Shortage of midwives, a bottle neck in health care provision

Shortage of midwives is still a challenge as Rwanda seeks to achieve goal 3 of the Sustainable Development Goals - Maternal and Child Health.
Some of the participants follow proceedings at the event. (Teddy Kamanzi)
Some of the participants follow proceedings at the event. (Teddy Kamanzi)

Shortage of midwives is still a challenge as Rwanda seeks to achieve goal 3 of the Sustainable Development Goals — Maternal and Child Health.

This was said during celebrations to mark the International Day of the Midwife, held at the University of Rwanda’s College of Medicine and Health Sciences on Thursday.

Andre Gitembagara, the president of the Rwanda Nurses and Midwives Union, noted that although nurses and midwives contributed to the country’s achievements in MDGs, human resource gaps still remain. 

“Nursing and midwives contributed a lot in MDGs which ranked Rwanda among the best countries in achieving MDGs. The profession is now well regulated in the country, with good policies, standards, scope of practice, code of conduct and school regulations.”

“We, however, have a gap of 45 per cent in health centres and 20 per cent in district hospitals of the recommended workforce.

‘‘There are 1, 238 registered midwives in the country compared to the required 4,000 midwives.

This leaves room for traditional birth attendants to continue helping in deliveries,’’ he said.

Gitembagara noted that although the Ministry of Health recommends posting of A1 midwives or nurses in the maternity ward, there is no budget for that.

As a result, A2 nurses, assist in health centres at night and weekends which puts mothers and babies’ lives at risk.

WHO recommends one skilled birth attendant for every 175 pregnant women, but many developing countries like Rwanda have only one midwife per 8,600 births. 

Josephine Murekezi, the president of Rwanda Association of Midwives cited low salary as a major challenge in promoting midwifery in the country.

“Midwifery as a profession is not well known and supported. Many students do not choose midwifery as a profession although there is an indication that the situation is changing... There are over 35 midwives who graduated from midwifery but currently not employed due to salary issues,” she said.

According to recent evidences from Lancet Series (2014 ) , 83 per cent of all maternal deaths, stillbirths and newborn deaths could be averted with the full package of midwifery care including family planning. This requires midwifery personnel to be trained to international standards.

United Nations Population Fund (UNFPA) Rwanda Representative, Jozef Maeriën, called for joint efforts to invest in midwifery as a way of reducing maternal and newborn deaths.

“Well-trained and supported midwives working in communities are uniquely positioned to provide the compassionate, respectful and culturally sensitive care a woman needs during pregnancy and childbirth. Midwifery is equally important for newborns during the first month of life, and is a significant contribution to sexual and reproductive health in general,” he said.

“Significant investments in midwifery are essential if the world is to achieve its ambitious goals of reducing maternal and newborn deaths. These critical health-care providers can help millions of women to give birth safely each year, but much more needs to be done.”

The role of midwifery in reducing maternal and neonatal mortality in Rwanda has been crucial during the past decade. As per the recent data the neonatal mortality rate stands at 20/1000 Live births and the maternal mortality ratio has dropped from 487 per 100,000 live births (2010) to 210 /100,000 live births (2015). Currently Rwanda has eight midwifery schools with more than 1,100 midwifery in services.

UNFPA supports the Rwanda Association of Midwives to bring midwives together in order to combine efforts to address challenges which are still facing midwifery through advocacy.

This year the theme of the International Day of the Midwife is “Women and Newborns: The Heart of Midwifery.

“This theme reiterates the central role of midwives as the global community strives to achieve the Sustainable Development Goals of reducing maternal and newborn mortality and ensuring universal access to healthcare services.