Midwives to change maternal, child health scenario

Bangladesh is set to witness a new era in healthcare with the introduction of professional midwives who can dramatically improve the quality of maternal and child health.

Taking examples from developed countries, mainly Europe, which has performed remarkably well by introducing specialised midwifery some 300 years back, Bangladesh has already begun training and recruiting midwives in upazila and union health facilities.

Some 1,400 certified midwives have already been recruited while 600 more, the first graduates of a three-year diploma programme, will be deployed soon.

“We have estimated at least 20,000 professional midwives will be required for Bangladesh,” said Prof Habibe Millat, MP, at the two-day Third Global Midwifery Symposium which opened at Copenhagen yesterday.

“We have begun the recruitment, and will complete recruiting the required number in near future,” he said representing Bangladesh.

The UN Population Fund, World Health Organization and the International Confederation of Midwives organised the symposium at Bella Centre as part of a four-day 4th Global Conference of Women Deliver beginning today.

Addressing a session, Prof Habibe said, “Introducing professional midwifery as an autonomous profession is the beginning of a new era in Bangladesh's health systems.”

He expects professional midwives to make a significant contribution to maternal, newborn, sexual and reproductive health in Bangladesh.

The introduction of specialised midwives in Bangladesh began after Prime Minister Sheikh Hasina announced in a United Nations assembly in 2010 to recruit 3,000 by 2015.

The issue is of paramount importance if maternal and newborn deaths are to be reduced in line with the Sustainable Development Goals (SDGs) announced by the UN in September 2015.

According to the SDGs, maternal mortality has to be brought down to 70 per one lakh live births and newborn mortality to 12 per 1,000 live births by 2030 globally.

According to the June 2014 issue of The Lancet, a globally acclaimed medical journal, every year there are an estimated 139 million births globally.

Of them, an estimated 289,000 women die during pregnancy, childbirth or soon after while 2.6 million suffer stillbirths and 2.9 million infants die in the first month of life.

A majority of these deaths occur in the developing world, mostly in Africa and Asia. “Poor quality maternal and newborn care is a major factor,” it said, suggesting expanding midwifery.

The Lancet defines midwifery as skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families throughout pre pregnancy, pregnancy, birth, postpartum and the early weeks of life.

They are to conduct all normal deliveries but will refer pregnant women to gynaecologists only when complications arise.

According to the UNFPA, professionally trained midwives can provide 87 percent of essential maternal and newborn care.

The Lancet said even in low resource settings, maternal and newborn mortality and stillbirths could be reduced by 27 to 82 percent.

“In that case, specialist doctors can handle only the emergency cases that eventually enhances the possibility of survival,” said Dr Malin Bogren, an international midwifery specialist working for UNFPA Bangladesh.

Besides, the total quality of maternal and newborn care improves, she told this correspondent.

Rebecka Orrenius Alffram, senior programme specialist (education and health) of Swedish International Development Cooperation Agency (SIDA), told the symposium that maternal mortality in Sweden was some 900 per one lakh live births in 1711, when the country introduced professional midwifery.

Today, like most European countries, Sweden has maternal and newborn mortality of 0 to 3 per one lakh live births a year, she said, highlighting the profession's importance.

According to the Bangladesh government data, maternal mortality is 170 per one lakh live births though the MDG target was 143, while under-five child mortality is 43 per 1,000 live births.

Prof Habibe said doctors in Bangladesh remain mostly in towns, for which midwives could play an enormous role in improving maternal and child health.

Some 700 to 800 students are enrolling in midwifery diploma course per year while 31 midwifery teachers were enrolled in the online master's programme of a Swedish university.

“Our prime minister has announced providing scholarships if any midwife wants to do PhD in it,” he said, adding that relevant laws and policies were also on the cards.