Somalilandsun: Around the world, women lack adequate access to quality health care, which make pregnancy and childbirth difficult and, in some situations, fatal. Midwives provide crucial maternal care in many parts of the world and can help mothers and children lead healthy lives before, during, and after birth. The UN’s Global Goals for health and well-being (Goal 3) and gender equality (Goal 5) both address the need for providing adequate reproductive and health care for all.
Midwifery matters for all childbearing women, their babies and families, wherever in the world they live and whatever their circumstances. Evidence shows that skilled, knowledgeable and compassionate midwives and the care they provide reduce maternal and newborn mortality and stillbirths, keep mothers and babies safe, and promote health and well-being. Consequently, midwifery has a positive impact on the wider health system, and the economic sustainability of communities and countries.
Midwifery is a key cornerstone of Somali reproductive, maternal, newborn, child and adolescent health. To date, investments in the profession have focused on the training and employment of midwives; however, in order to maximize the potential of the profession, development is needed in all areas to best serve Somali families.
The need for education to provide a highly competent, qualified workforce
The first pillar of a strong midwifery profession is education, to provide a highly competent, qualified workforce.
Since 2009, UNFPA has supported the establishment of 14 midwifery schools across the country. The schools are currently providing quality midwifery training to 600 midwife students enrolled from rural villages who after graduation are able to provide quality midwifery care. Around 2,000 midwives have graduated from 14 of the UNFPA-supported midwifery schools since 2009 and are currently working in urban and rural setting across Somalia.
In 2016, UNFPA supported the development of a nationally and internationally recognized midwifery curriculum, as well as the revision of said curriculum in 2021. The undertaking was done in collaboration with the Ministry of Health Somalia and with technical support of the Canadian Association of Midwives and the University of British Columbia.
UNFPA has also supported the development of the Midwifery Strategic Document (2018-2023), containing key strategic objectives for a five-year plan: (1) approaching the regulation of midwifery and health professionals through the regulatory body development and legal frameworks; (2) strengthening and investing in midwifery education and research to improve availability and practice for the Somali population; (3) enhancing employment and deployment of the recognized midwifery workforce to ensure equity in accessibility, improving the work environment to enable maximum impact; and (4) improving midwifery practice through the strengthening of protocols, norms and guidelines, as well as strengthening supportive supervision and midwifery leadership.
The need for regulation of midwife activities
The second pillar of a strong midwifery profession is the regulation and certification of midwife practitioners.
In 2020, UNFPA assessed the status of the midwifery regulation in Somalia, with the technical support of the Canadian Association of Midwives. The strengths and gaps of these associations were identified and recommendation made to improve the midwifery regulation.
Similarly, UNFPA has supported the training of midwives on midwifery regulations so that they are able to better understanding the importance of midwifery regulation in maternal health and principals to establish midwifery regulatory frameworks.
The need for members to organize themselves in strong associations
The third pillar of a strong midwifery profession is the organization of members in strong associations.
Since 2010 UNFPA has supported the capacity assessment of three Somali midwives’ associations: Somaliland Nursing and Midwifery Association; Somali Midwives’ Association; and Puntland Association of Midwives.
UNFPA has assisted in building leadership capacities and advocacy skills of these members, empowering them to promote the midwifery profession and championing Sexual and Reproductive Health (SRH) and Female Genital Mutilation (FGM) abandonment across Somalia.
Despite UNFPA’s continuous efforts, challenges remain in the midwifery profession in Somalia. The most urgent gaps pertain to the lack of adequate infrastructure, such as beds and physical space, as well as logistical challenges, such as insufficient supplies and poor referrals to save lives during emergencies. Additionally, and in spite of the positive increase in midwife graduates, there remains a shortage of practicing midwifes in rural areas due to the limited financial capacity to absorb trained midwives into the health system. Furthermore, for the practicing midwives there is a lack of motivation and limited in-service training opportunities, due to insufficient work-related security and a lack of an equitable remuneration system.
In reality, midwives do much more than supporting women to birth babies: they deliver accessible, equitable, and high-quality sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) care in diverse settings across the globe, across the childbirth continuum, and across Sexual and Reproductive Health and Rights (SRHR).
According to the World Health Organization (WHO), UNFPA and other global authorities, there is an urgent need for SRMNAH care to be delivered by professional midwives who possess expertise not currently supported in most health systems. Midwives are also a cost-effective, critical solution to improve health outcomes and experiences for women and newborns, reduce health inequities in access and quality, and provide the continuum of SRMNAH care. Nevertheless, as Somalia, the majority of countries across the globe encounter barriers in developing and sustaining the enabling environment required to scale midwife-led continuity of care.
On the International Day of the Midwife, UNFPA reiterates our continuous support to midwives and the midwifery profession in Somalia to ensure better health for all.