A year later, on June 18, the same stadium reflected the same energy and enthusiasm. But this time, the spotlight shone on women.[break]
The scene outside the stadium mirrored a celebratory atmosphere as some 1,000 midwives from 103 countries gathered on a warm Durban winter day cheering for a common cause: The world needs more midwives.
Their voices were loud and clear, and so were their appearances as they took a five-kilometer walk along the Durban shoreline.
With their country flags swaying to the breeze from the Indian Ocean, their message echoed as they sang, “Until I Reach My Goal,” one of the many anti-Apartheid songs that have been tweaked for purposes leading to different causes.
And their goal is genuine, as these midwives from around the world work to help save lives of mothers and newborn.
From the United States to Uganda and Nigeria to Nepal, a midwife’s role remains the same, irrespective of the geographical borders that separate countries, but not the causes.
“A midwife is a midwife [in any part of the world],” said Bridget Lynch, President of the International Confederation of Midwives (ICM), in a 30-minute power-packed speech in front of some 3,000 midwives and other participants at the inauguration of the 23rd ICM Triennial Congress on June 19.
“Walking in Durban [is] declaring to the world that midwifery will no longer be invisible,” Lynch said.
And it was a moment that the world’s midwives were on the spotlight, especially Madina Rashidi from Afghanistan and Catherine Ojo from Nigeria, as they received the Midwife Award for their contributions to improving maternal and child health in their countries.
“Looking at the problems women face in my region prompted me to become a midwife,” 19-year-old Rashidi said, dressed in a traditional wear at the march, said in Urdu.
In her province of Jawzjan in rural Afghanistan, miles away from the country’s capital Kabul, lack of health services for women, she said, had been causing a lot of deaths.
To add up, there were no health professionals. Rashidi was the only woman in Shebirghan City to complete high school and was thus selected by her community to attend midwifery school.
“Since I’m from here, I thought I could just learn the skills and help my community,” she said of the two-year midwifery course she took. And it’s been two years since Rashidi has been working as a midwife.
Though ravaged by war and torn by poverty, Afghanistan has made improvements in reducing maternal mortality.
In 2002, the maternal mortality survey in the country showed alarming statistics: the maternal health ratio was 1,600 per 100,000 live births, prompting the Ministry of Public Health to bring maternal health to the forefront.
This is when, said Pashtoon Azfar, a midwife for 15 years in Afghanistan and also the founder of the Afghan Midwives Association, the country thought of strengthening midwifery.
The results are visible. From 17 midwifery programs in 2005, there are currently 32 midwifery education programs in Afghanistan’s 34 provinces.
The number of working midwives has also soared, from 467 in 2002 to 3,000 with an additional 800 in training.
“By the end of 2011, we’ll have another survey [on maternal and child health] and you’ll see the result of midwifery education,” said Azfar, who is also known as the Nightingale of Afghanistan.
Geeta Lal, coordinator of the midwives program at UNFPA, cited Afghanistan as “one of the most successful countries in midwifery.”
But as a war-torn country, it is starting everything from the scratch, making it rather easier to achieve success, whereas countries with preexisting health structures and strategies seem to be having a difficult time trying to incorporate midwives into their mainstream health sector.
In Nepal, Dr Naresh Pratap KC, Director of the Family Health Division in the Ministry of Health, said that Nepal’s health sector has a set of skilled workforce which is already delivering health services in rural areas.
“With the country’s existing financial situation, we can’t introduce new cadres [of midwives],” he said. But on a positive note, he added, “In the long run, we should be having a pilot project and include them [midwives] in the system.”
Speaking of success, the government official who was in Durban to attend the ICM Congress said Nepal is on the track and “will attain its MDG 5 goal.”
Last September, Nepal also received an MDG Award for “Improving Maternal Health”. The maternal mortality rate in Nepal stands at 281 per 100,000 live births.
The country plans to reduce the number by 134 per 100,000 live births by 2015.
But at a time when success is being scored, proponents of midwifery in Nepal are angry about the government’s position on midwifery.
Nepal does not have a legislation recognizing midwifery as an autonomous profession, nor do they hold protective titles. Also, there is no government body to regulate midwifery or licensing to practice it. Thus, Nepal has not been accepted as a member of the ICM.
Kiran Bajracharya, president of Nepal Midwifery Society of Nepal (MIDSON) and also a member of the Nepali delegation in Durban, said that the government should not be afraid to bring new policies and experiments.
“The government needs to change its attitude and take new approaches,” the Associate Professor at Tribhuvan University said.
