Why the world needs more midwives

May 5th marks the International Day of the Midwife, and here at Merlin we’re championing midwives working in some of the world’s toughest places.

In the UK we take it for granted that expectant mothers are guided through pregnancy with the help of a midwife. To give birth without a midwife present would be unthinkable, yet each year 48 million women give birth without the support of a trained midwife, and over 2.4 million of those women give birth utterly alone.

This tragically results in hundreds of thousands of women in developing countries dying from preventable causes related to pregnancy and childbirth; millions more suffer from infection and disability. More than 800, 000 newborn babies die during child birth, with over 3 million dying before they are even one month old. The majority of these lives could be saved by a skilled birth attendant.

Simply providing skilled care before, during and after childbirth can reduce the rate of maternal mortality and save the lives of newborn babies and infants. The difference one trained midwife can make, even with basic equipment is enormous. Midwives are vital, they save lives.

However many countries where Merlin works are facing a chronic shortage of midwives.

In Afghanistan, there is 1 trained midwife per 20,000 people. One guaranteed way to stem the needless loss of life we’re seeing in countries like Afghanistan is to increase the number of trained midwives in that country.

In Afghanistan, we have established a successful Community Midwife Education programme, which trains women in rural communities to be a midwife, on the basis that they will return to and help the women in their communities.

A similar programme is currently set up in Liberia. The Zwedru Midwifery Training School is helping provide Liberia with a new generation of community midwives through its free 2-year, full-time course.

These new midwives in Afghanistan and Liberia will go on to provide pregnant women in isolated rural communities with vital and life saving medical care. Midwives need more than just training to be successful – in the Democratic Republic of Congo, we also provide the community midwives with wages, supplies and communication to help them continue saving lives.

There are no quick solutions to reducing maternal mortality. We need to ensure that midwives on the ground in crisis countries get the support they need and thousands more are trained, in order to save lives. For this year’s International Day of the Midwife, help Merlin train and support more midwives and help save lives.

This Saturday, May 5, is International Day of the Midwife. It’s the prefect opportunity to acknowledge the vital work that midwives do around the world each and every day.

Catherine, who works at a special care baby unit in Nigeria, gives an insight into one day in her life in this video:

Performing miracles

Even in the most difficult circumstances, midwives everywhere are performing miracles to support safe deliveries and ensure that babies have the best start in life.

The world needs more midwives and governments need to do more to ensure that midwives everywhere are supported to do their jobs effectively.

Read our report Missing Midwives to learn more about the global shortage and the actions needed to address it.

British midwives help to Build it for Babies

This week I had the opportunity to meet up with a group of British midwives who are supporting our Build it for Babies campaign to raise funds for seven health clinics in Bangladesh.

It was impossible not to be impressed and inspired by the enthusiasm and commitment that each of the women had for providing the best possible care to mums and babies. Our discussion confirmed my assumption that being generally lovely must be part of a midwife’s job description.

Supporting midwives abroad

Watch our slideshow of midwives at work across the world

What was even more amazing was to hear that not only do the midwives do an amazing job delivering babies in the UK, but many of them are also volunteering their time to train and support midwives in other countries too.

They talked about the contrast in the midwifery services available in the UK with those available in countries like Bangladesh, Sierra Leone, Liberia and Ethiopia.

For many women in these countries only the most basic care is available at what can be the most dangerous time in the life of a mother and her newborn baby.

Missing midwives

There’s a global shortage of at least 350,000 midwives and this means that many women and babies die from complications that could be easily prevented by a health worker with the right midwifery skills, equipment and support.

By supporting our Build it for Babies campaign you can help ensure that seven new maternal health clinics in the north east of Bangladesh are fully staffed.

By doing so, you’ll help more than 3,500 newborn babies each year survive their first crucial weeks of life.

You can also show your support for #midwives and other #healthworkers on May 5 (and every day!) through your social media channels.

