The most vulnerable countries are often the most deprived when it comes to the issue of maternity and birth control. Indeed, too many women and men still do not know how to approach motherhood and enable women to give birth in decent health and hygiene conditions, and there are still too many women dying in childbirth, or neonatal deaths. According to the United Nations Population Fund (UNFPA), pregnancy-related complications are the leading cause of death for girls aged 15-19 years, and an estimated one million women each year suffer life-threatening complications during pregnancy.
However, one profession plays a key role in improving maternity conditions for these women and in preventing risks among the population: midwives. Midwives are the cornerstone of the fight against child mortality and for better conditions of access to care and information for pregnant women, and are at the heart of the 2016-2030 global strategy for the health of women, children and adolescents.
Thanks to midwives, many women see their health improve during pregnancy, and more and more births are carried to term in more appropriate sanitary conditions. All international organisations agree on this point: the midwife profession is the guarantor of better maternity and birth conditions throughout the world, and the World Health Organisation (WHO) estimates that by 2030, 9 million more midwives will be needed to enable women throughout the world to live their maternity properly.
However, midwives face multiple challenges in achieving their goals and gaining public support for their cause. Training, access to remote areas and the weight of beliefs are part of their daily lives – Difficulties that do not seem to discourage them, on the contrary. Here is a brief overview of this situation on three different continents, in India, Guatemala and Liberia.
Training at the heart of the system
That’s where it all starts: midwives who are trained and who have the means and knowledge to keep up to date and help the women that need them. Training in this profession is therefore essential in countries where reducing infant mortality is a real challenge for society. The Indian organisation Society of Midwives-India (SOMI) travels around the country to raise awareness among midwives, train them and enable them to keep track of developments in medical progress and innovation in this field. Every year in India, 35,000 women die in childbirth and there are still 272,000 stillbirths. The Indian government has also decided to accelerate the training and access to knowledge of midwives through the implementation of public policies. In particular, the government plans to create 85,000 additional midwifery positions, of which there are already 900,000 in the country.
In Liberia, 44% of women give birth at home and one in 138 deliveries results in death. Moreover, there are only 200 trained midwives for every 4 million people in the country. Liberia therefore decided to put the training of midwives at the heart of its government action, with the aim of reducing the infant mortality rate and the number of deaths in childbirth by 50% by 2023. In this context, the Liberian Ministry of Health has launched a partnership with the WHO and UNFPA to set up intensive training programmes for midwives. In addition, in 2018, Seed Global Health launched an initiative to strengthen midwifery education through the Clinical Nurse Specialist (CNS). The aim is to strengthen their technical skills, their understanding of the issues and risks associated with motherhood and how they can support women in the country. Other associations, such as Maternal & Child Health Advocacy International (MCAI), also offer training to develop skills in neonatal care and obstetric anaesthesia.
Midwives are the cornerstone of the fight against child mortality and for better conditions of access to care and information for pregnant women, and are at the heart of the 2016-2030 global strategy for the health of women, children and adolescents.
In Guatemala, between 88 and 153 women die in childbirth for every 100,000 births, and the country’s indigenous populations face twice as many maternal risks. The indigenous people – the Maya – make up 40% of the country’s total population and live mostly in rural areas. Most women give birth at home. Taking these specificities into account, UNFPA has set up training programmes for midwives to enable them to better understand how to handle maternity and birth issues and to raise public awareness in these rural areas. Local associations also play an important role in the training of midwives, such as the Corazon del Agua association, which has set up the first diploma course for midwives, also accessible to indigenous women.
The challenge of rural areas
Once trained, midwives face another obstacle, that of rural areas. Many women are cut off from any dispensary or hospital, and are not always familiar with the basics of health care. In Liberia, women who give birth at home, far from a medical system, often live in rural areas, and some of them do not know about the importance of midwifery. In addition, many villages are often difficult to access, and the country’s infrastructure does not allow midwives to move simply and quickly to these areas. The Liberia Midwife Association is one such organisation that helps midwives reach remote areas; particularly in the hinterland, and to raise awareness among the population and women directly, so that they understand why midwives have a key role to play in their pregnancies, their knowledge of birth issues, and the good health of their future children.
In India, women in rural areas have the least access to knowledge about pregnancy, contraception, births, etc., and have little or no access to services such as family planning. Many of them also never had the opportunity to attend school. UNICEF, the Government and several local associations are working to reduce the lack of knowledge and access to care for these women, especially those living in tribes, where the weight of traditions and beliefs can be an additional obstacle. For example, women can benefit from treatment based on food supplements, they are also made aware of the importance of health services and the role of midwives during pregnancy, or of the importance of eating properly, of not pursuing a too difficult professional activity that would put the pregnancy or the woman at risk. Midwives also help women learn and understand basic hygiene rules, such as washing their hands regularly to limit the risk of infection.
Indigenous women in Guatemala, in addition to living in remote areas, also face a language barrier, which prevents them from accessing information and advice from, for example, the Ministry of Health. The Maya and Guatemalans also have cultures and traditions that diverge in some places, which can lead to misunderstanding or even an inability to agree on issues such as motherhood and birth rates. Ninety per cent of births to be attended by midwives take place in these rural areas. It is therefore crucial to also have indigenous midwives who are able to take into account local traditions to facilitate understanding and communication on these vital issues.
That is what some local organisations are doing, such as one formed by midwives in the region of Concepcion Chiquirichapa. They created a natural medicine centre where Mayan women can give birth and be monitored during pregnancy. This type of structure therefore reassures these women who feel more confident and able to entrust their health and maternity to midwives attached to their community – examples of adaptation to be followed to improve access to care for pregnant women around the world.
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