After a policy on skilled birth attendants was passed in 2006, Nepal has produced 2,268 skilled birth attendants (SBA). However, to meet the MDGs, an additional 3,000 must be trained, Bajracharya said.
Leaders like Bajracharya and Laxmi Tamang, the latter the founder of the MIDSON, argue that SBAs can be made more efficient with additional competencies and education.
Nepal currently has a one-year midwifery program under the Institute of Medicine, which comes under the three-year staff nurse program. But they believe that a separate midwifery program is required since SBAs are only trained in limited skills while midwives give care to women from adolescence to menopause.
Thus, in order to strengthen their skills and competencies, organizations like MIDSON, along with UNFPA, are pushing and proposing for a three-year Bachelor’s course in midwifery.
A feasibility study to explore possibilities of starting a direct-level midwifery program in Nepal is in the pipeline, informed Kristina Castel, Technical Specialist on midwifery at UNFPA Nepal.
But as plans are being made, SBAs from rural parts of the country are coming to Kathmandu for advanced training in midwifery.
Sharada Chaudhary is one of them, and she is currently at the Maternity Hospital in Thapathali undergoing a two-month training program in midwifery.
“We have limited knowledge, and at times it’s difficult to deal with complications,” she said. “So if people like me and others get to learn more, they will be able to help save mothers and newborns.”
It was when Chaudhary saw a pharmacist’s wife, trained by her husband, going to houses and giving injections to women in labor and also newborns, she decided to take a stand and do something to change the situation.
“I really didn’t want this to happen,” said Chaudhary who now works in the midwestern district of Salyan.
As thousands of women are dying daily, Nikki Long, a 31-year-old recent graduate in midwifery from the University of New Mexico, said she traveled to Durban to become a “part of the [global midwifery] sisterhood.”
“Being a woman, and instead of just being angry about that [maternal deaths], I decided to do something about it,” she said of her decision to become a midwife.
And at a time when the ICM Congress is trying to push the need for midwives, developed countries like the US are cutting down on midwives.
“It’s getting a lot worse, in fact. There’s still a lot of hostility toward midwives,” said Ina May Gaskin in an interview to TIME magazine. Gaskin, a self-taught midwife, is credited to have revived the midwifery profession in the US, encouraging thousands of other women to join the league and thus establish the Midwives Alliance of North America. “If births matter, midwives matter,” she said.
In South Asia, though countries like Bangladesh and Afghanistan have showed efforts and taken initiatives, challenges of retaining and deployment of midwifery professionals still persists.
Dr Khaled Shamsul Islam, a focal person for midwifery at Bangladesh’s Ministry of Health & Family Welfare, said that since people are not really proud to serve in these positions, governments have to “create something attractive and glamorous.”
“We have to take the challenge for the betterment of the society,” he added while talking in an informal information-sharing session between the Nepali and Bangladeshi counterparts in Durban.
And about 30 minutes away from the ICM conference, issues in retaining midwives were being raised at the Prince Mshiyeni Memorial Hospital in south Durban.
Dr Ray Maharaj, Head of Maternal Health at the hospital, said that midwives need to be taught, and also a career path for them should be paved.
“There should be continuous development of staff. That’s how it works here,” he said.
The hospital currently has 123 midwives, 105 with basic skills and 18 with advanced midwifery skills, who collaboratively work with doctors and deal with 1,200 deliveries a month on average. The midwife-to-patient ratio thus stands at 1:4.
But even as it looks that progress is being made in these countries, from South Africa to South Asia, the statistics are grimly startling.
According to a report launched at the ICM Congress titled “The State of the World’s Midwifery: Delivering Health and Saving Lives,” 91% of maternal deaths occur in the 58 countries that this report focuses.
The document, a joint collaboration of 30 development organizations, proclaims that some 112,000 midwives need to be trained and deployed worldwide in these 58 countries and 350,000 globally. In this case, three in five deaths can be averted.
“[This report] is a call for action to strengthen midwifery globally, specifically address the governments of those [58] countries, calling all those governments to strengthen education, regulation and association of midwifery,” President of ICM Lynch said.
But amid all the positive energy at the ICM Congress in Durban and the enthusiasm of midwives to create a change, the truth seems to be harsh.
The State of the World’s Midwifery report states that 38 of the 58 countries will not meet their MDG 5 goals in time.
However, the success of the countries on track cannot be ignored, and certainly all of the countries are trying their best to combat maternal and child mortality and morbidity.
“We can do when we decide to work together,” Lynch said. “We’ve accomplished so much on this road to Durban.”
Related story
21st International AIDS Conference Kicks off in Durban
