An army of 1,000 midwives

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Giving birth – an African woman’s greatest danger?

For many women giving birth is joyous and empowering. For others, however, it is painful and an agonising process. The situation ascribed to different women is largely driven by a post code lottery that extends beyond country borders. Pregnancy and childbirth complications continue to remain the leading cause of death and injury for women in developing countries. In Somaliland these baneful effects are too well known. According to official statistics, Somaliland has one of the worst infant and maternal mortality rates across the globe. Falling pregnant in Somaliland dramatically increases your risk of death – a risk introduced by post-partum haemorrhages, eclampsia, infections and other child birth complications.

As the country fights against these dismal health outcomes, one of the greatest contributions is being driven by Edna Adan, a retired nurse and her mission to train 1000 midwives in Somaliland.

The Community Midwife programme

Somaliland’s health plight is intensified by numerous external factors but one of the greatest of them all is the lack of appropriately skilled health workforce. In response to this, Edna Adan and her staff at the Edna Adan University Hospital have established a community midwife training programme to improve maternal and child health across the whole of Somaliland.

The Edna Hospital Foundation states ‘since the opening of the Edna Adan Maternity Hospital in March 2002, the hospital has been able to reduce the maternal mortality rate by one-fourth compared to the national rate’. Since its founding, the hospital has trained over seven hundred students, many of them in nursing and midwifery, but the hospital also provides training to pharmacists and laboratory technicians.

Does the world need more midwives?

Across developing countries many hospitals and clinics are staffed by limited number of physicians and in rural areas access is considerably worse. In most regions community midwives are responsible for more than maternal health. They remain critical to educating local communities on wider health issues such as family planning, sanitation, immunisation, nutrition and safe drinking water. The community midwives integrate into local communities so well they often reach areas doctors cannot. The success of Edna’s programme has welcomed the opportunity to open new training facilities in two other cities – these training sites base their courses on the model used by the Community Midwife programme.

Model – how the community midwife programme is increasing manpower

  • It is a two-year training course concentrated on basic nursing skills and maternal and child health.
  • Class room study is combined with clinical training
  • Students must assist a minimum of 60 births to graduate
  • Students are selected from different regions of the country to ensure skills are being spread to all regions of Somaliland.

Lessons to be learnt

  • Bridging the health workforce gap: Allocating resources to build short training programmes to provide skilled birth attendants for communities will help reduce infant and maternal mortality – especially as the local communities wait several years to train doctors and nurses.
  • Urban vs rural dilemma: Recruiting students from all regions of the country will help stimulate an even distribution of health workforce across the country.
  • Pass it on: This community midwife programme commenced with one teacher and approximately 30 students. Once those students graduate they were able to teach other students. Using the cascade model to train students to become teachers is important for rapid scale up and spreading knowledge to different regions of the country.

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Author Information

Kathryn Schulz joined The New Yorker as a staff writer in 2015. In 2016, she won the Pulitzer Prize for Feature Writing and a National Magazine Award for “The Really Big One,” her story on the seismic risk in the Pacific Northwest.

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