Visit our virtual clinic to buy anything from a stethoscope to a midwife’s salary for our Build it for Babies appeal

Je salue le courage et l’abnégation de nos vaillantes sage femmes qui oeuvrent inlassablement certaines au risque de leur vie, pour le renforcement du système de santé en prodiguant des soins de qualité aux femmes et aux enfants.
je profite de votre tribune pour réitérer mon engagement ferme à défendre le noble métier de l’ensemble des professionnels de la santé en général et de celui de la sage femme en particulier en prélude à la célébration de la journée mondiale de la sage femme.
Au Niger, nombreuse sont – elles qui sans relâche contibuent contre vent et marée à soulager la souffrance de la femmes nigériennes et des enfants en situation de détresse faute de soins spécialisés.
Notons, un accent particulier doit être mis sur la formation des sages femmes, et en guise de rappel cela cette problématique a été évoqueé au 2ème forum mondial sur les ressources humaines tenu à Bangkok (Thailande) dont j’ai eu la chance de prendre part. Entre autres la motivation et la retention des agents de santé a fait l’objet de débatS.
En ce qui concerne le Niger, des efforts sont faits dans ce sens, notamment le rehaussement du saliare des tous les agents de santé, le recrutement important de sage femme, médecins et autres professionnles de santé. Cette volonté de poursuivre les efforts, afin de motivé davantage le personnel constitue un point fort pour l’atteinte des objectifs du millénaire pour le développement dans nos pays en voie de développement. Il s’agit là d’un bon exemple à suivre… pour que vive la santé.

Boubacar Thiombiano
Directeur des Ressources Humaines
Enseignant permanent à l’Ecole Nationale de Santé Publique.

“The mediocre teacher tells, the good teacher explains, the superior teacher demonstrates and the great teacher inspires.”  Midwifery education is no different from any other subject in that the quality of instruction impacts the quality of service delivery.  In the Middle East and North Africa, there are many obstacles that must be overcome to improve the midwifery education system.  One such obstacle is an updated and regulated midwifery education system.

In most Arab States midwives face challenges similar to those in many other countries: low status of women, gender issues, and being subjected to nurse and/or doctor and employer abuse or conflict. The lack of a distinctive representative body or having one that is not structured or credible has led to an undefined role for midwives in society. Moreover, in the absence of enabling legislation and practice regulation or formal recognition and support for midwives, young girls (and their families) are reluctant to pursue an education or career in midwifery.¹

In the midwifery education systems of the Middle East and North Africa, the “great teacher who inspires” is absent. In fact, the midwifery education systems are mainly training oriented and prioritize the “doing” domain of learning and memorization.  One might compare this to culinary training which consists of learning the recipes from a cookbook instead of culinary education which prepares one for writing a cookbook with new ingredients.²  Although midwifery education programmes have to be competency-based and so mostly training oriented, the concept of competence itself has to be updated to include those skills which make a midwife proficient in adjusting or adapting to a specific situation.The midwifery education system should produce competent midwives whose services meet a woman’s sexual and reproductive health needs and rights on one side, changing priorities within the health system on the other side in addition to the professional guidelines of the midwifery profession.  The education system should also ensure a minimum level of cultural sensitivity and adaptability to the needs of specific populations.Here we come to the need for a balance between these two types of education – training through memorization and repetition of behaviors and education in critical thinking and adaptability -so that midwives can develop critical thinking while continuing to develop clinical skills.

This approach has been implemented in Djibouti (with the support of EMRO, 2004-2005), in Tunisia (with the support of UNFPA-Tunis, 2008) and in Yemen (with the support of the World Bank, 2010) where the midwifery education programme and a national midwifery strategy have been updated and developed respectively. The tools developed by ICM can help facilitate and strengthen efforts to improve midwifery education and service delivery and “The State of the World’s Midwifery Report”, published by UNFPA in 2011, is another outstanding resource that deserves the attention of all stakeholders interested in improving women and newborns health.   It is important that not only other countries in the Middle East and North Africa but also countries in Europe, Asia and other areas of the world assess the number and working conditions of midwives as well as the education system that trains them so that the services provided to childbearing women can be improved.

Join ICM and WRA in celebrating and showing support for midwives and the work that they do!  Click here to learn more about WRA’s Action of the Month, “Midwives Matter”, and what you can do to show your support for midwives on the International Day of the Midwife, May 5^th.

References:

1. Ghérissi A., Brown J.M., El Adawy M. Midwifery in North Africa and the Middle East Background Paper. The State of the World’s Midwifery Report. UNFPA, 2011  http://www.unfpa.org/sowmy/resources/docs/background_papers/23_GherissiBrownElAdawy_MidwiferyNorthAfricaMiddleEast.PDF

2. Adonyi Y. Understanding Differences Between Welding Education and Training. 2012 http://letu.academia.edu/YoniAdonyi/Papers/145858/Understanding_Differences_between_Welding_Education_and_Training.

On May 5^th, people all over the world celebrate the difference
midwives make in saving the lives of mothers and babies.  International Day of
the Midwife is about spreading awareness of the need for midwives and the impact
they have on maternal and child health. It is also about advocating for
government commitments to improve maternal and neonatal health by raising the
number of midwives, and increasing funding and legislative support for
midwifery.  These efforts are not just a means to advance a professional
occupation, but are an opportunity to advance the status of girls and women
everywhere and have a positive impact on the lives of everyone in their
communities.

