International Midwives Day: Africa needs 551,000 midwives to reduce maternal mortality

International Midwives Day is an opportunity to raise the profile of midwives’ life-saving work, because without greater investment in them, Africa is unlikely to reach Millennium Development Goal 5.

Thousands of mothers in Africa are dying in childbirth and 551,000 more midwives are desperately needed to help prevent unnecessary maternal deaths.

International Midwives Day (5 May) is an opportunity to raise the profile of midwives’ life-saving work, because without greater investment in them, Africa is unlikely to reach the goal to reduce maternal mortality by three quarters by 2015.

Midwife and HIV activist Esther Madudu, 35, is affectionately known as “Ija” (aunt) in her community; a nickname she earned for her dedication to reducing the rate of HIV transmission from mothers to their children.

She has also become a symbol of all African midwifes since Africa Medical Research Foundation (Amref) chose to nominate her for the Nobel Peace Prize 2015 to bring attention to the thousands of needless maternal deaths.

Supporting mothers with HIV

As a midwife at Tiriri Health Centre IV, a mini government hospital in Soroti, eastern Uganda, Madudu has seen firsthand the importance of integrating HIV with sexual and reproductive health services.

Madudu has had a huge impact on women in her community. She carries out integrated antenatal care, which includes counseling, HIV testing, delivering babies, immunisation, post-natal clinics, post-abortion care, follow up of mothers and their babies, as well as activities such as de-worming, and treatment and prevention of malaria.

As a result of lack of available qualified midwives, Esther and her colleague have to share the workload of four people between them.

“Though I have a busy schedule, I squeeze time and ride a bicycle to the villages for home visits, to follow up mothers who have been diagnosed with HIV and to check whether they are adhering to the treatment and advice I offered at the health centre,” Madudu said.

“But the heavy workload makes it difficult to do all our work effectively. At times, we are so tied down at the health centre, we cannot go out to make the visits. There is a risk that because of stigma, women might not follow our advice, because they do not want other people to know they are living with HIV. Because of this, they do not take Nevirapine at onset of labour, then go ahead and breastfeed their babies, putting their babies at greatly increased risk of infection with HIV.”

Reducing maternal deaths

Thanks to the dedication of midwives like Madudu, the World Health Organization reports that Uganda has made some progress towards the Millennium Development Goal 5. However the lack of resources and trained midwives means there are still far too many maternal deaths at around 4,700 each year.

Tiriri is deep in a rural area. There has been no electric power for some time since the rebel group, the Lord’s Resistance Army struck the area in 2003.The health centre relies on solar power to light the maternity ward. Esther explained: “This makes our work very difficult, particularly in the maternity ward. Sometimes the mothers bring candles, but it is not easy to carry out a delivery by candlelight.”

Alongside other duties, the two Tiriri midwives deliver 45 to 50 babies every month. Following training from AMREF, Esther is now able to handle more difficult deliveries, but those that are beyond the capacity at Tiriri are referred to the district hospital, 26 kilometres away.

Talking about AMREF’s campaign to get global recognition for the important role midwives play in saving the lives of mothers and their children in Africa, Esther said: “I am excited by it. I want the entire world to understand the need of mothers and the need for more trained midwives to address their needs.

“I also see this as an avenue to advocate for better infrastructure. We need more and better equipped health facilities. Maternal mortality in Africa is alarming and this campaign is a step in the right direction to get the world to pay attention. I am just a midwife but there is a lot for me to do out there where no one else goes. The world needs to see this.”

Visit Stand Up For African Mothers to sign the petition for Esther Madudu’s nomination for the Nobel Peace Prize 2015

Read more about HIV and the post 2015 development agenda

Image: Esther Madudu, nominee for the Noble Peace Prize 2015, holding a statute of an African woman signed by many leaders across the world
© James Odong