Midwives: Heavy workload undermines childbirth care

During a recent survey on the state of midwifery in Kenya, Christine Adhiambo (not her real name), a midwife in Kisumu County, said they endure many challenges.

Adhiambo said many patients in maternity wards were being attended by one midwife on duty for the entire day. She said the hospital where she worked was understaffed.

“I would like staff to be increased because we have a shortage. We are supposed to follow up on a mother’s progress up to 24 hours after delivery. These patients are not being followed up. If a mother has an issue, she will stay with it or go to another facility,” she lamented.

Career stagnation

Another midwife in Vihiga expressed concern about a lack of career progression and support from the county, despite many of them furthering their studies. She said they have been asking for better contracts like those of their colleagues in other fields, given their capacity.

“We are not paid according to our qualifications which discourages others from pursuing further education as they are not happy getting little pay despite having higher qualifications,” she said.

The grievances are just but a tip of the iceberg of a worsening situation as depicted by many of their colleagues who were also interviewed.

And a report, Midwives Voices, Midwives Demands, by the White Ribbon Alliance Kenya (WRA Kenya) has now lifted the lid off the bad state of midwifery in the country. It shows 71.9 per cent of midwives cited heavy workload and understaffing as great impediments to the provision of quality and dignified care to women and girls.

Gendered struggles

The midwives say they continue to face persistent and gendered struggles in pursuit of their economic rights, singling out pay inequity, lack of recognition and autonomy in their roles, and lack of a clear career pathway as some of the thorny issues that need to be addressed urgently.

Not being prioritised for personal protective equipment (PPE) and being omitted from Covid-19 vaccine priority lists also feature prominently among their grievances.

Angela Nguku, WRA Kenya executive director, said lack of a career pathway or professional recognition of the midwives’ roles prevent them from attaining formally recognised training, accessing positions with higher pay, and having a voice in health system leadership to raise the profile of their work.

Ms Nguku added that the Covid-19 pandemic has exacerbated the pre-existing challenges, resulting in unintended pregnancies, a decline in accessible, facility-based care, and increased demand for midwifery services.

“Midwives have not been prioritised for PPE and are omitted from vaccine priority lists in countries where they are not considered formal health professionals. Yet, midwives cannot cease work, just as women’s sexual and reproductive health needs do not cease during pandemics,” she said.

To improve their welfare, the midwives have demanded clear career progression guidelines. They also want to be recognised as professionals and allowed to participate in decision-making in matters pertaining to their profession.

Decision-making

In addition, they want to be involved in leadership and to provide autonomous care in partnership with other care providers.

Training of young midwives and recruitment of mentors to mould them into the professional practice and ensure continuity of the profession is another a top priority for them.

To enhance service delivery, they want counties to provide adequate drugs, non-pharmaceutical supplies, delivery equipment, and adequate physical space to serve clients while honouring their privacy and dignity.

According to the United Nations Population Fund (UNFPA), there is currently a Global shortage of 900,000 midwives, a situation that threatens women’s lives and health. The sexual and reproductive health agency says the global midwifery workforce now stands at 1.9 million, about two thirds of what is needed.

UNFPA notes that fully supporting midwifery could avert 67 per cent of maternal deaths, 64 per cent of newborn deaths and 65 per cent of stillbirths, saving an estimated 4.3 million lives yearly.

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