350,000 women and 3 million neonates die each year as a result of mostly
preventable circumstances.  Ninety-nine percent of maternal deaths occur in
developing countries and sixty percent of these maternal deaths happen in only 6
countries: India, Nigeria, Pakistan, Afghanistan, Ethiopia and the Democratic
Republic of Congo.

Every woman, everywhere, should have the right to a safe childbirth
experience.  This includes the right to deliver where, with whom, and how she
wants.  Whether a woman wants to give birth in a hospital, health facility, or
at home, she should have access to skilled care during, before and after
childbirth.  But inequities of qualified care continue to exist throughout the
world, in both developed and developing countries.  In many countries, midwifery
services are underfunded because of budget cuts and as a result of market-driven
policies.  Other countries have not yet made the decision to provide any funding
for midwifery services.

And yet midwives are key to achieving the reduction of maternal and neonatal
mortality and morbidity called for MDGs 4 and 5.  There is a shortage of 350,000
midwives globally.  If this shortage was addressed, more than one million babies
each year could be saved.  With more educated, competent midwives working in a
regulated system and the legislation to back it up, a huge difference can be
made in the lives of mothers, children and the families with whom they are
connected.

But governments need to do their utmost to support this system by supporting
midwifery education, legislation and regulation of the midwifery profession.  In
places where governments have already made commitments to improving the status
and number of midwives, such as in Malaysia, Sri Lanka and Thailand, we find
proof that by supporting midwives there is a reduction of maternal and child
mortality and morbidity and society as a whole is supported.

The International Confederation of Midwives has established global standards
on the education, competencies, and regulation of the midwifery profession as a
guide for governments and associations (available here).
These standards make it easier to educate midwives, ensuring that individuals
seeking care from midwives receive competent treatment and inspiring confidence
in the midwifery profession as a career choice.

On the International Day of the Midwife, we demonstrate our commitment to
supporting midwives with mothers, colleagues and partners worldwide.  The White
Ribbon Alliance for Safe Motherhood and the International Confederation of
Midwives are natural partners in the fight to improve the number, status and
working conditions of midwives around the world for the benefit of mothers and
babies and their families.

Join us in asking for governments and individuals to celebrate midwives:
Download the ICM’s resource packet to learn what you can do to celebrate IDM or click here to learn more about WRA’s Action of the Month: Midwives Matter.

The size of the nursing-midwifery school classes in Tanzania is rapidly shrinking, and the shortage of midwives is felt throughout the country. According to the 2010 Tanzania Demographic Health Survey, only half of births in Tanzania are attended by skilled health personnel. For every 100,000 births in Tanzania, almost 800 women die needlessly in child birth. Most of these are avoidable with access to care and skilled health workers.

The White Ribbon Alliance in Tanzania (WRATZ) is working hard to reduce maternal mortality and to bring the issue of the shortage of midwives to the forefront of the political agenda. As part of this work, WRATZ is working to promote midwifery as a profession and to improve the status and working conditions of midwives. This includes working to improve the public perception of midwives and the need for improved working conditions.  An example of these efforts is a short film, “What I Want Is Simple“, which is airing on Tanzania national television and radio spots.

Recently, with the financial support of the Health Policy Project, WRATZ organized a public hearing on this issue. Those in the audience were asked if they would choose nursing and midwifery as a career for their children. Of the one thousand people in attendance, only thirteen raised their hands in approval, which led to an in-depth discussion on the subject. Among other findings, it was revealed that students were hesitant to apply to midwifery schools due to the bad timing of acceptance letters. They had to make an enrollment decision for all the other schools a long time before the midwifery schools finalized their acceptance process.

Armed with this knowledge, civil society can now advocate with the Ministry of Health and Social Welfare and the Ministry of Education and Vocational Training of Tanzania for the necessary changes and timing adjustments to be made so that more students will be encouraged to join the depleting cadre of midwives.

We have seen demand increasing in countries with some of the worst maternal mortality statics, but there are still many inequities between rich and poor and urban and rural areas. For example in Nigeria, among the richest of women in the country, more than one in four women uses family planning methods. It’s a number that’s not as nearly as high as it should be. However, it’s a marked improvement from the poorest women in the country where less than 3 percent use contraception.

