The government needs to urgently increase its investment in the midwifery workforce and midwife-led continuity of care to create an enabling environment, promote quality delivery and support sustainable maternal and new-born health services, The New Times heard yesterday. Speaking exclusively to this publication on the International Day of the Midwife, celebrated on May 5, the President of the Rwanda Association of Midwives; Josephine Murekezi said that there are still challenges especially based on the small number of midwives as compared to the demand, making service delivery challenging. “We have only one midwife in every health center and this means that she or he is required to work 24 hours, seven days a week which of course is impossible. We are supposed to have four midwives so that if one is on day duty, another one comes in on night duty. While one is taking her day off, there should be a replacement just in case,” she said. According to the 2014 State of World’s Midwifery report, only 59 per cent of Rwanda’s midwifery needs are being met by the country’s existing health workforce. It should be noted that midwifery is not limited to expectant mothers. Midwives also provide sexual and reproductive health information, family planning counselling, antenatal care, new-born and postpartum services, and they help to combat HIV. The numbers Murekezi said that despite the challenges, the number of midwives have improved over the years, rising from five in 1995 to the current 2,142. “When the first midwifery school started in 1997, the first intake had 16 female midwives and it has since grown to the number we have today but we need the government and its partners to invest more in this profession so that the numbers can grow,” she said. In 2000, as part of the Millennium Development Goals, countries around the world committed to reducing their maternal mortality rates by at least 75 per cent by 2015. Rwanda is one of only nine countries to have achieved this goal. According to the Ministry of Health, although maternal deaths were cut by more than half in less than a decade, the country continues to register high cases of maternal deaths. An estimated 210 out of every 100,000 women succumb to maternal mortality as compared to 487 deaths 2010. The Ministry’s death audits list postpartum hemorrhage, complications of prematurity and fetal distress among the main causes of maternal mortality in the country. Postpartum hemorrhage is the loss of more than 500ml or 1,000ml of blood within the first 24 hours following childbirth while fetal distress may occur when the pregnancy lasts too long when complications of pregnancy or labour occur. However, according to the 2015 ‘Trends in Maternal Mortality’ report, a woman in Rwanda has a 1 in 85 chance of dying of pregnancy-related causes in her lifetime. By comparison, a woman in Norway faces a 1 in 11,500 chance of dying from such causes. Murekezi called on the midwives to celebrate their achievements and encouraged them to be united and work as a team towards a common goal of gender equality. She said that Rwandan midwives have been working with Ethiopia and Tanzania on a project called ‘50 Happy Birth Days’ and the teams have achieved their set goals of mentoring all midwives across the country. COVID-19 and maternal health Murekezi touched on the issue or maternal health in relation to the COVID-19 pandemic, pointing out that there are no known risks of severe illness or foetal compromise for pregnant women. “So far we have not had any pregnant women who tested positive with COVID-19. We are prepared and we have protective equipment in case there is one,” she said. This can be attributed to the inadequate number of health workers trained in essential midwifery skills to meet the country’s need for sexual and reproductive health care. Organisations like the United Nations Population Fund (UNFPA) are partnering with the government to boost the number of competent midwives by strengthening midwifery education, regulation and associations. Speaking to The New Times, the UNFPA Country Representative; Mark Bryan Schreiner congratulated the midwives in Rwanda describing them as the backbone of healthy families and communities. “In Rwanda, UNFPA supports national efforts to strengthen and protect the maternal health workforce, providing safe and effective maternity care to women and their babies through quality education. We also enable and support regulations as well as strengthening Rwanda’s midwifery associations,” he said. According to the World Maternal Index by the World Health Organisation, UNFPA and UNICEF, the average maternal mortality rate in Africa is 400 deaths for every 100,000 women, and twenty times higher than the average for industrialised countries.
