is bleeding, birth delay, cutting the cord safely, helping a baby who is not breathing, and much more.
Shirin Gul also found that she was learning new things about topics in the lesson while doing practical exercises, like acting out a role play. Shirin Gul enjoyed pretending to be a woman who is using family planning, talking to a friend who does not know about it and gets unexpectedly pregnant. She had never participated in a play like this before! She had to concentrate well as she needs to remember what to tell her pregnant friend.

While she is closely watching the other participants practicing first aid for a new-born with no breathing, her understanding of what helps in such a situation improves. Shirin Gul was first concerned that she would have difficulties learning the lessons. As Shirin Gul is illiterate, she learns best when she sees, hears and repeats. She was quite surprised when she found that she was able to learn the lessons, as they are created exactly for people like her.

Once the training week was over, she left happy with her certificate. She learned a lot of important and good things, which she will use in her work as a traditional birth attendant.

Recent developments

Currently, the BLiSS program is available in 7 of the 34 provinces of Afghanistan. We would love to equip more Afghans with these invaluable skills. Due to the political difficulties and the increased security concerns in certain regions, Operation Mercy and BLiSS partner organizations were unable to expand into unreached provinces in 2015. In addition, funding challenges were particularly acute in 2015, with much European funding redirected towards the increasing numbers of refugees arriving in Europe.

In response to these challenges, BLiSS facilitators are working more strategically in selecting areas of health education needs, and in choosing effective criteria for selecting community members. Through this approach, BLiSS will be able to annually reach 2360 households from poor and illiterate communities in need of health education, positively impacting these households with healthy pregnancy and birth skills training. This is a reduction of 70 households on our original target.

Although it has been frustrating to not be able to re-establish BLiSS and Operation Mercy in the Wakhan, it has been encouraging to see that it has been possible to re-start BLiSS activities in this area in the second half of 2015. We are still learning how best to implement this work from a distance, but the project manager has done a good job of connecting with and supporting the facilitators from far away. Although this is not a long term solution, it has been a good lesson to see how the work can be maintained for this time.

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