The Midwife and the Nation

My experience of midwifery encompasses both personal and professional lives.  First, like many Ugandans, I carry the ‘Maternal-Related’ experiences of my family and friends; good and tragic.  Secondly, I am privileged to be among the community of practitioners and educators of midwives in Uganda.  Therefore, when I was invited to speak at the International Day of the Midwife that took place at Ntare Senior Secondary School in Mbarara, Uganda, last year, I wanted to blend the stories that are familiar to me and the professional group that strives, every day, often under impossible conditions, to bring life safely into the world.  Midwives shape the story of a nation.  We ought to remember that!

For many of us, when we talk about maternal life, we remember not the hundreds of babies who are safely born every second around the world.  We cite, by heart, the number of women and newborns who will die in the next eleven seconds (UNICEF, 2017).  Or the more than eight hundred (800) who will die in a day due to pregnancy and childbirth-related complications, the majority of which are preventable.  These data translate into personal stories of tragedy.  This is the story of my beautiful cousin Betty.  A young, vibrant, brilliant mathematician, and a beloved mother of four (2018). It is the story of my beautiful niece, and, her little one (2018); the story of my sister-in-law and her little one (2006); and also, the story of my mother and her little one (1982), all of whom did not survive complications related to childbirth. I am sure you have your own story.

The maternal tragedy is not the story of one.  It is our collective story.  It is the story of the poor, members of parliament, of ministers and presidents.  It is the story of your sister, wife, mother, aunt, and grandmother.  It is the story of a nation.  And we so easily forget, that for every tragedy, there are millions of women and children who survive pregnancy and childbirth every day.  I am one of them. So are you.

Midwives have always been at the heart of the nations’ maternal story and they tirelessly shape it for better or for worse.  In Uganda, midwives oversee more than 2,000,000 babies who are born every year.  That is more than five thousand and five hundred (5,500) babies every day.  And yet, as crucial as midwives are, a gap of eight hundred and eighty-three (883) midwife positions in Health Center Twos (HC IIs) alone, exists countrywide (UNFPA, 2019). There are seven midwives per 1000 live births.  This means that a single midwife oversees more than 500 deliveries a year (more than twice the 175 recommended deliveries by the WHO), often under challenging circumstances and less than ideal conditions.  These data ought to keep us awake.  The WHO (2013) notes that midwives are “warriors on the front-line… battling to ensure that women survive childbirth and that babies are born safely even in the most marginalized areas”.  We know that access to skilled midwives/attendants mitigates child-birth related complications by up to 88% (State of the World Midwifery, 2014). That is an impressive figure.  And yet, corresponding investment in their education (including in-service training); regulation & resources, practice & work-place conditions have remained largely lacking.  

I often ask my students: why are you comfortable with this story?  Why don’t we have enough midwives?  We have and can (as a country) invest in a workforce that can effectively shape and change our maternal and child related story for the better.  Why aren’t we all rushing in? 

It seems to me, that beyond rhetoric, we have grown accustomed to these data.  And once a year, we enjoy the scheduled reminder of why and how midwives are important.  We make big speeches.  We march.  The media will throw in a story or two.  The President may even recognize and award a midwife or several.  One day is not an inconvenience.  Until next year.  

Frankly, this is simply not enough.  And it is a bit of a puzzle.  A critical gap exists between our occasional celebration of the midwife and our consistency in investment in the core areas that would significantly elevate the capacity of the midwives to continue to deliver on their outstanding promise: to bring life safely into the world.  

If we want our children, sisters, wives, mothers, aunties, and grandchildren et cetera., to be featured differently in the nation's maternal and child related data, we need to rush in.  A colleague recently said: that change, important change, means that we are evolving as individuals from: “thermometers who gauge the temperature of the room, to thermostats who set the temperature of the room!” Fellow Ugandan’s, here is this years’ challenge: What will you do as an individual to change and shape the story of the Midwife and the Nation? What and how will you invest?

We would like to hear about it.

Dr. Rose Clarke Nanyonga is the Vice-Chancellor at Clarke International University.

This article was originally posted by The National Health Care Conferences (NHCC)

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