Today is the International Day of the Midwife! You might wonder, what is a "midwife?" And, why is there even a special international day celebrating them? I will explain, but before I do that, let me first talk about something totally different: airplane pilots!
Anyone who enters an airplane knows there is a pilot in the cockpit; someone who has been thoroughly trained in how to fly an airplane, who can manoeuvre the plane, who knows how to deal with emergencies, in short, someone who is responsible for our well-being and lives during the flight. We feel confident that the pilot in our plane has undertaken the right education, received the right supervision and training, and now possess the experience and skills to take us safely from one airport to the other. We also know that the pilot will have conducted regular (refresher) trainings and quality assessments according to international standards to be able to continue his or her work. So, a pilot is a professional, with the right education and training. None of us would ever consider entering a plane if we weren't assured of this.
What has that to do with midwives? In Bangladesh, the maternal mortality ratio dropped by a whopping 40% in the last 10 years, the risk of a maternal death is now down to 1 in 500 births, and thus a rare event! By any standards, this is a remarkable achievement! But still, more than 20 women lose their lives each day when giving birth! Approximately 15% of all deliveries may develop complications. However, our ability to predict which woman may experience potentially fatal obstetric complications is poor, and that is why all women should deliver with the assistance of a skilled birth attendant to identify and manage complications and/or refer her to a better equipped health facility. Still, out of every three pregnant women, two are delivering at home; many of them assisted by an untrained, unsupervised "provider," often a traditional birth attendant, locally known as "dai." Many maternal deaths occur to young women lacking the access to a skilled provider at birth. Isn't it strange then that when it comes to flying, we expect a trained pilot in the cockpit, but when it comes to delivering our babies, we let our women be assisted by an unskilled, untrained "provider?"
You may ask, if maternal mortality decreased by 40% over the last 10 years, why do we still need midwives? Quite simple: to go the last mile in order to achieve the Millennium Development Goals 4 and 5, global evidence suggests that investment in midwives is the only sure way of further decreasing maternal mortality. A midwife has many similarities to a pilot. A midwife is a highly skilled professional who is responsible for women and children's health and well-being when providing reproductive and maternal health care. She has to know how to communicate with expecting mothers, their families, and other health care providers to provide quality care.
Communities trust her with the lives of wives, mothers and children, relying on her quality education, training and judgement for the provision of proper care, and the efficient functioning of the health care system. In short, midwives are an absolute essential workforce in further reducing maternal and neonatal deaths. It's a no-brainer, but sadly, even in the 21st century, pregnant women do not die of illnesses we cannot treat; they die because we haven't made their health and well-being our priority!
The good news is that for over a year, Bangladesh has been educating and training midwives according to international standards. This is a significant and highly commendable step in the right direction towards achieving MDGs 4 and 5 by 2015. So far, 180 midwives have graduated, out of a target of 3,000 by 2015. Still a small number, but this represents an important milestone towards improving maternal and neonatal health care in Bangladesh. This initiative followed Prime Minister Sheikh Hasina's Commitment to Maternal and Child Health that she presented during the 2010 MDG Summit in New York. The initiative to educate midwives in accordance with international standards illustrates a strong national commitment to save the lives of our mothers. But beyond that, the other real significance of this commitment lies in the fact that the standards and quality of midwives are not negotiable!
By providing a trained and strengthened faculty for the midwifery programme and developing a curriculum according to the standards set by the International Confederation of Midwives (ICM) for the education of midwives, Bangladeshi midwives will be as professional as those in other countries. The government has also taken the lead in strengthening the regulatory body for midwives. Regulation is not only needed for the practice of midwives, it is also to assure society of the quality of care that midwives provide. This regulation is important, as it will mean that anybody who is not trained/educated in accordance with these standards cannot use the title of "midwife," or practice as a "midwife." In the same way a pilot cannot take shortcuts in his or her training without putting the lives of others at risk, no shortcuts can be taken when training midwives. Should we confuse the capacity of someone to provide midwifery services as being a "certified midwife," we would be committing the same error as calling someone a "doctor" only because he or she has doctor-related skills. So, in future, when a woman seeks health care services from a midwife, she is guaranteed a high quality care.
Today, countries all over the world are observing and learning from Bangladesh and its approach to midwifery development. This gives it a golden opportunity to set the standard of what constitutes good maternal health care for women in the region. But most importantly, by investing in midwives, the country is developing the most sustainable solution for battling maternal mortality and morbidity for many generations to come. We salute Bangladesh for taking this bold and courageous step towards investing in midwives. Congratulations and Happy International Day of the Midwife!
This story was first published in The Daily Star.
