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This post is a tribute to a young midwife named Fancy in south eastern Uganda.

Fancy is the newest addition to the Mama and Family Project, funded by Swedish Organization for Global Health (SOGH) in partnership with the Uganda Development and Health Associates, to provide effective support to women and infants during pregnancy and after childbirth.

The World Health Organization (WHO) defines midwifery as the “care of women during pregnancy, labour, and the postpartum period, as well as care of the newborn”. However, the reasons midwives are needed and the ways in which they work around the world differ. The definition is universal, but the circumstances are not.

To celebrate this month’s observance of International Day of the Midwife, I had the honor of speaking with an incredible woman named Fancy. After fiddling with inevitable technical difficulties, we finally connected over Whatsapp. 

Fancy the midwife outside the Maina Clinic in Uganda. Photo credit: Moses Kyangwa

A day in Fancy’s life begins with morning tea (sometimes coffee). She arrives at the Maina Clinic and checks her list of patients to visit that day – some at home and some at the center.

It was Fancy’s aunt, also a healthcare worker, who inspired her to become a midwife. Fancy knew as a child this was what she wanted to do. After two and a half years of education and internships, she felt prepared to join the workforce as a midwife.

Fancy has a passion for her work, and keeps always in mind the mantra ‘serve two lives’ – the mother and the baby. This is sometimes difficult when there are resources missing, like gloves, machinery, light, or doctors. Making sure clean water is available during birth is also a concern and a leading reason for birth-related complications in Uganda. Fancy tells me that helping mothers deliver is difficult during the night when the sunlight is gone if there is no electricity.

Fancy mostly provides care for young women and mothers – which makes sense since Uganda has one of the largest youth populations and highest adolescent fertility rates in the world. It is not uncommon for her to “see eighteen year olds with three children already”.

Before the call, I had researched Uganda’s legal status of abortion and contraception. Though abortion is legal in certain circumstances (such as a danger to the mother’s health), many healthcare workers and citizens default to recognizing it as illegal. Fancy told me that abortion is not legal, and that women still do get abortions but illegally and unsafely. She also shared insights into why she believes supporting the work done by local people in their own communities is a necessity for any development program.

Perhaps the loudest and clearest words of the entire call came toward the end of our time together when Fancy told me: “a good midwife should respect and treat all mothers equally – with no discrimination.

Before our conversation ended, I spoke with the health center Executive Director, Moses. He said that midwives are taught to “be submissive” and simply accept their working conditions (like salary, rights, and status). This prevents midwives from speaking out about their struggles. If given the chance, Moses explained, midwives would voice their sadness about how mothers and babies they care for are sometimes failed by cycles of systemic failure – resources, doctoral care, education.

There is much the health AND finance ministries can and should do to improve things (and this includes international governments) – starting with empowering midwives to speak out and increase awareness of women’s health issues in all areas of Uganda.

Being Fancy in Uganda means having a passion for your work, an embedded resiliency, and the drive to continue serving women and girls in extremely vulnerable states. Midwifery is a difficult job, with many challenges. It requires knowledge, skill, passion, empathy, bravery, resourcefulness, multi-tasking, quick problem-solving, and grit.

Uganda, and the entire world, is fortunate to have people like Fancy – midwives who have chosen to use their hearts, minds, and skills for the terrifying and beautiful cycle of life.

The Conversation

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