International Day of Midwives

My experience of midwifery encompasses both personal and professional lives. First, like many Ugandans, I carry the “mothering’ experiences of my family, good and tragic. Secondly, I am privileged to be among the practitioners and educators of midwives in UgandaTherefore, when I was invited to speak at the International School in Mbarara, I wanted to blend the stories that are familiar to me and the professional group that strives, every day, often under impossible conditions, to bring life safely into the world. Midwives shape the story of a nation. We ought to remember that.

 Our Story 

I would like to start this conversation with a personal story. It is not the story of one, but of every woman (around the world) who will die in the next 90 Seconds in pregnancy or childbirth. It is the story of more than 350,000 women who die every year due to pregnancy-related complications. This is still the story of 368 women out of 100,000 recorded live births who will die in Uganda this year. The majority of these are preventable. This is still the story of 368 women out of 100,000 recorded live births who will die in Uganda this year.

This is the story of my beautiful cousin Betty; Young, vibrant, brilliant mathematician, and a beloved mother of four. It is the story of my beautiful niece and her beautiful little one both of whom did not survive complications related to childbirth. It is also the story of my sister-in-law, and Her beautiful little one (2006) Both of whom...again, did not survive complications related to childbirth. And, It is the story of my mother and her little one (1982) Both of whom did not survive the pregnancy-related experience.

Ladies and gentlemen, this is our story. It is your story. It is the story of your sister, mother, aunt. It is the story of beggars, members of parliament and, ministers. This is the story of a nation...our nation! And I want to tell you, we have someone, some people, who can shape and change this narrative and the story for better.

These are interlinked narratives. Let me tell you, therefore, about this other story...the story of the Midwives and the Nation: professional women (and men) who tirelessly shape our story—for better, or for worse. Midwives are in charge of more than 2 million babies born every year in Uganda: that is over 5,500 babies every day and 10,000 lives if you count the woman and the baby.

Yet a gap of 883 midwives’ positions in HC IIs alone exists countrywide (UNFPA, 2019). We have 7 midwives per a1000 live births. This means a single midwife conducts between 300-500 deliveries a year under often challenging circumstances, and less than ideal conditions and the gap at health facility level does not address the actual need given the increasing Ugandan population (UNFPA, 2017).

Here are some Must-know Facts;

  • Properly trained, midwives are able to provide 87% of essential maternal care (UNFPA, 2019)
  • And, they reduce the burden on doctors and other health professionals
  • Studies indicate that access to skilled midwives/attendants will mitigate child-birth related complications by up to 88% (State of the World Midwifery, 2014)

Sadly, as important as midwives are to the nation, corresponding investment in their; Education In-service Training, Resources, and Workplace-Conditions have remained largely lacking.

We are not a nation that can afford inaction So why aren’t we all rushing in? Why are we comfortable with our story when we have a workforce that can effectively shape and change it for the better? Where do we start?

Midwives are uniquely positioned to address and support most of the healthcare gaps that impact midwifery services across the country, they’re cost-effective and are often more trusted by communities worldwide. Recognizing the change must begin with us. I want to pose a challenge that has a little more to do with us—The Nurses and Midwives, as we continue to lobby for the much-needed investments and reform in these critical domains like education, In-service training, resources, and working conditions. We need to do some work. It starts with us. Today, I would like us to look inward first. It seems to me, that beyond the rhetoric we have grown accustomed to disempowerment.  

The problem with the disempowered house is this: there is a tendency that nothing can be engineered from within. The solution must come to us, not from us. This dangerously justifies our disengagement from the problem. And just as the world must learn to ask us the right questions and engage better with the issues that impact our professional practice; We too must begin to transition from this narrative—we are demoralized, but for us...we need help; we are disenfranchised; we are disempowered.

I love a recent idea from a friend: that change, important change, means that we are transitioning the nursing and midwifery workforce from “thermometers who gauge the temperature of the room to professionals who are commanding the Narrative—shaping our story. To becoming the Thermostat –Regulators who set the temperature of the profession. To Making ICT Work for us, to telling our story—we are shaping it, why can’t we tell it? And to finding Champions for our cause. Let’s start... I will take it with you.