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OPINION: Midwives are more important now than ever – let’s help them help us

by Simon Cooke and Sylvia Hamata | Marie Stopes International
Tuesday, 5 May 2020 08:00 GMT

* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.

This International Day of the Midwife, it’s time we helped them help us

Simon Cooke is CEO of Marie Stopes International and Sylvia Hamata is Young Midwife Leader at the International Confederation of Midwives. Both are SheDecides Champions.

Delivering a baby is just one part of being a midwife. This International Day of the Midwife, we want to highlight the least talked about aspect of midwifery: providing safe abortion and post-abortion care.

The meaning of midwife is ‘with woman’. By providing information and services, midwives are essential in enabling women to exercise their reproductive and sexual rights and choices. In some cases, this will mean assisting a woman with the birth of their first child. In others, it will mean supporting a woman to end a pregnancy or providing a woman with life-saving post-abortion care following an unsafe abortion.

Under COVID-19, the role midwives play is more important than ever. With lockdowns forcing women to stay home, or isolated in remote communities, many are struggling to reach essential contraceptive, safe abortion and post-abortion care services. Consequently, it’s projected that unintended pregnancies, unsafe abortions and maternal mortalities will rise.

Marie Stopes International estimates that up to 9.5 million women risk losing access to our services alone, resulting in up to 3 million unintended pregnancies, 2.7 million unsafe abortions and 11,000 pregnancy-related deaths. That’s unless services can continue and midwives, who are often best placed to reach women in their homes, or in rural regions where doctor’s clinics are scarce, have a crucial role to play.

Throughout this pandemic, we’ve heard from midwives around the world who are showing bravery and resilience in the face of challenges caused by COVID-19.

Vivian, who works as a Marie Stopes International midwife in Kumasi, Ghana, relayed that her centre has seen a rise in unintended pregnancies, with women unable to travel to her clinic during lockdown. One client shared with Vivian: “I had to lie and pretend that I was seriously ill before (security personnel) would allow me to come for your services.”

With women unable to access safe abortion and contraception services, some are taking matters into their own hands. Since the lockdown began, Vivian has delivered life-saving post-abortion care to a woman who had resorted to an unsafe abortion at home. In the face of these challenges, midwives like Vivian are showing inspiring perseverance to adapt to the evolving crisis. From hand and respiratory hygiene, to social distancing with clients and the use of personal protective equipment, midwives are determined to keep services open, safely.

Similarly, we are hearing from members of the International Confederation of Midwives in Nigeria that women are finding it harder to access sexual and reproductive healthcare services, including post-abortion care. In these settings, midwives play a vital role in providing information on services available and referring women for care, during the lockdown. 

These are just two stories from the millions of midwives working hard every day to provide care. This International Day of the Midwife, we need to recognise the midwives working on the frontline. Perhaps more importantly, we must reduce the burden on them by slowing the rate of unintended pregnancies and unsafe abortions, by expanding access to safe services.

Fortunately, there are concrete, evidence-based steps that governments can take to save lives: from defining safe abortion and contraceptive services as essential, to allowing women to access care remotely via telemedicine. We also need to remove the unnecessary restrictions, which limit the services that midwives can provide.

In many countries, safe abortion and post-abortion care must be signed off by doctors, despite WHO guidance and strong evidence showing that midwives can provide the services safely. By removing these barriers to access and protecting a woman’s right to decide, we can prevent time-sensitive procedures from being delayed, reduce the risk of COVID-19 exposure for clients, and free up doctors’ time for COVID-related emergencies.

As SheDecides Champions and senior leaders in two organisations powered by midwives, we are committed to advocating for a world where midwives can support women to make their reproductive healthcare choices safely, whatever that choice might be. Our healthcare workers and midwives are working extraordinarily hard to deliver life-saving care for us, and for women all around the world.

This International Day of the Midwife, it’s time we helped them help us.