May 5 was this year’s International Day of the Midwife. To commemorate this day in Nigeria, The Wellbeing Foundation Africa, UNFPA, the United Nations Population Fund and The National Association of Nigerian Nurses and Midwives (NANNM) hosted the first Global Midwifery Conference in Nigeria on May 4th and 5th. With Nigeria accounting for the second largest number of maternal and child deaths in the world, there is still so much work to be done.
The Conference was an opportunity for midwives and nurses to update their midwifery knowledge and skills, recognising the importance of key practice areas that contribute towards saving lives. The audience, especially the student midwives of the FCT School of Midwifery, Gwagwalada, were given the opportunity to discuss their priorities with policy makers and key officials, with the aim of informing the political platform.
Your Nigeria Health Watch Team summarises the five big issues that were discussed at the Conference:
- We must train more midwives: Midwives are so critical to the development of the health sector, and we are just not training enough and we are not doing enough to keep up the skills of those that we have trained. “There are 98 schools of midwifery in Nigeria at the moment and 3500 midwives are graduated annually,” Mrs. Alheri Yusuf, Deputy Registrar at the Nursing and Midwifery Council of Nigeria said. However, the system is not efficient enough to employ them, despite the obvious need. Recruitment and retention is an ongoing challenge. The Minister of Health who was represented by a Director of Human Resource Management, Mrs Didi Watson Jack, said there are plans by government to guarantee availability of at least one PHC in each of the 10,000 wards in the country, which would lead to employment of more midwives. If something is not done urgently about the employment situation of these midwives, there will be no reduction in the high rate of maternal and child mortality in Nigeria. Without midwives, women & newborn babies will continue to die needlessly from complications at birth.
- We must scale up the role of long-acting reversible contraceptives (LARC): Nigeria’s population is growing at an unsustainable rate. Many women who want to plan their families just do not have access to the commodities. Mrs. Nike, the UNFPA representative, who started the session said that less than 10% of PHCs in Nigeria had the capacity to deliver long-acting reversible contraceptives. While this is changing, we are still very far off from the target of 36% by 2016. There is some good news – a new policy was passed at the National Council of Health earlier this year approving task shifting so a broader selection of staff can be trained to deliver services. This is a profound change in Nigeria as in doing so, we have responded to the needs, not focused on the egos, of healthcare professionals. The reality is that many areas don’t have access to nurses, so limiting the access to facilities with highly skilled staff was never going to be sustainable. This policy change has had a profound impact on the ability of the country to deliver on contraceptives. The only chance we have in turning the Nigerian health sector around will be to use the full skills of all healthcare professionals. Professor Emmanuel Otolorin, who was on the panel, informed the audience about how his team was leading in building capacity in this regard across the country.
- Mothers are often afraid of midwives. The image of the midwife in Nigeria is scary. They are generally loud and very assertive. This is the way it has always been – but it does not have to be anymore. This was the cry of Kate Anolue’s talk at the conference. She narrated her experience of counselling pregnant women in Nigeria, and the reaction that she got. Many women wanted to come again… but unfortunately she is based in the United Kingdom (UK). Antenatal classes are a rarity in Nigeria. Another midwife who also works in the UK told of her experience coming back home to volunteer. Coincidentally, her key message was also on the need for more empathy from midwives – calling it “women-centred care”, she said, “everyone needs a caring midwife.”
- The role of midwives in the campaign to End Female Genital Mutilation (FGM) in Nigeria: Nigeria is estimated to account for approximately 15% of all women who have suffered FGM worldwide – the most of any country. Although the Nigerian Government had earlier in 2015 outlawed FGM, there is still so much work to be done by the government, the people and of course, midwives, as laws and policies alone will not end this barbaric act. The role of midwives in ending FGM cannot be overemphasised. FGM is a deeply rooted cultural practice and many midwives face social pressure from their communities to perform it. FGM Consultant, Dr. Comfort Momoh, stressed the need to strengthen midwives’ capacity on FGM prevention and care, in order to empower them to resist such pressure. As frontline health workers, they have exclusive knowledge about the practices within the community they serve. By serving as role models, counsellors and advocates, midwives can contribute to the elimination of this practice.
- Importance of Personal Health Records (PHRs): Dr. Alero Roberts of The University of Lagos started her session by sharing a story of Sharifah, a woman who was in labour at a local clinic and, due to complications, had to be transferred to a comprehensive clinic in the next town. The receiving nurse took a history – it was painfully short of details as no one knew her past medical history. Sharifah was the quintessential ‘unbooked case’ as not much could be done for her.She said it could all have been so different if Sharifah had been given a Personal Health Record. It was then the audience understood the need for every pregnant woman to have her medical records to hand to health personnel at any point of service. We can only imagine the number of lives lost as a result of our careless attitude towards records. Dr. Roberts ended her session by urging midwives to demand for the simple effective tools that make their work easier and profitable.
As we remember the great work midwives do in saving the lives of our mothers and newborns, we remind the government that investment in midwives is an investment in a healthy and wealthy nation. Every Child Matters. It is unacceptable that women and their babies continue to die in childbirth because of lack of access to midwives. We must continue to train and support our midwives so they also can stand on an equal footing with midwives from around the world. Midwives are the silent soldiers and without them, we cannot reduce maternal mortality in our country.