What it’s like to be Fancy: Midwifery in Uganda

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.

Let’s Talk Equality: Midwives of the World – Part 1

In order to reach a completely equal society, all basic human rights need to be secured. One of these is maternal health. The success of a country can often be traced back to successful maternal health programming. Therefore, my project partner Anna and I decided to create a documentary series about midwives around the world.

To create this documentary and to get a fair picture of the situation for mothers and midwives around the world, we have collaborated with the White Ribbon Alliance (WRA). The WRA is an incredible organization for maternal health, and a network for volunteers  from all over the world. We decided to focus on White Ribbon Alliance Indonesia, or “APPI” (Aliansi Pita Putih Indonesia), and visited their team in Jakarta earlier this year. With the three parts of our documentary, we hope to do two things. One is to present a fair picture and comparison of the maternal health situation in Sweden and Indonesia. The other is to inspire people to make a change in their local communities, just like the volunteers of the White Ribbon Alliance do, or like midwives do in their daily work.

In this first part you will follow us to a private maternity clinic in Helsingborg, Sweden, called Mammakulan. The midwives at Mammakulan create an inspiring team of women that want to make a change in their societies. They are passionate about their work, and want to share their knowledge with the world. Rather than following us through our experiences with this project, we will let you meet all of the inspiring individuals we have met shooting the series through interviews. We hope that you will find these observations and conversations just as inspiring as we did. We are beyond happy to share with you the first part of Midwives of the World!

Feel free to like, comment and share! The next part will be focusing on White Ribbon Alliance Indonesia, and will be published in the near future. In the meantime, let’s get together for moms, and let’s talk equality!

Tilde and Anna – Let’s Talk Equality

Celebrating Midwives with Voices from Around the World

Today is the International Day of the Midwife and we’ve collected voices of women and midwives from around the world to celebrate the important work midwives do as health professionals, leaders and partners, and in safeguarding the human rights of women and girls.

“I think midwives are women’s best friends – wanting every woman to feel free, strong and beautiful through every stage of life and womanhood.” – Caroline, Mother, Sweden

“I love it as a midwife when I help women deliver safely until both mama and baby are discharged home both healthy. Maternal death and stillbirths, although relatively rare, just break my heart.” Malerotholi, Midwife, Lesotho

“My midwife was fantastic and I hope to meet her and tell her. She is responsible for making the welcoming of our daughter a calm and safe experience where I felt that she would do anything for me and our baby and she also made the father feel safe and included.” – Sofi, Mother, Finland

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“There are so many ways that midwives partner with mothers, as they seek to provide the best possible health for their newborns and indeed their entire families. One example is the important role that midwives play in helping a new mother to breastfeed. It takes a lot of practice and many helping hands along the way.” – Janet Lewis, ICM Technical Midwife Advisor

“Midwives are the key to making women feel safe and bold though their pregnancy and while giving birth. By supporting women through their first steps as mothers and helping them bond with their newborn, women can enter motherhood empowered and with more confidence.” – Caroline, Mother, Sweden

“Midwives matter to me because, they have the knowledge to bring babies to life with love and care like no doctors.” – Alejandra, Mexico

“Midwives matter to me because every mum counts.” – Maria Sidéras, Midwife, Sweden

“Midwives matter to me because they are advocates for women on a personal level but also on a wider structural level. The role of midwife is central to a holistic model of health, which in an increasingly medicalised context, is invaluable. So often midwives challenge the dominant medical approach because it can be actively hostile to women and may not always work with the women’s innate physiological ability to give birth, but intervenes unnecessarily leading to increased risks for mother and baby. In my opinion midwifery is feminist work, placing women in the centre of their own care, showing them respect, facilitating their autonomy, offering reassurance and supporting them to make informed decisions.” – Aster, Mother and Student Midwife, UK

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“I was inspired to train as a midwife by those who cared for me during my own pregnancy and birth. My community midwife with all her support and reassurance helped me feel confident in the decisions that I made throughout my antenatal and postnatal care even when they went against the status quo. I trusted her and felt that she truly listened to me; I only wish she had been my midwife at the birth of my son as well. I think continuity of care is so valuable.

