Midwives from the five continents, donors, government representatives, UN agencies and other organizations working on maternal care (such as ourselves!) filled up the conference room today to talk about strengthening midwifery. It’s the first day of the midwife symposium in Washington DC organized by the International Confederation of Midwives and UNFPA which precedes the Women Deliver Conference on Monday.
We met with some of the participants last night, most of us were weary eyed and jet lagged, but we were all at the conference centre by 8am ready to start!
So many issues were presented and discussed, impossible to list them all out, but here are a few which stick to mind:
UN agencies support the strengthening of midwifery as a key strategy in the reduction of maternal and neo natal mortality. Someone cites that 500,000 more midwives are needed by 2015 to help reduce maternal mortality. While programmes in some countries have pushed to upscale the number of midwives trained, infrastructures and follow up haven’t necessarily followed. So in some cases it has been quantity instead of quality.
Another problem: there are no standard regulations which are followed by all countries to define the scope of work of a midwife – a midwife in one country may have very different skills and qualifications from a midwife in another country. Countries and regions have their own definition and expectation of what constitutes a midwife.
In one country there are six different types of midwives and in practice only few can actually perform a delivery. Elsewhere midwives cannot practice liberally working directly with the community as they have no legal basis to do so.
As one participant explained “How can we train midwives on injecting oxytocin after the baby is born when it’s illegal in their country for midwives to give injections?”
Listening to participants it is also clear that different regions need midwives with different additional skills… A representative from South Africa voiced clearly that HIV was a major issue for midwives there, affecting the role they played in the follow up of a pregnancy and neonatal care.
So what are the mandatory statutes of care of a midwife? What is the “core” scope of a midwife’s work? What ‘legal’ basis does this have and how is it regulated? How many medical actions should a midwife be able to perform? Does it depend on the context? All these issues are being discussed, problems shared, while a process is underway with the ICM and WHO to clearly define the “basic competencies for essential midwifery care”.
A few cries for help ring out, especially from:
Liberia – “Our midwives don’t have proper means to refer patients. In some cases they use hammocks and wheelbarrows to take the patients all the way to the hospital during an emergency”
Somaliland – “We don’t receive bilateral aid as we’re not recognized as a country, yet we only have a few hundred midwives for the whole of Somaliland! Due to the war some midwives died and others left the country.”
Democratic Republic of Congo – “We’re trying to get ourselves organized, but there is no regulatory body or any importance given to midwives and the role they should play in my country.”
Some effective strategies are also shared, such as in Uganda where mother to mother support groups are created to help them follow up the pregnancy spreading the word on midwife services available or in another case involving community leaders so that they support decisions to help refer patients on time.
However the reality on the ground is that needs are huge but the means seem meager. There is a long way to go! A phrase is repeated several times throughout the day: “We need midwives now more than ever!”
In some countries, especially where maternal mortality is high, we cannot just work on long term solutions though. What about innovations? Shorter term solutions? These are our thoughts as we close down for the day.
Fatouma and Kate