Midwives: for a better tomorrow

The world celebrates the International Day of the MidWife on 5th May to champion the lifesaving work of midwives.  This year the theme is “Midwives: for a better tomorrow”!

This theme has special implication this year as 2015 is the target year of the Millennium Development Goals (MDGs).  Bangladesh has made remarkable progress toward achieving Millennium Development Goal Five – Improved Maternal Health. From a maternal mortality ratio (MMR) of 322/100,000 in 2001 to 170/100,000 in 2014.

Antenatal care (ANC) also increased, with 63.9% of pregnant women having at least one ANC visit, against the country minimum standard of four visits. Deliveries by  skilled birth attendants remain low at 42.1%.

Much still remains to be done; overall socio-economic development, increasing education and empowerment of women, and the declining fertility rate were significant drivers behind the reductions seen in maternal mortality to date.  The Nation now needs a fresh, new approach to accelerate further reductions in preventable maternal and newborn deaths: Midwifery offers an affordable solution, from a physician-led care to a Midwifery-led maternal and newborn Care.

A Midwife is a person who has successfully completed a midwifery education  programme that is recognised in the country where it is located and that is based on the International Confederation of Midwives (ICM) Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery. The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum  period, to conduct births on the midwife’s own responsibility and to provide care for the  newborn and the infant. This care includes preventative measures, the promotion of normal birth, the detection of complications in mother and child, providing essential medical care or other appropriate assistance. The Midwife knows how to diagnose and manage non-surgical emergencies in pregnant mothers and newborns, and most importantly, when to refer to the ObGy Specialist Doctor.  The midwife has an important task in health counselling and education, not only for the woman, but also within the family and the community. This work should involve antenatal education and preparation for parenthood and may extend to women’s health, sexual or reproductive health and child care. The State of the World’s Midwifery (SoWMy 2014) report has identified women having access to midwifery-led care as critical to reaching target goals in all reproductive health areas. 

UNFPA works closely with the government, civil society and other stakeholders including professional bodies to intensify the efforts to improve maternal and newborn health. The Honorable prime Minister, as part of the UN Secretary-General’s “Every Women Every Child” Initiative, committed to ensuring availability of skilled attendance through scaling-up midwifery education and creating 3000 new midwifery posts. UNFPA applauds the Government’s for the recent creation of the promised 3,000 Midwifery posts, and the establishment of Midwifery three-year diploma courses in 31 Medical and Nursing colleges through the Country.  More midwives will be needed to meet the needs UNFPA is supporting the Government  to run two  programs for the education of midwives: (a) A six month certificate course in midwifery for existing  Nurse-Midwives, was launched as an interim programme in August 2010 to upgrade them to meet International Confederation of Midwives’ (ICM) standards. Currently, 1289 nurse midwives received training and working with their functional designation as Certified Midwives at the facility level. An additional 120 nurses are currently being trained (b) Since 2013, a landmark initiative in Bangladesh: a three year direct-entry diploma midwifery program.   There are 2025 students (03 batch in three years) receiving training from 31 nursing institutions. At the end of 2015, 500 students will graduate as Midwive and deployed to some Upazilla Health Complexes (UHC) to provide 24/7 midwifery-led maternal care.

In this vein, efforts by BRAC, currently offering Midwifery training in seven concern universities are a welcome contribution. Both UNFPA and BRAC count with generous financial contributions from dedicated donors such as Canada, Sweden and DFID, to make Midwifery a reality.

In coming years, a more deliberate investment is needed to ensure all health facilities assigned with ANC, delivery, and PNC tasks provide quality 24/7 midwifery services.

Some aspects will need particular attention:

a) Quality of training: starting from a skilled faculty, an internationally recognized curriculum, teaching aids and other resource materials, a conducive learning environment including student dormitories, and enough pre-service practicum on

b) Health Workforce Strategy: recruitment, deployment, retention, development and compensation;

c) Legal/Policy: the Midwifery Act and professional regulation has been developed  and submitted for appreciation and approval by Parliament, to protect the public’s rights and safeguard midwives. Midwifery Association.

d) Institutionalization of Midwifery-led Maternal and Newborn Care to minimize C- section rates, decrease pregnancy related complications and morbidity, such as obstetric fistula, and increase child survival.

e) Community information and awareness raising to the competencies and role of the Midwives CAN contribute significantly to the improvement of maternal and neonatal care in Bangladesh by developing:

- partnership with women to promote self-care and health of mothers, infants, and

- respect for human dignity and for women as persons with full human rights;

- advocacy for women so that their voices are heard;

- cultural sensitivity, including working with women and health care providers to overcome those cultural practices that harm women and babies;

-A focus on health promotion and disease prevention that views pregnancy as a normal life event.

On this 5 May 2015, International Day of Midwives, UNFPA salutes all midwives and  students in training who have chosen the most noble profession in the World: Help bring a New Life to the World in a dignified manner for both Mother and Baby.

By: the UNFPA Team in Bangladesh