Midwives are partners with women and their families when they truly listen, when they provide non judgemental support and provide evidence based information without personal bias. Partnership is not about telling women what to do or funneling them through a system without true regard for their personal circumstances and wishes. I think the work of midwives takes a huge amount of energy and they need more support and recognition.” – Aster, Mother and Student Midwife, UK

“As a father and husband, I request everyone to respect midwives because they are our integral part not only for our generation but also for the future generation” – Shantanu Garg, ICM Project Lead

“Midwives have more adequate knowledge about birth and babies than doctors, they understand the body better, in a more natural way.” – Sofia, Mother, Åland Islands, Finland

“I was pregnant with my firstborn in the U.S., and now I am expecting my second in Finland – countries with very different maternal and newborn healthcare systems. I have also lived in many countries, like India and Tanzania. Having access to quality midwifery and maternal health care services is absolutely crucial for women to be able to experience safe, healthy pregnancies and births. In many countries, women lack access to proper maternal health care services altogether – and in countries like the U.S., access is uneven because the cost of healthcare is so high and pregnancy and birth have been heavily medicalized and largely taken away from the hands of midwives. I believe midwives play a huge role in normalizing pregnancy and birth as natural conditions, not medical conditions or illnesses – and every single woman around the world should be able to experience pregnancy and birth with a qualified, trained midwife by her side.” – Emma, Mother, Finland/USA.

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“Midwives have been a most important source in saving women’s and children’s lives all over the world – not only in modern times but also in history. I hope that all of you feel the importance of what you’re achieving, no matter where in the world you are working.” – Ingela Wiklund, Board Member ICM

Learn more about the International Day of the Midwife through the International Confederation of Midwives

A Mother’s Keynote Address to Canadian Parliament

This speech was given by Faridah Luyiga Mwanje, Communication Officer with White Ribbon Alliance in Uganda, to the Canadian Parliament today, on the International Day of the Midwife. 

I stand before you today as a woman, as a mother, as a citizen of Uganda and an advocate for reproductive health and rights.

I am happy and honoured to be here, but a few years ago I never would have imagined that I would come to Canada to thank the Canadian Government and Canadian organizations for their continued investment in the health of women and children globally – and specially to talk about the realities faced by adolescents in my country.

But my life changed forever when my own sister, Remie Wamala, died in childbirth in 2013. She bled to death at a hospital in Kampala leaving behind a heartbroken husband and four children. Her baby, my nephew, Lucky Wamala survived but suffered brain damage.

Remie was only one of the 17 mothers and 106 newborns who still die every day during childbirth in Uganda. My sister was a mature married woman who worked for the government on women’s health – but a disproportionate number of those who die giving birth are still children themselves.

Following my sister’s death, my response was to join White Ribbon Alliance, which like the Canadian Network for Maternal, Newborn and Child Health campaigns to put an end to these preventable deaths.

Earlier this year when the members of White Ribbon Alliance Uganda met to discuss our plans for the future, we collectively decided to focus on the rights of adolescents. Why? Because one in four babies born in Uganda is born to a girl who is aged less than 19 years old. Not only does that end her chances of education and better future, but early pregnancy puts the lives of both mother and newborn at even greater risk than faced by older Ugandan women.

So why are young people in Uganda having babies so young? Poverty, early marriage, the low status of girls and women, lack of education and poor health services – including family planning – are all interconnected causes.

Uganda is not alone in having suffered conflict in recent years, and yet we know that girls in conflict settings are at high risk of rape and other forms of gender-based violence. Issues of sexual assault, domestic violence, genital mutilation, early or forced marriage are often seen as ‘normal’ or swept under the carpet in my country. Lack of education and society’s perceptions of gender mean that the only way these things can change is when citizens are involved in that change from the very start.

We can only guess at how many of these girls even had a choice about having sex. All too often, girls are preyed upon by older men, or ‘sugar daddies’ with their gifts of food and money. Even some teachers are accused of trading good marks for sex with pupils. In a hungry family, parents may turn a blind eye to such abuses, while marrying off your daughters means one less mouth to feed.

And once a girl is having sex, what can she do to avoid pregnancy? What will happen if she asks the health workers in her community for family planning? Over and again, we hear how adolescents are too afraid and ashamed to approach health staff in case they are shouted at and abused for their ‘wicked’ behavior.

I can tell you that even older, married women still lack access to contraception. And once a girl is pregnant, what can she do? She may hide her pregnancy for as long as possible, missing out on critical ante-natal care. Despite the risks, she may give birth while hiding at home, alone and without help from a midwife. And because she is still so young, her risk of dying during the birth is five times higher than for her older sisters.

And who is to speak out and hold to account those who are raping and exploiting or simply neglecting young people, and those who are failing to provide them with critical health services? Currently, instead of those responsible having to change, it is the young – voiceless and powerless – who are blamed and stigmatized.

Yet it doesn’t have to be like that. White Ribbon Alliance Uganda has already shown that by harnessing the power of citizens to hold our leaders accountable, we can achieve rapid and tangible results.

