White Ribbon Alliance

women in health centre (683x1024)


June 23, 2014
Brigid McConville

The new Lancet Series on midwifery will be music to the ears of activists for women’s rights and health the world over. We have been saying for a long time that the world needs midwives more than ever. Now we can prove – in detail - what a massive difference midwives can make.

“Application of the evidence presented in this Series could avert more than 80% of maternal and newborn deaths, including stillbirths,” according to Lancet editor Richard Horton. “Midwifery therefore has a pivotal, yet widely neglected, part to play in accelerating progress to end preventable mortality of women and children.”

We have already made tremendous progress. Cutting maternal deaths around the world by half in the past decade is a huge - yet largely unsung - achievement.

How can we now apply this new evidence to tackle the remaining half?

Our experience in White Ribbon Alliance is that lasting change comes when citizens know their rights and demand accountability from governments and others who are responsible for promised improvements.

This new Lancet evidence will be used by White Ribbon Alliance members around the world as they put pressure on their governments to invest not only in midwives but in quality care. And care cannot be of good quality unless women – and midwives – are treated with respect.

As you will know, the White Ribbon Alliance Charter for Respectful Maternity Care has really taken off in recent years. The abuse suffered by women in pregnancy and childbirth at the hands of health care workers was once a taboo subject, but it has been midwives themselves who have broken through this taboo, leading the charge for improvements not only for the women they care for but within their own profession.

The Charter has provided a springboard for action in many countries. For instance, in Nigeria, the Minister of Health recently endorsed our call for Respectful Care, writing a memo which was then endorsed by the National Commission on Health, including all State Commissioners. Now in Kwara State – in a global ‘first’ - the White Ribbon Alliance is bringing communities together with health workers and the state government to make sure that Respectful Care is built into the health system, and that policy is turned into practice.

But how will we test that health care is truly respectful, truly of quality? We know that ‘training’ in Respectful Care is not enough, just as we know that governments and policy makers cannot be left to ‘mark their own homework’. Only the women who use the health system, and the midwives who work in it, can give a true picture of the realities and the action needed.

To provide this true picture, White Ribbon members in India are gathering feedback from women on the quality of care they receive through a free mobile phone service. This citizen led evidence, gathered by consumers of health care about their own experiences, will be even more powerful in combination with the Lancet evidence launched today.

Meanwhile the midwives who want to see a better system are also speaking out about the lack of respect meted out to them as health workers. In Tanzania, White Ribbon members – facing a disastrous drop from 200 to 20 new students in a leading midwifery college - called communities together to talk about midwifery as a profession. After holding discussions in schools with parents and pupils alike, the new intake to the midwifery college was doubled.

In Malawi, midwives have been challenging the lack of a career ladder in their profession, and refusing to remain invisible amid the ranks of nurses. Lennie Kamwendo cheered us all at the ICM in Prague recently by telling us how in Malawi midwives have succeeded in re-naming the ‘Nursing College’ as the Nursing and Midwifery college, and that there are plans afoot for midwives to have distinctive uniforms in recognition of their vital and unique skills.

These are small but significant steps, for we will simply not have the midwives we need to deliver quality care if young people are not attracted to midwifery as a career. We will simply not keep the midwives we need if they are not then employed, regularly paid, and provided with the means of a safe and decent way of life for themselves and their families.

It should go without saying, but if we are going to use the evidence of the Lancet to bring real and lasting change in countries, we have to listen to the voices of women and midwives in those countries. And what they are saying is that unless women know that they will receive quality and respectful care, they will not go to the health centres that could potentially save their lives. And unless action is taken to make midwifery a more attractive career, we will not have the midwives needed to bring about change.

Yet with enough midwives – providing quality respectful care to women wherever they may live – we now have the evidence to say that we can put an end to the scandal of preventable deaths of women and newborns.

So we thank the Lancet and look forward to using this evidence to fuel our actions for change for all women and midwives.