Shared Barriers and Shared Strategies for Midwifery
By Elena Ateva, Maternal and Newborn Health Policy and Advocacy Advisor,White Ribbon Alliance
A new report from World Health Organization, International Confederation of Midwives and White Ribbon Alliance titled, Midwives’ Voices, Midwives’ Realities, highlights the social economic and professional barriers midwives face in their daily work and life. These findings will not surprise any practicing midwife. What might come as a revelation, however, is how pervasive and common those barriers are and how widely spread, defying any economic or geographical borders. These shared barriers also present an opportunity for all midwives to join forces and advocate for the respect that they must be afforded so they can provide the quality, respectful care that women and babies need to be able to survive, thrive and transform our world.
This is the largest global survey involving midwifery personnel to date — 2,470 midwives from 93 countries. The report shows that midwives are highly committed to providing the best quality of care to women, babies and their families but are constrained by multiple barriers including lack of adequate pay, proper medical supplies, and most importantly, a lack of voice. There is a need to redress complex hierarchies of power and transform gender dynamics that play a critical role in the provision of maternity services. Midwives report being disrespected, subordinated by the medical profession and discriminated against based on their gender.
“Obstetricians have taken over childbirth and midwifery personnel work mostly as their obstetric nurses, following orders and discouraged to voice their opinion,” reports a midwife from Greece.
“Midwives should be given as much respect for their expertise in pregnancy and normal birth as the obstetric doctors are given for their expertise in abnormality for pregnancy and birth.” (Midwife, UK)
Shockingly, midwives also report harassment, verbal bullying and at times, physical and sexual abuse at work. In addition, many report inadequate and unsafe accommodation and very low salaries, sometimes not even enough to live on. One fifth of midwives say that they rely on another source of income to survive, leading to exhaustion.
A large number of midwives, 89% of respondents, report that clear understanding of midwifery is vital to overcome professional barriers such as the devaluing of midwifery and medicalization of childbirth. Midwives demand that midwifery should be an independent profession, separate from nursing, and with its own regulations. In addition, midwives should be policy-makers so that the essential contributions of midwifery to maternal and newborn child survival can be reflected in policies.
“Midwives should have their own governing body, as essentially we are not nurses. We are midwives.” (Midwife, South Africa).
“Having midwife managers and supervisors who are part of the management team allows our issues to be more visible and enables the correct decisions to be made.” (Midwife, Peru)
The report indicates that if the voices of midwives are listened to, and if midwives can overcome gender inequalities and assume positions of leadership — quality of care can be improved for women and newborns globally. White Ribbon Alliance is convening a group of more than 40 stakeholders to develop a Global Midwifery Advocacy Strategy that will advocate for strengthening the collective voice and power of midwives and for their participation in global, regional and local policy-making so that policies can be informed by the critical contributions of midwifery for the benefit of mothers and babies. It is only when we join forces that we can overcome these barriers and ensure respect for midwives and respectful maternity care for women and newborns.
The first-ever, groundbreaking global survey of midwives conducted by World Health Organization, International Confederation of Midwives and White Ribbon Alliance, was released on 13 October 2016 in Geneva. Follow #MidwivesVoices to learn more.
