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Midwives are the backbone of maternal health systems

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 and Guardian, 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 midwives in South Africa who are delivering frontline health services in the midst of the COVID-19 pandemic.

 

As the world grapples with the grave challenge being posed by the coronavirus and 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 centers, and hospital wards and in women’s homes under difficult circumstances, often risking their own lives and well-being. 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.

 

Ms. Elgonda Bekker, the President of the Society of Midwives of South Africa spoke to some of the issues that are still facing midwives, suggesting that one of the biggest challenges is that they are still not an autonomous practice and are still connected to nursing. Bekker pointed out that certain competencies required by midwives are sometimes ignored by individual managers.

 

Dr. Muna Abdullah, from UNFPA said that during times of crisis, maternal services often bear the brunt of not getting attention. However, she emphasised that "at the centre of the UNFPA’s work is to ensure that women still have access to these services during times of crises. She hailed the work of midwives and pledged to work with them to protect them during COVID-19. She also highlighted the global leadership role of UNFPA as the lead UN agency on midwifery.

 

All the discussants raised the issue that during the time of this pandemic, sexual and reproductive health rights often get lost amongst the need for other health rights. The major issue in responding to COVID-19 is that health resources get diverted to fighting the pandemic, at the expense of others. In this regard, it will mean that less resources will be allocated to midwifery services and to access to safe antenatal care.

 

Dry Mofokeng noted that the issues and challenges facing midwifery and access to sexual and reproductive rights existed before COVID-19. She pointed out seeing that the government's efficient responsiveness to issues during these times of crisis means they have the ability to provide these services.

 

Dry Melinda Suchard from the National Institute for Communicable Diseases raised the issue 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. She said there is a need to plan and arm people with the knowledge to get through the pandemic. She said having insecure midwives who do not have any knowledge will not be of help to 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 not helpful. One of the participants of the webinar commented about the need to ensure young people are heard.

 

Nothing with concern, Bekker said that the nursing council of South Africa are in charge of the regulation of midwives, however, 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.

 

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 (PPE) 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 prioritized as part of the overall health sector response to the pandemic.

 

In their 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. This will ensure that the midwives are ready to survive mothers for the next couple of 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 as well as the profession. 

 

Dr Mofokeng summed up the essence of discussions of midwives being the cornerstone of strong, resilient health systems. The webinar might have only been an hour long but it provided a number of great insights in the world of midwifery and why scaled up investments in quality midwifery care and support are central during this time of COVID-19.