Advocating with Midwives

By Lennie Kamwendo, National Coordinator, WRA Malawi

Last month, Frances Ganges and Katy Woods from the Global Secretariat and Rose Mlay, WRA Tanzania, Robina Bityei, WRA Uganda, and myself from WRA Malawi led an advocacy workshop in association with the International Confederation of Midwives (ICM) with midwives and government officials from both Anglophone and Francophone Africa, i.e. Uganda, Malawi, Zimbabwe, Tanzania, Republic of South Sudan, Ivory Coast, Central African Republic, Democratic Republic of Congo, Cameroon, Burundi and Gabon.

The focus on strengthening midwifery through the adoption or adaptation of the ICM standards and competencies for midwifery education, practice and regulation as well as advocacy related to midwives, was timely. Many of the countries represented at this workshop are experiencing unacceptably high levels of maternal mortality even as we approach the great milestone of the Millennium Development goals in 2015, which is a short three years from now. Funding constraints, lack of adequate tutors, material resources, migration of midwives and lack of regulatory frameworks are some of the common challenges.

The workshop facilitators enabled participants to refocus on the definition of a midwife, as there appear to be many varieties of cadres which are referred to as midwives in many of our countries. It is important to have a clear criterion so that when one is a midwife in one country, she/he can be recognized as such in another country. This would truly fulfill the phrase “A Midwife is a Midwife is a Midwife!”. The ICM believes that this midwife can practice in a variety of settings including the home, community, hospital or clinic as long as they have the seven competencies summarized as follows:

Requisite knowledge from obstetric, neonatology, social and other relevant sciences
Provision of high quality culturally sensitive health education for health promotion
Provision of high quality culturally sensitive antenatal care including referral of complications
Provision of high quality culturally sensitive care during labour including selected emergencies
Provision of comprehensive postpartum care for women
Provision of comprehensive care to newborns from birth up to two months of age
Provision of abortion-related care within applicable laws of a particular country

One of the challenges that some participating countries will have is adopting or adapting these ICM competencies because of the nature of midwifery in those countries. It was obvious from the discussions that in many countries, formal midwifery education and practice are either non-existent or at a rudimentary stage. In some countries, regulation of midwifery education and practice is still developing.

While these are obviously major challenges, both ICM and WRA as well as the relevant countries must view these challenges as opportunities for advocacy work. The ICM competencies and standards are likely to “sell” better when countries are starting from scratch, compared to those whose midwifery programmes are understood to be well established. What do people think?