In my country we have brought communities, health workers and policy makers together in a series of Citizens Hearings. We continue to be a watchdog through our Community Based Monitoring Teams and Citizen Journalists. As a result, we have seen real and rapid improvements in life saving emergency obstetric care, with new operating theatres built and staffed for the first time in three rural Districts.

Now we must make sure that adolescents are no longer neglected. I welcome this Voice of Women event and I urge you to pursue a comprehensive approach to Reproductive Maternal Newborn and Child Health, and to also to intensify your efforts towards adolescent health, Sexual Reproductive Health and Rights and fragile states, key areas that were missed out by the Millennium Development Goals (MDGS).

Although many of the MDGs were of critical relevance to adolescent girls, no targets focused on them specifically, resulting in adolescent girls being hidden. Healthy girls, mothers and newborns are vital to the success of the sustainable development goals. We know that healthy empowered women will send their children to school, have them vaccinated, and feed them well. They can also say “I DECIDE  …if I marry, I DECIDE when I marry, I DECIDE if I have children, I DECIDE when I have children…”

It’s been acknowledged that the MDGs lacked a strong accountability component. The commitments made to women’s and children health by the United Nations were not discussed adequately by political leaders, civil society, the media and other key stakeholders. Clearly inputs from citizens were absent. It is therefore critical that we now make every effort to ensure the participation of citizens in the Sustainable Development Goals (SDGs).

We must support adolescents to participate actively to hold their governments accountable since they bear the worst brunt of discrimination and poor service delivery. The motto of White Ribbon Alliance is NOTHING ABOUT US WITHOUT US – so let us involve adolescents, and their communities, and our government in creating the change we need.

I thank the people of Canada for their support, and I call upon the government of Canada to continue helping people in disadvantaged regions whose lives are at risk. Women, children and adolescents should not face death simply because of where they live or who they are. None of us can calculate the value of the lives of girls and mothers lost during pregnancy, childbirth and afterwards. Only our many orphans, widowers and close family members know the true cost of a mother lost, and I can tell you that these lives are priceless. That is why we must invest in the health of girls, women and newborns.

Thank you for listening.

FaridahFaridah Luyiga Mwanje is a communication officer with White Ribbon Alliance in Uganda. She became involved with WRA Uganda after her sister died while giving birth, leaving behind a devastated husband and four children. In the wake of her family’s tragedy, Faridah, a mother herself, vowed to do all that she could to prevent the needless deaths of mothers and newborns.

Midwives Matter. But will SDG’s deliver?

Fact: Every day, approximately 800 women die from preventable causes related to pregnancy and childbirth.  This accounts to 289,000 women per year.

Fact: Every year 3 million infants die in the first month of life. Among those, nearly 3/4 die in their first week, and 1/3 die on their day of birth.

Fact:  Midwives that are educated and regulated to international standards can provide 87% of the essential care needed for women and newborns.

Fact: Today, only 22% of countries have potentially enough adequately educated midwives to meet the basic needs of the world’s women and newborns.

Yesterday was the International Day of the Midwife.  The theme for this year is “Midwives: for a better tomorrow.”

It reminds us of the critical role of midwives in creating a brighter future for mothers, babies, and families.  Continued progress and sustainable development will not be a reality unless mothers and babies survive and thrive.  Investment in midwives is fundamental in accelerating progress toward these goals. -Frances Ganges, Chief Executive International Confederation of Midwives

We are only months away from the Millenium Development Goals’ (MDG’s) targets coming to close and whilst we absolutely must celebrate the success and enormous achievements that have been made, the fact remains that  the child mortality rate has only halved, so failing to achieve the goal of a 60% reduction; and instead of the 75% goal, the maternal mortality rate has decreased by only 45% .

The end of this year marks the end of the MDG’s and the start of the SDG’s – Sustainable Development Goals.  In March 2015, a set of 17 provisional SDG’s with indicators was proposed.  SDG 3 is “Ensure healthy lives and promote well-being for all at all ages.” Associated with this SDG are 13 proposed targets, three of which pertain directly to maternal and newborn health; one to health care accessibility and one to health care availability.

  • Target 3.1 – By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.
  • Target 3.2 – By 2030, end preventable deaths of newborns and children under 5 years of age.
  • Target 3.7 – By 2030, ensure universal access to sexual and reproductive health-care services, including for family planning, information and education, and the integration of reproductive health in to national strategies and programmes.
  • Target 3.8 – Achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.
  • Target 3.c – Substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially least developed countries and small island developing states.

