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May 05
The case for midwives in South Africa. Is midwifery prioritised enough?

By: Joan Dippenaar (Technical Advisor: Health Systems Training Institute and Specialist Midwife)

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All South African midwives are trained as general nurses and midwives, and are seen as nurse- midwives, able to work in any healthcare setting. They form an integral part of South Africa's healthcare system, meaning that a woman will see a midwife at any stage of her pregnancy, right through to giving birth and to the post-natal period.

Skilled attendance (Defining skilled attendant: joint (WHO/UNFPA/UNICEF/World Bank statement 1999)  is the golden standard for maternal healthcare. And not all registered midwives in South Africa have developed the level of proficiency that meet this standard, with inequity in the context between the private and public sectors in service availability and quality.]

Midwives are the sole providers of maternal care in pregnancy and birth worldwide. As the International Confederation of Midwives celebrates International Day of the Midwife on 5 May, it is indeed time to reflect on the value of the midwife in a healthcare system by looking at the data and investing even more in midwifery as probed by the theme for 2021. 

To reduce the risk of problems when giving birth, women should be attended to by a skilled professional. A first study of its kind to be conducted in the country, the South Africa Demographic Health Survey (SADHS) of 1998 indicated that only 3 in 7 women in the public sector see a medical doctor once in pregnancy and birth. South Africa has an attendance skills level of 94% meeting the required international standard for maternal health but has not been able to reduce the maternal mortality to reach the set acceptable level for quality of care in birth and new-born care yet.

Although the 2012 Reproductive and Maternal Child Health Services (RMCH) programme and continued efforts made a difference since it was successful in many areas to improve maternal health outcomes, the Saving Mother's report 2016 still identified areas to be improved in clinical care with special reference to maternal deaths related to hypertensive disorders in pregnancy and still births. Overall the quality of maternal care is hampered by health system factors, equity issues and human resource challenges with reference to midwifery care and a supportive environment. In 2016 the skilled provider attendance was unchanged from 1998 (94% and 95%, respectively), but there have been changes in the types of antenatal care (ANC) providers. In 1998 about 33% of women were seen by a medical doctor, once in pregnancy and birth in. In 2016, 17% of women received ANC from a doctor and 77% from a nurse or midwife (SADHS 2016). 

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Visit the SACsoWAch website: https://www.sacsowach.org/index.php/who-we-are

The midwife is the key person to deliver qualitative, comprehensive, lifesaving care for the mother and baby in all the stages of pregnancy, birth and aftercare.  It is time to have a hard look at the data in South Africa and take stock of the global crisis of midwifery also reported by the president of the Society of Midwives of South Africa (SOMSA), Dr Elgonda Bekker. The questions asked are:

  • Does South Africa have enough midwives in the healthcare system? 
  • Are they sufficiently trained for their independent role?
  • Is the healthcare system supportive with an effective back-up system of skilled medical doctors? 

South Africa needs to follow the data on the provision of midwives for the future, but also investigate whether the healthcare system is midwife and mother friendly, and supportive. Without competent midwives in a competent healthcare system mothers and babies will suffer.

An important article by the Mail and Guardian highlighted how Midwives are the backbone of maternal health systems, and today, this is the State of the World's Midwifery 2021. Also see this information recently published by the Royal College of Obstetricians and Gynaecologists for healthcare professionals regarding Coronavirus (COVID-19) Infection in Pregnancy.  




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