Sanaa, Yemen/ Mogadishu, Somalia/ Cairo, Egypt – Armed with a first aid kit mainly containing obstetric drugs and tools used for prompt resuscitation of babies, Mrs. Arwa Molatf goes around the southern city of Taez, in war-torn Yemen, a precarious journey she takes several times per week to reach women in need.
The crisis, now in its third year, has exacerbated the situation for 352,000 pregnant women in the country, of whom 52,800 women face life-threatening delivery complications in a country that already has one of the highest maternal death rates in the Arab region.
The ongoing conflict has caused the closure of more than half of the country’s health facilities. It has also inflicted extreme damage to roadway infrastructure linking main directories, forcing Mrs. Molatf to duplicate her efforts to cope with the pressure.
“Midwives now work day and night to save lives of mothers and newborns. I oversee 5 deliveries per week, mostly for poor, marginalized and displaced women,” Molatf who has been providing midwifery services for 22 years now, said.
Molatf describes a wide range of hardships facing midwives, including difficulties in transferring women with delivery complications to more specialized hospitals, and a chronic shortage of emergency drugs that could save the lives of mothers and newborns.
Saving lives but not officially recognized
Midwives are more likely than doctors to remain in post during crises, often finding themselves expanding their services to cover up for the lack of specialized medical personnel. Some Arab countries though do not fully acknowledge midwifery as an independent and autonomous profession, while others do not have a recognized definition of professional midwives.
“I act according to what I have studied and the available tools. I stay with mothers and consult over the phone with an obstetric physician,” Molatf said. “What I mostly encounter with women who are poor or displaced is lack of awareness related to pregnancy and delivery,” she added.
The conditions were no less difficult in the Yemeni capital city, Sanaa, where another veteran midwife has been providing services for 28 years. Arwa Radman was forced to suspend her work for several weeks in 2015, when a rocket landed near her house, inflicting severe damage to her clinic and tools.
Midwives need training, support and security
Properly educated and enabled midwives are effective providers of sexual and reproductive health services, so efforts to make health systems more resilient to crises will be more successful if they involve a strong focus on midwives.
In crisis-affected countries like Yemen and Somalia, their work is not limited to obstetric care and deliveries. They provide sexual and reproductive health consultations, support and promote healthy families and do outreach activities in their communities.
However, faced with a lack of proper financial and security support, the current situation has forced midwives like Mrs. Radman and others, to work more independently and hope for the best.
“Because of the dire circumstances, nobody pays me anymore. I work mostly for free now or provide consultations over the phone. I offer midwifery service at homes because I have no clinic and my house was damaged,” said Balqis al-Twiti, another midwife from the Yemeni capital city.
UNFPA as a key midwifery supporter
UNFPA has provided support to over 600 midwifery schools globally, including by providing them with training materials, books and equipment.
Fardowsa Abdulkadir Smatar from Galgadud- Dhusamareb, Somalia, a recently graduated Somali midwife explained that she chose this profession out of her realization that Somali women and their children are the most vulnerable group in her community.
“The main reason why I have chosen this noble profession is to save the lives of mothers and their newborns,” she said.
UNFPA works closely with the International Confederation of Midwives (ICM) and a network of over 40 global partners and hundreds of regional and national partners, including ministries of health, education and human resources for health, midwifery associations to strengthen midwifery globally.
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In the Arab region there are some signs of reforms benefiting midwives in several countries, including Morocco, Tunisia and the United Arab Emirates.
“The Moroccan government has given a high importance to midwives by strengthening their skills, establishing adequate regulations for the midwifery practice and improving midwives working environment,” Ms. Hanane Mosbah who also is General Coordinator of the Arab States Regional Midwifery Network said.
“There is a growing interest in the role of the midwife in the Abu Dhabi government, which supports the development of the profession. There is a growing commitment to provide evidence on the effectiveness and safety of midwifery practice,” she added.
