A coordinated effort by the United Nations Population Fund (UNFPA) along with 30 development partners, “The State of the World’s Midwifery 2011: Delivering Health Saving Lives” has become the first of its kind in the new millennium. [break]
The first report was published in 1976.
During the five-day ICM Congress that started on June 19, The Week caught up with the coordinator of The State of the World’s Midwifery Report 2011, Vincent Fauveau, to discuss on issues surrounding midwifery and also Nepal’s placement in the report.
Nepal is one of the 58 countries reviewed in this Report, and the country’s midwifery barometer stands at an alarming rate: four midwives per 1,000 live births, 345 birth complications per day with 280 in rural areas, and one in 80 women at a lifetime risk of maternal death.
Here are the excerpts:
The first report of this kind was published in 1976. Why did it take so long to come up with another one? Do you think it’s because midwives were neglected in the health equation?
Yes, indeed. With the movement of the MDGs, maternal mortality came into the limelight, which was otherwise neglected. Years after, MDG 5 is still neglected. We’ve discovered that governments haven’t invested enough in midwives and others with midwifery skills to prevent deaths of women and newborn in the developing countries.
We’re still making hypothesis on the negligence and invisibility of midwives. One of the answers is that midwives have culturally been associated with women involved in birth. They’re much more than that—they’re professionals who have full competencies, they can deliver an incredible amount of interventions that weren’t known because no one has looked at their training curricula.
Another hypothesis might apply in the Indian subcontinent [South Asia] where midwives were often from lower castes because they had to touch the placenta [also considered impure]. So they weren’t considered on the same level as other health practitioners.
Also, midwives have often been confused as mid-nurses. In many countries, you have nurse midwifery competency or diploma in nurse midwife. Among nurse midwives, not all go into midwifery.
So midwifery has sort of lost interest, and it’s only now, in the last five years, we’ve initiated a joint program that has realized the potential. This report explores what midwifery could bring to the MDG, not only MDG 5 but also 4 and 6 [children and HIV/AIDS]. We’re convinced that countries should invest more in midwives and midwifery skills.
When we talk about midwives, we’re talking about separate sets of cadres. Do you think it would create some conflict among doctors/nurses and midwives?
We’ve to face one reality that doctors don’t usually work in small health centers and villages.
They are deployed to bigger hospitals or private sectors while midwives are totally deployed where they are needed.
It’s also less expensive to train a midwife. It’s a three-year program, as opposed to years of study for a doctor.
To realize the potential of midwives, it also is an economic potential. Their competencies are worthy in the investment.
Midwives have a number of lifesaving functions that she should be authorized by the doctors and councils to perform in order to save lives.
But she also needs to partner with doctors when the level of complication is too high, and when she realizes she can’t deal it by herself.
She should also have constant interaction with doctors concerned and be supervised in some cases.
Coming to Nepal, when the government says the country is progressing without midwives, do you still think that the government should invest in midwives?
I still believe that governments should invest in midwives because the progresses we’re observing in Nepal isn’t so much due to the health services than to the development of the country—education, awareness in women, communication, urbanization.
But particularly in a country like Nepal, with so many rural and inaccessible populations, these women are still under very high mortality and newborn mortality dangers.
If officials consider the findings of the survey by rural versus urban, and by poor versus rich, they will see that the poor and rural people still have unacceptably high maternal mortality, and it’s for these people the government should invest in midwives.
In Nepal’s context, what, according to you, is a significant finding in the Report though that the country has stood out as compared to other countries?
You look at the data for Nepal. The proportion of women attended by skilled birth personnel is 19% of all births. Do you think it’s acceptable that in Nepal, still 70% of women deliver without any assistance? That’s what’s striking in Nepal.
Even though the graph shows that there’s a satisfactory decrease in maternal mortality, I believe that’s due to the two richest quintile of the population—well-off people make a difference in the maternal morality.
But the two poorest quintile of the population aren’t making any difference. And this is a question of equity, human rights, and this is what the government should consider.
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