So what needs to happen? Clearly, more must be done to reach women in rural areas and to increase demand in places where women don’t even know about family planning methods. It is also important to focus on girls and young women, who are more at risk of losing their lives in childbirth – yet simultaneously much less able to reach family planning services.

It is health workers, most often midwives, who are responsible for overcoming these barriers, by  providing education, advising on reproductive health, and distributing services to those most in need. Health workers can be most effective in this effort if they are well trained, equipped and supported as part of a well-functioning health system, and it is vital that renewed efforts on Family Planning take this in to consideration.

A recent study we’ve seen from the Oxford Journal on Afghanistan (one of the worst places in the world to be a mother) shows that increasing access family planning cut maternal mortality by a third – and that was without access to emergency care during childbirth. If that can be done in Afghanistan, imagine what a difference well supported midwives, along with increased access to education and contraception for women, as part of a functioning health system could make around the world

What can you do to help change this? Visit http://www.whiteribbonalliance.org

The White Ribbon Alliance envisions a world with a sufficient number of health workers, particularly midwives, that are better supported to ensure skilled maternity care for all women and their newborns. In order to achieve this key advocacy objective, WRA supports national level campaigns in persuading decision makers to take specific national actions to improve the numbers, distribution, working conditions and competency of health workers, with a specific focus on midwives.

In preparation for the International Day of the Midwife (May 5th), WRA is partnering with the International Confederation of Midwives to mobilize constituents and support advocacy efforts promoting midwifery as a profession and calling for more midwives, better supported.

Join Us!

Help us advocate for more midwives!

Plan and organize an event in preparation for the International Day of the Midwife: Download the resource packet.

Email WRA your plans for IDM or share your advocacy success.

Successful advocacy often happens when the same issue can be raised at different levels of decision making.  Recently, I was in Bangladesh and spent time with VSO partner the Health Rights Movement Bangladesh (HRMB). I was able to see an example of this joined up work at different levels.

At a national level, HRMB lobbies for an increase in the recruitment of health workers and improvements in the terms and conditions so that nurses, midwives and others stay in the profession.  However, the biggest problem is the unequal distribution of health workers in rural and urban areas.

“Trying to get doctors to stay in rural areas is like trying to make a river flow upstream,” Nitai Kanti Das, of HRMB told me.  However HRMB have achieved some successes: “After some research with health workers, we made a recommendation to the ministry… if health workers stay three years in a rural placement, then the state will pay for further education”. The Ministry of Health has put this in action.

At the same time I was meeting HRMB in their hot dusty office downtown, the Bangladesh Prime Minister, Sheikh Hasina, was at the UN General Assembly in New York. She was asking for the release of US$40 billion pledged by donors last year at a session of ‘Every Woman, Every Child’ chaired by UN secretary general Ban Ki-Moon.

Sheikh Hasina also announced a new midwifery course as part of the national health programme. One hundred midwives have already been trained under the programme and by 2015 the government aims to have 3,000 newly trained midwives.

It’s now the role of civil society activists such as Health Rights Movement Bangladesh to hold the Government to account for progress on this programme.

By Steve Lewis: VSO International

Travelling around Cambodia to talk to health workers for the Valuing Health Workers research, I was often puzzled at how each hospital or health centre had communicated the research and our presence, to their staff.

When we arrived at the first hospital, we were met with surprise and also a hint of trepidation – it was interpreted to me that the staff weren’t expecting us. I looked at my colleague expressing silent surprise; remembering the previous meeting we had with the hospital director, arranging the day and time.

However, the director kindly accommodated us into his working day and we were sent off to find people to talk to. When we finally got a small group of nurses together, I explained the purpose of the research and that everything they told us would be anonymous and confidential.

When the group of nurses started to talk about their day-to-day working lives, the low and late disbursement of their salaries, the lack of equipment and drugs and how they had worked without electricity, we soon forgot about our sweaty backs, lack of sleep and the 11-hour journey to get there.

Travelling to our second health site – a large health centre in the same province – an extraordinarily unexpected bit of organising had taken place and we were greeted by about 30 health staff, awaiting my ‘presentation’. So much for voluntary participation in the research!

Having explained to staff that we wanted to hear their views, we asked people to split into smaller groups based on their gender and professional cadre. We asked health workers: “what motivates you and keeps you going, day to day?”

The midwives told us how good it feels to deliver a baby safely and how happy they are when they save someone’s life. My own personal favourite though was the group of male nurses who said a “caring profession” was the ultimate way to woo potential songsas [girlfriends]. Not sure how we’ll translate that one into government policy.

Read our Valuing Health Workers in Cambodia report.