These targets are clearly needed. However, I strongly argue the indicators associated with several of these targets are vague and lacking in the specificity required to drive action forward.  For example, one of the indicators for target 3.1 is simply listed as “Skilled birth attendance” without any reference to the kind of skilled birth attendance or a benchmark for monitoring success. Failure to set an indicator for the proportion of women having care from a skilled and qualified midwife is missing a great opportunity. There is clearly more work to be done if the SDG’s are going to be the driving force that they could be, to continue to build on recent strides forward in maternal and newborn health.

I believe that irrespective of the SDG’s, there has never before been more momentum to keep driving forward the message that midwives matter and that investing in a high quality midwifery workforce is what’s required to ensure a better tomorrow for mothers and their newborns around the world.

Want to learn more? Follow #IDM15 & @world_midwives 

Cover Photo Credit: H4+ Partnership, Flickr Creative Commons

Celebrate Midwives!

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Today is the International Day of the Midwife. Midwives are essential for women all around the world, whether it is for seeking advice on contraception, sexual and reproductive health, or for life saving interventions during pregnancy and childbirth.

When I ask my sister-in-law, Liza, what she enjoys about being a midwife, she always responds with a heartwarming smile and tells me about helping a woman breastfeed her newborn and the essential connection between mother and baby. She tells me about the importance of a kind and guiding individual for women giving birth. She tells me about the joy of seeing parents hear their newborn baby cry for the first time. Liza is an inspiration to listen to and I believe she has one of the most important jobs in the world.

Today, more than ever, the world needs midwives. It is estimated that 200 000 women and girls die during pregnancy or childbirth each year. 800 women and girls die every day.

That’s like 2 crashed jumbo jets filled with pregnant women and girls, every single day!

The number of women who die during pregnancy and childbirth is unacceptable, and this is not a global problem, 99 % of maternal deaths occur in developing countries. Further, the fact is that for every woman who dies, 20 more experience serious complications that can lead to childbirth injuries like Obstetric Fistula.

Surviving childbirth should not be a stroke of luck, depending on where you are born!

To make matters even worse, it is estimated that infants die at a number ten times that of women and girls who die during pregnancy and childbirth! Infants survival rates are also closely linked to the health and life of their mothers. Saving babies requires us to save mothers too.

But did you know that the majority of the causes of maternal mortality and morbidity are preventable?

What we need in the world today is for women and girls to receive the information to make well-informed decisions about their lives, including their health and their pregnancies. Furthermore, if women had access to the care that they need before, during and after pregnancy and childbirth, women’s lives could be saved. For women to receive quality information and care, access to a midwife is essential.

Midwives are a key to prevention!

It is estimated that 350 000 midwives are needed in the world today, to meet the needs of the hundreds of thousands of women and girls that will find out they are pregnant in the near future.

“Midwives, midwives, midwives!” is what obstetric fistula surgeons repeatedly iterated the importance of at the International Working Group for Obstetric Fistula meeting in Dhaka, Bangladesh in November last year. If there were enough midwives, access to quality contraception, care and information, these surgeons would hopefully be out of a job one day.

There are several organizations that specifically work to educate midwives in developing countries, such as the International Confederation of Midwives and UNFPA.  These organizations set standards for the training of midwives and conduct midwifery training in many developing countries around the world. Educating midwives is essential to increase the number of midwives available in developing countries.

Dr. Edna Adan, who is seen in the above video, works to educate midwives at her hospital in Somaliland. Training a community midwife costs $200 a month. You can support her work of educating midwives by giving to the Edna Adan Maternity Hospital as part of the Raise for Women Challenge on Crowdrise.

Laerdal Global Health is a non-profit organization that creates innovative solutions to midwifery training. They have put together an incredibly light-weight, low-cost childbirth simulator that is specifically made for developing countries, called the MamaNatalie. This birthing model makes it easy to simulate normal to more complex birthing scenarios, covering several of the main causes of maternal death. I’ve seen this model demonstrated and I’m amazed! Here’s a video demonstration:

Leardal Global Health works together with Jhpiego to support midwifery training and decrease maternal mortality through the Helping Mothers Survive initiative. For each MamaNatalie simulator that is bought, Laerdal Global Health donates one! It is interventions like these that are necessary to create sustainable development and save lives.

If anyone who reads this feels compelled to become a midwife, or become involved in training midwives in developing countries, all I can say is, “DO IT!”

You are needed more than ever and we will be celebrating you, not only today, but every day of the year, because you are needed to save lives!

 

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The featured image for this post is from The School of Midwifery at Makeni, Sierra Leone, by Direct Relief on Flickr.