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MNCH Thought Leadership Series

Midwives are a lifeline for better maternal health, Nigeria must invest in them: OpEd

Editor’s Note: The World Health Organisation (WHO) has declared the Year 2020 as The Year of the Nurse and The Midwife. In this Thought Leadership OpEd for Nigeria Health Watch, Olajumoke Adebayo, a Young Midwifery Leader at the International Confederation of Midwives (ICM), writes about the critical roles that midwives play in reducing maternal mortality around the world and why Nigeria must begin to pay attention to investments into this health workforce cadre, for the good of its mothers and children.

Midwives are health professionals specifically trained to provide care for women during pregnancy, labour and childbirth.  Most people are familiar with these functions, but less aware that they also have expanded roles to provide care before pregnancy and beyond childbirth. A critical factor in the fight against maternal and child mortality, the unique nature of midwifery care means that midwives can practice in a hospital setting, at the community level or at home.

The World Health Organisation (WHO) has declared 2020 the Year of the Nurse and Midwife. Midwifery in Nigeria is largely dominated by women and faces issues of lack of recognition and adequate renumeration when compared to the entire health workforce. If Nigeria is to make adequate progress towards reducing maternal and child mortality, the role of the midwife must be given adequate attention.

Image source: International Confederation of Midwives


The UNFPA points out that midwives can help prevent two-thirds of all maternal and neonatal deaths, and deliver 87 percent of all essential sexual, reproductive, maternal and newborn health services. Despite this fact, only 42 percent of people with midwifery skills work in the 73 countries where more than 90 percent of all maternal and newborn deaths and stillbirths occur. The WHO notes that where midwives are the main providers of care during pregnancy, women are less likely to give birth prematurely or lose their babies before 24 weeks of pregnancy, according to a study published in The Cochrane Library. It shows that in midwife-led care, the emphasis is on normality, continuity of care and being cared for by a known, trusted midwife before, during and after labour. This continuity of care is delivered in a multi-disciplinary network of consultation and referral with other care providers.

Data analysed from 13 studies involving over 16,000 women revealed that women were reported to be happier with the care they received from midwives; they had fewer epidurals, assisted births, and surgical incisions to reduce the risk of a tear. Finally, in midwife-led settings, women were no more likely to have caesarean births, but they tended to be in labour for about half an hour longer on average. Conclusions from the research, which was conducted by researchers from King’s College London, Sheffield Hallam University, the University of Warwick and the National University of Ireland Galway, noted that the perception that women have to be cared for by a senior clinician in order to get the highest quality of care is not true. Professor Hora Soltani from Sheffield Hallam University, said, “Midwives provide a sense of normality and by having a midwife they know during pregnancy it allows the mother to feel comfortable and at ease during labour which in turn is much better for the baby.”

Countries that invest in midwives have better maternal health indices. Photo source: EpiAFRIC

Countries that invest in midwives have better maternal health indices. For instance, the Dutch midwifery system relies heavily on midwives with policies and systems to back up their practice. Midwives in Holland are totally autonomous. The system prevents midwives and obstetricians from behaving in ways that are bad for women. Other countries where midwives roles are appreciated include the United Kingdom, New Zealand and Australia.

It’s time for Nigeria to invest in Midwives
In Nigeria, the voices of midwives are barely heard and there seems to be little investment in the education of midwives and nurses. Midwives at the workplace are not allowed to practice within their full scope, which include competencies to carry out cervical cancer screening. If there is a midwife in a primary health centre, women don’t have to go far to access most sexual and reproductive health services. Investing in midwives is important to help reduce maternal and child mortality, but also goes beyond that. It is a path to achieving Universal Health Coverage without leaving women behind.

Image source: WHO

There have been pockets of successful maternal and child health interventions in Nigeria. One that comes to mind is the Abiye project in Ondo State. This was a major success in reducing maternal mortality in Ondo State.  One important contributing factor was the state’s investment in midwives. In a conversation with a midwife who worked for the primary health system, she emphasised the investment in continuous training of midwives, pointing out that this made them confident to carry out and give quality competent care. The Midwifery Service Scheme and the SURE-P MCH Scheme are other evidence to successes of midwives in reducing maternal mortality in Nigeria.
How can Nigeria as a country ensure that the status of midwives is recognised and the power of this workforce is harnessed to improve the health of women and children in the country?

First, invest in Midwifery Education. Midwifery education should not only stop at the midwifery schools, but graduate education and capacity building should also be strengthened for midwives. Midwives that are well educated are more confident and able to provide quality care, which means that women and children will get the best quality care during pregnancy and birth.

Second, improve workplace conditions. The provision of water, sanitation and hygiene (WASH) facilities to availability of necessary equipment would translate to quality care for women and children. Good salaries and other allowances are also important to encourage midwives and increase retention of midwives in Nigeria. The world needs 9 million more nurses and midwives if it is to achieve UHC by 2030. Nigerian nurses and midwives are increasingly migrating to other countries with better work conditions and salaries. Now is the time for Nigeria to invest in improving work conditions, job satisfaction and salaries to increase retention and reduce further shortage of midwives.

Midwives stay longer with patients and understand the issues affecting women and children. Photo source: EpiAFRIC

Third, strengthen leadership and participation of midwives at decision-making levels. Midwives stay longer with patients and understand the issues affecting women and children. It is important they are not left out of program design, implementation and policy decisions that affect the care of women and children in Nigeria.

Fourth, address workplace violence and protection in humanitarian settings. Midwives increasingly face workplace violence. It’s important to create a safe environment for midwives to work. Two midwives were lost in last years’ Islamic State West Africa Province (ISWAP) killings. Midwives are at the frontline of care in humanitarian settings, they should be protected.

As the global health community focuses its attention on The Year of the Nurse and Midwife, it is time for Nigeria to do the same by increasing investment in midwives, so that they in turn can save our mothers and babies.
 
Do you know states investing in their midwives? Give them a shoutout on our social media platforms, @nighealthwatch on Twitter and @nigeriahealthwatch on Facebook. What else can be done to invest in Nigeria’s midwives? Let us know!

About Author: Olajumoke Adebayo is a Reproductive Health enthusiast passionate about designing sustainable health solutions for women, girls and young people. She is a Young Midwifery Leader with the International Confederation of Midwives, Carrington Youth Fellow 2018 and LenniB( leaving no Nigerian Behind) champion 2019. She is currently the Team lead for Reprolife Nigeria, a social enterprise focused on improving the Reproductive health of women, girls and young people through the use of new media.

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