Midwives key for maternal health

Lazarus Sauti

“Every birth is a natural birth: each of us is part of nature, not separate from it, and nature is always stunning in its variety. Your birth, then, is part of the natural world, however it unfolds,” Lauralyn Curtis, certified childcare educator, shares with the world.

Although birth is a natural process, as noted by Curtis, it is fraught with danger.

Dr Edwin Gamba Muguti, Zimbabwean healthcare practitioner, says that a myriad of complications can occur which can result in stillbirth and severe injury and deformity of the baby.

Mothers, he said, can suffer various injuries or even die whilst giving life.

Dr Muguti added: “Overseeing, monitoring and intervening in this process is the midwife who may be a specialised nurse or a specialist doctor otherwise called Obstetrician.

“The availability of competent midwives is, therefore, of paramount importance to countries within and across the Southern African Development Community (SADC) as it can reduce 80 to 90 per cent of maternal deaths.”

Sadly, in most SADC member-states, there is still a critical shortage of midwives, and this has severely hindered the region’s chances of meeting Millennium Development Goal 5, which seeks to reduce maternal mortality by three-quarters this year while also improving the ratio of pregnancies attended by skilled health workers.

The Southern African Network of Nurses and Midwives (Sannam) – a network of nurses and midwives of the SADC region, which was formed in 2002 – concurs:

“There is an acute shortage of midwives which is threatening Southern Africa’s capability to achieve the Millennium Development Goals number 4 (to reduce child mortality) and 5 (reducing maternal mortality and achieving universal access to reproductive health).

Sannam added, “The shortage of skilled and competent midwives also results in women and their newborns dying from the complications that can simply be prevented by a midwife with the necessary skills, the right equipment as well as the right support.”

African Medical and Research Foundation (Amref) Health Africa – Africa’s leading health development organisation, bringing good quality health care closer to those who need it most, also said like many African countries, SADC member-states have a shortage of midwives, both in numbers and competencies.

“The sad reality is that African mothers are dying because they are unable to get the health care they need.

“The problem is that there are not enough trained midwives to provide the care needed,” noted Amref Health Africa, adding that many women in African countries travel long distances, by foot or on the back of a bicycle, to reach a midwife.

As a result, added Amref, too many women do not make it in time, leading to their death or the death of their baby.

Amref also noted that the majority of midwives serving on the continent only received basic training and require upgrading or further training in order to meet global standards for midwifery.

The shortage of midwives in Southern Africa is also fueled by brain drain – a cancer seriously affecting most developing nations of the world.

“Due to poor working conditions in most countries in Southern Africa, most midwives cross the borders to Botswana, South Africa and other western countries to seek for greener pastures,” added Dr Muguti.

The World Health Organisation – a specialised agency of the United Nations (UN) that is concerned with international published health – agreed: “In most developing countries, midwives are often at the bottom of the ladder of the health system.

“Because of this and other serious reasons, the region is losing huge numbers of trained midwives.”

Accordingly, strategies and strong systems must be put in place to stem challenges affecting midwives and stalling development in the regional grouping.

The Amref Health Africa said: “Government sectors need to give midwives due recognition and spare no effort to ensure that their needs are met.

“If the needs of this profession are met, the needs of the nation will also be met.”

It also said that more research on the benefit that midwives provide will also be critical to improving midwifery.

“Research is a cornerstone to development, and African countries must promote research in midwifery so as to save citizens,” noted Amref Health Africa.

Dr Muguti also urged research and development institutions to collaborate with national, regional, continental as well as international researchers to improve practices in midwifery.

“Collaboration is the key to high quality research. Midwifery institutions in the region must, therefore, constantly seek to make links with midwife researchers so as to improve practices, and enhance social and economic development,” he explained.

Dr Muguti said in most African countries, traditional birth attendants play a vital role in improving maternal health; therefore, government sectors must recognise and support them.’

“As traditional birth attendants play an important role in improving maternal health in most, if not all, African communities, government sectors together with development partners should be duty bound to ensure activities and professional calling of traditional birth attendants are supported,” he said.

Significantly, the United Nations Population Fund (UNPF) – the world’s largest international source of funding for population and reproductive health programmes – and Amref Health Africa urged governments to invest in midwifery training.

“One trained midwife can look after up to 500 mothers every year, and safely deliver 100 children. See the life-saving difference midwives can make.

“Consequently, government sectors and stakeholders in the health fraternity must invest in education and training of midwives to increase access to quality health services as well as to reduce needless deaths of mothers and their newborn children,” affirmed the UNPF and Amref.

Policy decision makers in the SADC region must also scale up education and training of midwives by increasing physical space, regional and national budgets for recruitment, deployment and retention of midwives in rural areas over and above strengthening midwifery regulatory bodies and associations to ensure that issues affecting this important cadre are addressed and their continuous professional development is institutionalised.

Frankly, midwives are a pillar of reproductive health programmes; therefore, it is crucial for regional governments and all stakeholders to propagate and support their role in the health systems.