What we do today, will pay off tomorrow: the case for midwives

Not so long ago, in Mymensingh, Sufia gave birth to her first child. She went into labour in her home, on the outskirt of the city, with her mother-in-law and a neighbour to support her. The labour took a long time and the family contacted the local health care facility to ask if they could check upon Sufia. They did not have time to attend to her but said everything was fine. "Births take time" the person said without examining or checking Sufia or the baby. Sufia felt something was wrong, but nobody took her to the hospital. After two days of painful labour, she finally gave birth to a stillborn boy. The baby was perfect in every way, but did not survive the long birth. Today, Sufia is not only mourning her lost son, but also knows that something went wrong in her body after being in labour for so long. These days, she cannot hold her urine and starts to smell bad. Sufia is 17 years old and has still a full life ahead of her, but is already traumatized by a lost child and genital injuries that might be permanent. The boy's life could have been saved and Sufia could have been spared from injuries. How?

Now, let's go fast forward, say 10 years from now! In 2023, Bangladesh is hopefully a middle-income country by now, and our children and grandchildren will most probably look back and reflect on the revolutionary steps that were taken in 2012. You may ask what happened in 2012? Well, last year, Bangladesh launched the national midwifery education programme! Now why was this so revolutionary and ground breaking? For a start, midwives save lives! Our daughters and our granddaughters will most probably survive pregnancy and childbirths simply by having midwives by their side. Fortunately, most pregnancies and births are completely normal and end well; more precisely 85% women go through a pregnancy and birth without complications. It is the remaining 15% of the women we should be particularly concerned about. But since we can only to a certain extent identify who will have complications during pregnancy or childbirth, all pregnant women will need a professional by their side when going through pregnancy and giving birth. In Bangladesh, nearly half a million women will be at risk every year while pregnant and giving birth. Today, about two million women deliver their children without any skilled professional to support and save their lives if there are complications (BDHS 2011). Together with a functioning referral system and strong collaboration within the health care system, midwives have the required knowledge and skills to save these women. Moreover, women have a right to a professional trained health care provider to support and partner with her, at every stage of maternity.

Bangladesh has made remarkable progress in decreasing maternal mortality to 194/100,000 live births and must be congratulated for the great efforts. However, the remaining decline in the maternal mortality ratio will require much more efforts and work. In many countries, such as Sweden and Indonesia, the success of eliminating maternal mortality is strongly linked to educating and deploying midwives in the health care system and Bangladesh has started the long but promising journey to make this happen.

That's why 2012 was perhaps a historical year, with the introduction of the national 3-year Direct Entry Midwifery Programme in public institutes. And this year the programme also started in private institutions. The midwifery programme is based on international standards and took several years to develop in collaboration with government, international organizations and development partners. There will be many adjustments and changes needed in years to come, but the most important thing is that young women who have passed the Higher Secondary Certificate will have the chance to become a professional maternal health care provider. When the government opened the applications of 525 seats in the midwifery programme, over 7,500 eligible women applied. This proofs that there is a huge interest among young women in Bangladesh to be trained as a midwife. In that respect, we should hail the bold and courageous decision makers and officials who were part of the launching of the midwifery programme in Bangladesh in 2012. Numerous civil surgeons, nursing institutes and college principals will be remembered for their struggle in developing a solid midwifery faculty to teach the students in the essential midwifery skills and competencies.

In 10 to 20 years ahead, hopefully every woman has a midwife by her side from early adolescence to when she enters menopause. Every time a young woman needs family planning, when she gets pregnant, wherever she decides to give birth, after her delivery and many other occasions in her reproductive life, there is a professional midwife to counsel and support her. Of course, medical doctors and nurses are there too, but only when their expertise is needed and in collaboration with the midwife. If this collaboration succeeds, the chances are very good that many women and children's lives will be saved. And that's our goal: that no woman dies when giving life! So, investing in midwives is investing in the overall development of a nation.

The process of developing professional midwives, currently underway in Bangladesh, will be documented and recognized over and over again. Lessons will be learned, stories will be told and experiences will be shared with other countries. Bangladesh is indeed brave, and the commitment made in 2010 to educate and deploy midwives in the health care system will affect many women and families for decades to come. The government's commitment to educate and post four midwives in every Upazila Health Complex to cover 24/7 services by 2015 is a very positive step forward to provide women a continuum of maternal health care. The post creation of the midwifery posts is currently the most urgent step forward which needs to be taken immediately, not to lose the competence of the already 534 educated midwives.

The efforts, commitment and work done now may not directly save the lives of women giving birth today, but will affect the lives of our daughters and granddaughters in future. In other words, what we do today, will pay off for the Sufia's of tomorrow!

————————–
Arthur Erken is the UNFPA Representative in Bangladesh.