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Midwives save lives through thick and thin

Ambassador Rita Rudaitis-Renaud
Midwives are on the front lines, adapting their services so that women continue to get the care they need.

A smiling midwife holds open the doors at the back of a vehicle.

A midwife opens the doors to a mobile health clinic to provide healthcare to her patients.
Photo: UNFPA DRC

The bustling streets of Kinshasa, Democratic Republic of Congo (DRC), went quiet when COVID-19 forced the city into lockdown in March.

But as mothers from all corners of the globe know well, if there is one thing a pandemic can’t stop, it’s the arrival of a baby who is ready to enter the world. With movement restrictions making it harder than ever to access health services, expectant mothers in Kinshasa and in many developing countries face increased uncertainty about giving birth safely.

Midwives are on the front lines, adapting their services so that women continue to get the care they need. Working with the United Nations Population Fund (UNFPA), midwives with the DRC Midwifery Association have gone into Kinshasa’s streets in mobile health clinics equipped to bring care to their patients.

With realities like no running water, limited electricity and patients who may not be able to pay, the task of providing midwifery care in developing countries was already daunting, forcing midwives to innovate and come up with solutions.

A midwife wearing a mask holds a Pinard horn to the abdomen of a pregnant woman, who is also wearing a mask.
A midwife provides a patient with prenatal care, which helps reduce risks of pregnancy complications. Photo: UNFPA South Sudan

“Then COVID comes along,” says Kirsty Bourret, a Canadian midwife who has worked alongside midwives in the DRC and Haiti through development programming supported by Global Affairs Canada (GAC). She explains that the emphasis on treating COVID-19 over other health concerns means that many women’s health issues, like limited access to contraception and the prevalence of gender-based violence, are now compounded, making midwives’ jobs even more challenging.

“And then there’s the fact that most of these midwives are women,” she adds. “There is a household and economic burden that many midwives are now having to manage in addition to everything else.” For example, they may have husbands that are out of work, and children who are no longer in school to care for, all while continuing their life-saving work.

A seated woman folds cloth while a group of people watch.
A midwife provides a patient with prenatal care, which helps reduce risks of pregnancy complications. Photo: UNFPA South Sudan

Despite all this, midwives are among the strongest advocates for continued access to women’s health, and they are finding creative ways to stay connected to the communities they serve. The South Sudan Nurses and Midwives Association is using teleconsulting, radio and information sessions to get the word out. They have also adjusted their facilities for physical distancing and are teaching mothers about effective handwashing and using masks.

Canada has been working with countries like South Sudan to strengthen the midwifery profession for years. For example, with support from Canada and other donors, South Sudan has increased the number of trained midwives from 8 to 800 over the past decade.
The World Health Organization estimates that with enough midwives trained to international standards, global maternal deaths, stillbirths and neonatal deaths would be reduced by 80%. Both cost-effective and culturally sensitive, midwives also provide other life-changing care, from access to contraception to case referrals for gender-based violence.

In remote regions with no other health services, local midwives help fill a critical gap, especially during the pandemic, as health workers are even less likely to travel from village to village.

Two healthcare workers at a hospital bedside.

Gulbadan Rahimi, left, a midwifery student with the Aga Khan Foundation Canada program support by GAC, is helping to provide care.
Photo: Kiana Akheri/Aga Khan Foundation Canada

Gulbadan Rahimi lives in a rural mountain village in Afghanistan. After seeing many mothers and babies die, and losing children of her own, she decided to become a midwife with an Aga Khan Foundation Canada program supported by GAC. “I am so happy that I will be going back home to be a consultant there for mothers,” she says.

In the current environment, many midwives are going beyond women’s health to also promote life-saving information about water, hygiene, sanitation and how to prevent the spread of COVID-19.

Ma Shwe Wutt Hmon is sharing information about the COVID-19 virus in her Myanmar community. A mother of two, she goes door to door to distribute pamphlets in her village and nearby villages. For those who cannot read, she reads the information to them.

A key part of GAC’s midwifery programming has been strengthening midwifery associations. These organizations provide a standard of care and advocate for women’s health, for midwives and the midwifery profession. With expertise from organizations like Cuso International, the Canadian Association of Midwives (CAM) and the United Nations Population Fund, Canada has helped bolster these organizations in a number of countries, and the investment is now paying off: the trained, passionate midwives who make up these organizations are now advocating for women's health, and are finding new and innovative ways to bring care to mothers in the current crisis.

A woman wearing a mask hands an information sheet to a woman at her home.

Midwife Ma Shwe Wutt Hmon, who was trained through World Vision Canada’s GAC-funded ENRICH program, provides COVID-19 information sheets to people in her community.
Photo: World Vision Canada

When asked what has struck her most about the impact of Canada’s support of midwives, CAM midwife Kirsty Bourret says that it’s confidence.

“It has really helped midwives to understand their value as health care professionals and their ability to impact sexual and reproductive health in their countries,” she says. “When you have that confidence in yourself and you understand your value and your place, you are going to mobilize yourself in the most extenuating of circumstances because you believe not just in what you can provide, but in what midwifery can.”
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