Planned investments in the midwifery workforce are essential for enhancing maternal and newborn health globally and with the potential to save over 4.3 million lives annually by 2035.
Midwives save lives, and help in averting serious childbirth injuries, maternal and neonatal deaths by delivering up to 90 per cent of comprehensive Sexual, Reproductive, Maternal, Newborn and Adolescent Health (SRMNAH) interventions.
Data by the World Health Organisation (WHO) affirms that there is improved quality care, rapid and sustained reductions in maternal and newborn mortality when services are provided by educated, well trained, regulated, and licensed midwives.
ROLE OF MIDWIVES
WHO defines Midwifery as 'skilled, knowledgeable and compassionate care for childbearing women, newborns and families across the continuum, from pre-conception, through pregnancy, birth, postpartum, to the early weeks of life'.
It sees midwives as important defenders of women's rights, ensuring that all women and newborns enjoy the right to quality care for a positive childbirth experience including 'respect and dignity, a companion of choice, clear communication by maternity staff, pain relief strategies, as well as mobility in labour and birth position of choice'.
CHALLENGES
Mrs Netta Forson Ackon, the President of the Ghana Registered Midwives Association, explains that midwifery has evolved from domiciliary (home-based care), to institutional care practice.
However, practitioners are currently overburdened with midwife to patient ratio of one to 387 patients as shown by the Ministry of Health's 2021 Holistic Assessment on Midwives to Women in Fertility Report.
The Report says the statistics are an improvement on the 2020 ratio of 1: 560, though they both exceed WHO's recommendation of one midwife to: 175 patients.
Despite the amazing things that midwives do, the fact still remains that there is still a huge global shortage of 900,000 midwives, especially in developing countries, as practitioners often lack the skills and supportive environment to perform their jobs.
Dr Forson says this has contributed to a 'brain drain' of professionals to developed countries for better service conditions, which is still a huge concern for Ghana's development.
The country's skilled birth attendant rates currently stand at 74 per cent, with disparities showing 90.6 per cent for urban centres and 68.9 in rural areas, hence the need for more investment in midwifery training for equity and access to quality services.
WHY INVEST IN MIDWIFERY?
The United Nations Population Fund (UNFPA), which is the United Nation's Sexual and Reproductive Health Agency, has reaffirmed its commitment to collaborate with government and key organisations, to lower Ghana's maternal mortality rate of 308 per 100,000 live births with planned investments in midwives and midwifery training.
The Agency has been championing and contributing to quality maternal healthcare in Ghana and insists that investing in midwives could avert two-thirds of maternal and newborn deaths by 2035, help strengthen primary health care systems and provide a pathway to Universal Health Coverage.
Ghana has barely seven years to achieve the 2030 Sustainable Development Goal (SDG) target of reducing its maternal mortality to 70 per 100,000 live births.
Dr Wilfred Ochan, the UNFPA Country Representative, says promoting and investing in midwifery is more crucial for positive impact on many reproductive health indicators to achieve the SDG targets.
UNFPA's ROLE IN ENHANCING MIDWIFERY
The UNFPA, together with its partners have been working to scale up quality midwifery education, policies and services in countries worldwide, in addition to strengthening midwifery institutions, associations and regulations.
It also works closely with national governments to ensure a well-regulated, autonomous profession with midwives enjoying a clear title and properly defined scope of practice.
It has also been supporting higher education programmes for midwives in developing countries including Ghana, which now follow a competency-based midwifery curriculum that is aligned with global standards and is now running a bachelor's degree programme for professionals.
Dr Ochan says the UNFPA has from 2009 to 2022, helped countries to educate over 350,000 midwives in line with international standards, through its groundbreaking 'State of the World's Midwifery' reports.
In Ghana, it has led interventions in strengthening midwifery education, regulation and associations, in partnership with the government, other professional associations and key allies, he said.
He said, 'these interventions include equipping over 20 skills labs of midwifery training schools, in-service capacity building of midwives' including educators, and development of nursing and midwifery strategic plan and policy guidelines amongst others'.
UNFPA, he said, desires a world with a 100 per cent access to skill birth attendance with no rural-urban disparities or any group left behind.
This world, he said, can be created through joint partnerships, more investment in midwifery training and regulation for their full-scope practice within a supportive environment, equitably deployment to all levels of care so that there is a 'midwife' at every birth, and properly remunerating them.
Among the numerous supports by UNFPA in Ghana, is the recent donation of midwifery training tools and equipment worth 30,000 dollars, to the Nursing Department of Midwifery at the Kwame Nkrumah University of Science and Technology (KNUST) in the Ashanti region.
Dr Emily Kamwendo-Naphambo, the UNFPA Deputy Country Representative, told the media after handing over the items to the institution, that the Agency has been working with the KNUST for more than 10 years in the discharge of quality education.
She said the Agency and its partners, would not relent on providing the relevant technical and logistic assistance for Ghana to achieve the targeted 'zero maternal deaths, unmet Family Planning need, and domestic violence by 2030'.
UNFPA admits that when properly trained and supported, midwives could offer one of the most cost-effective and culturally sensitive paths to achieving universal health care including Family Planning, information and counselling on Female Genital Mutilation, and assistance to survivors of gender-based violence.
Dr Barnabas Yeboah, the Director of Nursing and Midwifery at the Ministry of Health, said his outfit has been working with UNFPA and other allies to strengthen midwifery training by establishing more institutions and developing the relevant curricula for postgraduate programmes for nurses and midwives.
RECOGNITION OF MIDWIVES
Dr Ochan, on the 2023 International Day of the Midwife (IDM) held on the theme: 'Together Again: From Evidence to Reality,' commended all midwives for their invaluable roles played as frontline heroes during the fight against the COVID-19 pandemic.
He commended them for tirelessly putting in their best and risking their lives to save others by ensuring continuity of essential reproductive health care to mothers and newborns during the pandemic and other emergencies.
He called on all stakeholders to join forces in giving equal recognition and appreciation for the work of midwives, and to advocate the strengthening of their role within the healthcare delivery system.
The IDM, established by the International Confederation of Midwives in 1992, has since been celebrated annually on May 5 in partnership with member organisations and observed by more than 50 nations.
It is a chance to celebrate the achievements of midwives, and their contribution to lowering neonatal and maternal mortality and morbidity by ensuring quality sexual and reproductive health outcomes, motivate policymakers to implement change by recognising the unique professional role of a midwife, and lobbying for adequate midwifery resources.
Dr Ochan ceased the opportunity to announce some plans which include the building of centres of excellence and a community of voices to advocate maternal health, through an externship and mentoring project for five top awardees of best practices during the IDM celebrations and awards ceremony.
He explained these candidates would be vetted and selected and sent to other facilities in their regions to educate their peers for replication of best practices over one year.
The UNFPA promised to work closely with the key partners particularly the Ministry of Health (MOH), Ghana Health Service and Associations on how best to systematize this idea and move beyond the awards event to translating and institutionalizing good practices beyond the individual, to the benefit of other institutions and systems strengthening.
Source: Ghana News Agency