Job losses induce midwife crisis

‘We knew what the impact was going to be,” says Pretoria-based birth doula Sithabile Shobowale, recalling the announcement of the lockdown from March 26. 

Her voice is hoarse and is muffled by the hiss of static on the phone. She spent the morning home schooling her children and says she has been talking “too much”.

Doulas give nonmedical emotional and physical assistance during and after childbirth.

When the lockdown was announced, doula work — a field dominated by women — was considered nonessential, which effectively cut them off from their clients. 

“We felt the impact immediately.  Hospitals basically went into lockdown and didn’t allow for non-essential workers. And we are considered as ‘non-essential’,” says Shobowale.


As the Covid-19 pandemic rages on, research shows that its effect on women has been far-reaching. It has knocked their incomes, but increased the burden of unpaid childcare on them. Gender-based violence has intensified and the lockdown threatens to isolate women from their usual support systems.

Sithabile Shobowale.

The Covid-19 outbreak left doulas scrambling to ensure their clients were not left in the lurch. Under level 5 of the lockdown, home visits were prohibited and now, under level 3, many hospitals still don’t allow companions during birth. 

Doulas adapted to the new way of doing things. But the lockdown has made eking out a living in an already unsung profession even more difficult.

Like many others, Shobowale went digital. “Some support is better than none,” she says. “It is not ideal. But that was the only way, especially at the beginning of the lockdown. 

“Everyone was really scared about risking their own health and that of their clients. So the beginning was quite rocky.”

Shobowale is the cofounder of OoMamma, a platform that offers antenatal and postpartum support. Since the lockdown, OoMamma has held “virtual nurture circles” that connect mothers and childbirth practitioners.

Hiring a doula may not be as common in South Africa as it is in other parts of the world, but they provide a service that has existed for thousands of years. 

The word “doula” comes from ancient Greek, meaning “a woman who serves”. But the word’s contemporary use is linked to the natural birth movement that gained traction in the 1960s in the United States.

“In the period just after birth, all the focus is on the baby. And, as a mom, you’re also just worrying about your baby. Nobody’s worrying about you,” Shobowale says. “So your diet slips. You don’t sleep well … and you could also suffer from postpartum depression.”

This is where a doula comes in. In 2016, the World Health Organisation (WHO) recommended women have companions with them throughout labour, citing evidence that continuous support improves childbirth. The days and weeks after childbirth are also critical in the lives of mothers and newborn babies and also requires support, according to the WHO.

Tertia Alkema.

The Covid-19 pandemic has put mainstream support systems in jeopardy. The National Income Dynamics Coronavirus Rapid Mobile Survey released earlier this month found that 16% of the mothers and pregnant women surveyed at the end of June reported having last visited a hospital or a clinic in April or earlier. And 37% of the mothers cited Covid-19 fears as the reason they did not seek out care.

The report estimates that the pandemic has resulted in a 56% decrease in healthcare visits by mothers.

The same survey gave the troubling revelation that women also bore the brunt of the pandemic’s harsh economic effect. 

Of the estimated three million jobs lost during the first month of the lockdown, two million were those of women. Among those still working, women experienced a greater decline in the average number of weekly hours worked than men.

This is in line with global trends. According to a study by the International Labour Organisation, sectors that are dominated by women — including domestic and service work — have been hardest hit by the pandemic.

“Previous crises have shown that when women lose their jobs, their engagement in unpaid care work increases, and that when jobs are scarce, women are often denied job opportunities available to men,” the study reads.

“The bigger their losses in employment during the lockdown phase and the greater the scarcity of jobs in the aftermath of the Covid-19 crisis, the harder it will be for women’s employment to recover. This crisis therefore threatens to nullify women’s gains in the labour market.”

Shobowale says the doulas have already felt the effects of mothers having less disposable income. Some medical aid schemes pay for their services. But, according to Statistics South Africa, only 16.4% of South Africans are covered by a medical aid.

“It makes the pool a lot smaller, because not everyone has medical aid,” Shobowale says. “So people have to budget for a doula.”

Tertia Alkema, who has been a doula for 12 years, says her income has been cut by two thirds because of the lockdown.

“A doula has to do a lot of things in person, because it’s a hands-on profession. We do massaging and help with pressure points. We help with pain relief, get the baby in a good position and help with progress,” she says. “And just being in the room brings some kind of peace and trust. So it’s been challenging doing all that online. And not everyone wants to do that … We’ve managed, but it’s not been the best.”

Alkema has been able to do home births. She says the lockdown has been lonely for some mothers, especially single parents without family nearby. “Imagine you’re a single mom and you have to be on your own. I mean, it’s unthinkable … So it makes for a lot of lonely people.”

Soweto-based doula Mapule Seakamela says she chose to go into the profession because she wanted to create a peaceful birthing experience. 

She says the lockdown has been tough, but adds: “I can’t focus on the difficulties. Instead I try to find ways to always be encouraging.”

Seakamela says if people really understood the role the doulas play in childbirth, they would be considered essential. Through her training, she discovered the difference having a companion at birth can have on the experience. 

“It made me truly understand how special that connection with a doula is. They are always reflecting positivity, encouragement and strength onto the mother, letting them know that they’ve got this. They can do it.” 

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Sarah Smit
Sarah Smit
Sarah Smit is a general news reporter at the Mail & Guardian. She covers topics relating to labour, corruption and the law.

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