Midwives, "the Frontline and Backbone of Maternal Health," Face Difficult Working Environments

Our coverage of the Women Deliver 2013 conference continues–with a Storify featuring highlights from the second and third days  of the conference, this guest post by Sandeep Bathala of the Wilson Center.

Midwives play a critical but unheralded role in maternal health. Their skills are sometimes marginalized in otherwise well-meaning discussions about professionalizing care, and, as was discussed at the Wilson Center earlier this month, they often work in conditions that undermine their ability to provide high quality, respectful maternity care. So when I found the room overflowing at Wednesday’s Women Deliver session, Midwives: Empowerment, Respect, and Quality, I took that as a good sign that midwives will not be overlooked much longer. Here are some highlights from the session:

“Midwives are the frontline and backbone” of maternal health, said Pat Brodie of the Papua New Guinea Maternal and Child Health Initiative and WHO Collaborating Center for Nursing, Midwifery, and Health Development. But, she pointed out, recruitment of midwives has failed to keep pace with need, in part because so many positions carry non-existent or low salaries, few incentives for success, little time off, and lack professional training opportunities.

Gajananda Prakash Bhandari, Program Director at the Nepal Public Health Foundation  described how some issues such as the risks of walking long distances at night, or a lack of support husbands and mother-in-laws who prefer women stay close to their families can discourage women from becoming midwives. Bhandari noted that in places where midwives have higher job satisfaction and feel secure, there are notable increase in their use, which means healthier mothers and children. He proposed scaling up new community-based security committees to address concerns about the safety risks of traveling at night, noting that this could also protect midwives from abusive family members of pregnant women.

Afghanistan is one of the least secure places in the world to be a midwife, and it has one of the world’s highest maternal mortality ratios. However, as Pashtoon Azfar, a regional midwife adviser for the International Confederation of Midwives (ICM), pointed out, this was not always the case. In the 1950s, female members of the Afghan royal family were midwives and teachers of midwives, exemplifying the respect for midwifery at the time.  In fact, as Azfar said, the literal translation of “midwife” in the local language is “competent.” But, more than three decades of war took a severe toll on the country’s health system and under Taliban rule, women were denied access to education, and, as a result, there was an extreme shortage in female health providers, including midwives. As a result, maternal mortality skyrocketed: in the 1990s, the maternal mortality ratio was estimated to be 1,300 maternal deaths per 100,000 live births. As Azfar pointed out, there have been major changes that Afghanistan in the past decade, particularly the revitalization of midwifery that has been part of health systems strengthening efforts, including an effort by USAID and Jphiego to advance midwifery. “Engagement of women in this profession has led to some level of political and social empowerment,” said Azfar. “However, still there is a long way to go.” For instance, the program is still addressing challenges related to policy development, selection criteria, recruitment, education, deployment, and supervision of midwives. But, there are clear positive effects already: participating midwives have reported increased self-confidence and economic benefits for themselves and their families, as well as a new ability to leave their homes, and midwifery has a bigger presence at the policy level.

For more on this week’s news and events on midwifery, read UNFPA Deputy Executive Director Kate Gilmore’s op-ed, “Midwives do more than just deliver babies in The Hindu, check out coverage of the Second Global Symposium on Midwifery from UNFPA, the ICM, or follow the discussion on Twitter at #midwivesmatter, #midwives, as well as coverage of Women Deliver at #WDlive and #WD2013.