UN calls for upgrade in midwifery services globally

June 23, 2011
ABC Radio Australia

Up to 3.6 million deaths could be avoided each year in 58 developing countries if midwifery services are upgraded, according to a United Nations report.

The State of the World's Midwifery 2011 report, released by the United Nations Population Fund and partner organisations, says that 350-thousand more midwives are still needed globally.

In Vietnam, five to seven women still die almost every day due to pregnancy or childbirth. In Cambodia, there is an average of six midwives for one thousand live births.

Presenter: Liam Cochrane

Speaker: Della Sherrat, UNFPA's international coordinator for skilled birth attendants in Laos.

Click here to listen to the audio program (Windows Media)

SHERRAT: Yes in fact Asia as a region has one of the most diverse regions in terms of midwifery needs. We have countries like where you're speaking from in Australia where of course you still have a shortage of midwives there, but many women have access to midwives and to services for midwifery services. Whereas in countries like Laos, only 20 per cent of women have access to any services at all, and Timor Leste equally the same and Bangladesh, and then in between that, there's a huge range. So huge diversities and huge differences across the whole of the Asia region.

COCHRANE: And can you spell it out for us, I mean what are the consequences of not having enough trained professionals to play this role?

SHERRAT: Well we don't want to undermine women's natural confidence in giving birth. Sixty per cent of women will go through pregnancy and birth with absolutely no problems, so we don't want to make birth into a medical emergency. However 15 per cent of women will have some kind of life threatening complication where they do need very expert, even down to having surgery, which is obviously beyond the role of the midwife. But unless you've got midwives there working with women, seeing them throughout their pregnancy, assisting them throughout their birth, then we can't identify which of those women are going to have a problem, because these problems are not easily identifiable, and even though the woman might be healthy, they're not always preventable. So we can't predict them, we can't prevent them totally, so what we have to do is to have somebody there who has got these skills to deal with them, to recognise that's something going wrong to begin with, and then if possible try to do something before they get a serious problem. And then if a problem arises, to be able to do something, which can arise from giving a life saving drug to making sure that the woman is being transferred to the right place and kind of accompany the woman and provide services and provide treatments on the way there so that she can arrive at the hospital for the surgery in a good condition. So many women that we see here in Laos arrive at the hospital and there's very little that can be done for them because they're almost taking their last breath as they're coming in the door.

COCHRANE: Is there a wide acceptance across Asia of midwives and the role of midwives, or are there still cultural barriers?

SHERRAT: Yes, yes, well that's one of the biggest problems is that because for generations women have been having birth particularly here in Laos and some parts of Cambodia and Vietnam and other places, just on their own, then there is a reluctance to sort of call in any health services. But of course in some of these countries within our region here we have very poor services that don't reach out of the urban cities. And of course where you have large populations, particularly women, who are living still in the remote rural areas, then they just don't have access to the services, even if there weren't these cultural taboos. But there are many cultural taboos, many communities don't want to be seen by a male for example. Very often it's very difficult for girls to leave their communities and go and train to become a midwife or a health provider. So most of the health providers are men, and this then causes problems that people don't want to use them during pregnancy, particularly during childbirth. But then there are all these cultural issues around birth and around the spirits and making sure that it's seen as a kind of fatalist thing that if people have been good then the spirits will look after them, and there's no need for health services. So there's just a lack of knowledge that although the majority of women will go through pregnancy and childbirth with no problems, that really all women need to have the skills attendance that a midwife can give, and can be connected to the hospital so that if they need be there can be a rapid transferral for her and her baby. Many more babies die as well, it's not just mothers who are dying because of the lack of care, newborn babies are dying because there is no skilled person when they're born to look after them.