PURPOSE:
To examine how regulatory gaps and the growth of private sector midwifery education have shaped the midwifery workforce in Afghanistan (2001–2024), and to explore the implications for maternal and newborn healthcare quality and professional standards.

DISCUSSION:
Since 2001, Afghanistan’s midwifery profession has expanded significantly through public direct entry competency-based midwifery Diploma and one Degree programs1-2. In response to high market demand, private sector institutions also grew rapidly, making midwifery the largest female professional workforce in the country1-3. However, regulatory oversight has not kept pace with this expansion. The Afghanistan Midwifery and Nursing Council (AMNC), which received its formal decree in 20184, faced major technical and financial constraints, further exacerbated by international sanctions and restrictions on women’s participation in leadership and governance. As a result, AMNC remains an underdeveloped regulatory body, limiting its ability to ensure quality education and monitor professional practice. This regulatory gap has contributed to widespread variation in educational quality, including adequate clinical practice and graduate competence, especially in the private sector. Thousands of midwives with inconsistent competency levels now fill workforce gaps, raising concerns about maternal and newborn health care quality and safety. A lack of reliable national data further hampers workforce planning and quality assurance.

EVIDENCE WHERE RELEVANT:
Feminist Marxist theory shows how control over women’s labor and knowledge, including in health professions (like midwifery) maintains structural power imbalances and limits professional autonomy5 6. In fragile contexts like Afghanistan, strengthening midwifery regulation is essential: global evidence demonstrates that high-quality midwifery care can significantly reduce maternal and newborn mortality7.

KEY MESSAGE:
Strengthening midwifery regulation and education in fragile settings is essential to building a competent workforce to meet global SRMNAH needs. Without strong regulation, fragmented private education undermines care quality and public trust. Addressing these gaps is critical to achieving “One Million More Midwives,” and advancing SDG 3 and SDG 5. Regulation - implementation 1