Midwives are the backbone of maternal health systems

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This year May 5 marked International Day of the Midwife, celebrated under the theme “Midwives — Celebrate, Demonstrate, Mobilise, Unite”. To mark the day, the Mail & Guardian, and the United Nations Population Fund (UNFPA), in collaboration with the Commission for Gender Equality (CGE), held a free live webinar on May 8. The webinar was titled “A Tribute to Midwives — amid Covid-19 and beyond”. It was held to celebrate the midwives in South Africa who are delivering frontline health services in the midst of the pandemic.

As the world grapples with the grave challenge posed by the Coronavirus that is sweeping the world, women continue to get pregnant, and babies are still being born.  Midwives as the primary caregivers are working tirelessly in communities, health centres, hospital wards and in homes under difficult circumstances, often risking their own lives and wellbeing. In her opening words, Dr Tlaleng Mofokeng, a commissioner at the Commission for Gender Equality, acknowledged midwives as the backbone of healthy families, communities and health systems.

Traditionally, midwives have played a vital role in responding to pandemics. With national health systems in many countries totally overwhelmed, midwives are demonstrating their courage and resilience by continuing to support childbearing women in the toughest of circumstances.

President of the Society of Midwives of South Africa Elgonda Bekker spoke about some of the issues that midwives face. She said that one of the biggest challenges is that theirs is still not an autonomous practice; it is still connected to nursing. Bekker pointed out that certain competencies required by midwives are sometimes ignored by individual managers.

Dr Melinda Suchard, head of the Centre for Vaccines and Immunology at the National Institute for Communicable Diseases and Elgonda Bekker, president of the Society of Midwives of South Africa
Dr Melinda Suchard, head of the Centre for Vaccines and Immunology at the National Institute for Communicable Diseases and Elgonda Bekker, president of the Society of Midwives of South Africa

Dr Muna Abdullah, a health systems specialist at UNFPA, said that during times of crisis, maternal services often receive inadequate attention. One of UNFPA’s central roles is to ensure that women still have access to these services in times of crisis. She hailed the work of midwives and pledged to work with them to protect them during the Covid-19 pandemic. She also highlighted the global leadership role of UNFPA as the leading UN agency on midwifery.

Several participants raised the issue that in the present crisis, sexual and reproductive health rights are getting lost; the major issue is that health resources are being diverted to fighting the pandemic, at the expense of others. Too few resources are being allocated to midwifery services and for access to safe antenatal care.

Mofokeng noted that these issues existed before Covid-19. She pointed out that the government’s efficient responses to Covid-19 issues during these times of crisis means they have the ability to provide these services when the crisis is over.

Dr Melinda Suchard, head of the centre for vaccines and immunology at the National Institute for Communicable Diseases said that the virus is not going anywhere, and that this poses an occupational risk for midwives. She said that even as South Africa works to flatten the curve, this just means promulgating the curve. There is a need to plan and arm people with the knowledge to get through the pandemic: having insecure midwives who do not sufficient knowledge won’t help anyone.

Even in times of relative normality, young people’s voices are often ignored or silenced. However, during this pandemic, there is an even greater need to ensure the young people are listened to when it comes to sexual and reproductive health rights. Abdullah said in her work with the UNFPA she has found that young people are vocal that the policies put in place by older people are often not helpful.

Bekker said that the nursing council of South Africa is in charge of the regulation of midwives, but since the lockdown the council has been closed, which means that many final-year midwifery students are being left in limbo regarding their future. “If the midwifery students do not complete their course and graduate, this may well mean a shortage in the midwifery sector in 2020. This could have very serious consequences for ensuring that there is adequate access to sexual and reproductive rights from all South African women.”

Dr Manu Abdullah, health systems specialist, United Nations Populations Fund
Dr Manu Abdullah, health systems specialist, United Nations Populations Fund

It was mentioned during the discussions that in many countries hit hard by the Covid-19 crisis, midwives are dying due to lack of personal protective equipment and overall lack of support. Midwives in many health facilities are being redeployed to respond to the virus, and this leaves women without access to life-saving, time-critical services. Maternal and newborn health must be prioritised as part of the overall health sector response to the pandemic.

In her closing remarks, Suchard said that midwives need to have access to information and become more knowledgeable, as this would help to ensure that they do the best job in providing care, while Abdullah said midwives need to make sure that all their supplies are ready for the next few months. Bekker said there needs to be a strengthening of agency for midwives and mothers. The profession not being recognised as autonomous does not help the work being done. She said agency needs to be given back to the women who work as midwives. Mofokeng said that midwives are the cornerstone of strong, resilient health systems. The webinar might have only been an hour long, but it provided a number of great insights into the world of midwifery, and why scaled up investments in quality midwifery support are central during the Covid-19 crisis.

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