Midwifery Education in the Middle East and North Africa
By Atf Gherissi, PhD, MEdSc, CM, Assistant Professor in Health Science Education at Université Tunis-El Manar
“The mediocre teacher tells, the good teacher explains, the superior teacher demonstrates and the great teacher inspires.” Midwifery education is no different from any other subject in that the quality of instruction impacts the quality of service delivery. In the Middle East and North Africa, there are many obstacles that must be overcome to improve the midwifery education system. One such obstacle is an updated and regulated midwifery education system.
In most Arab States midwives face challenges similar to those in many other countries: low status of women, gender issues, and being subjected to nurse and/or doctor and employer abuse or conflict. The lack of a distinctive representative body or having one that is not structured or credible has led to an undefined role for midwives in society. Moreover, in the absence of enabling legislation and practice regulation or formal recognition and support for midwives, young girls (and their families) are reluctant to pursue an education or career in midwifery.1
In the midwifery education systems of the Middle East and North Africa, the “great teacher who inspires” is absent. In fact, the midwifery education systems are mainly training oriented and prioritize the “doing” domain of learning and memorization. One might compare this to culinary training which consists of learning the recipes from a cookbook instead of culinary education which prepares one for writing a cookbook with new ingredients.2 Although midwifery education programmes have to be competency-based and so mostly training oriented, the concept of competence itself has to be updated to include those skills which make a midwife proficient in adjusting or adapting to a specific situation.The midwifery education system should produce competent midwives whose services meet a woman’s sexual and reproductive health needs and rights on one side, changing priorities within the health system on the other side in addition to the professional guidelines of the midwifery profession. The education system should also ensure a minimum level of cultural sensitivity and adaptability to the needs of specific populations.Here we come to the need for a balance between these two types of education – training through memorization and repetition of behaviors and education in critical thinking and adaptability -so that midwives can develop critical thinking while continuing to develop clinical skills.
This approach has been implemented in Djibouti (with the support of EMRO, 2004-2005), in Tunisia (with the support of UNFPA-Tunis, 2008) and in Yemen (with the support of the World Bank, 2010) where the midwifery education programme and a national midwifery strategy have been updated and developed respectively. The tools developed by ICM can help facilitate and strengthen efforts to improve midwifery education and service delivery and “The State of the World’s Midwifery Report”, published by UNFPA in 2011, is another outstanding resource that deserves the attention of all stakeholders interested in improving women and newborns health. It is important that not only other countries in the Middle East and North Africa but also countries in Europe, Asia and other areas of the world assess the number and working conditions of midwives as well as the education system that trains them so that the services provided to childbearing women can be improved.
Join ICM and WRA in celebrating and showing support for midwives and the work that they do! Click here to learn more about WRA’s Action of the Month, “Midwives Matter”, and what you can do to show your support for midwives on the International Day of the Midwife, May 5th.
1. Ghérissi A., Brown J.M., El Adawy M. Midwifery in North Africa and the Middle East Background Paper. The State of the World's Midwifery Report. UNFPA, 2011 http://www.unfpa.org/sowmy/resources/docs/background_papers/23_GherissiBrownElAdawy_MidwiferyNorthAfricaMiddleEast.PDF
2. Adonyi Y. Understanding Differences Between Welding Education and Training. 2012 http://letu.academia.edu/YoniAdonyi/Papers/145858/Understanding_Differences_between_Welding_Education_and_Training.