Training Midwives in Gambia


Professionally trained midwives are a key to success

In all countries that have achieved dramatic improvements in maternal mortality, professionally trained midwives have been a key to success. They have an essential role in achieving the Millennium Development Goals to reduce maternal and newborn mortality. Yet today, the training of midwives is inconsistent and the profession of midwifery often garners little recognition, meager income, and limited career opportunities. These factors contribute to the acute shortage of these valuable health workers.

What midwives do

Pregnancy, whether planned or unintended, is often a key entry-point into the health system, and midwives can provide a welcoming gateway. They often introduce women to the health system and ensure that women and their babies receive a continuum of skilled care during pregnancy, childbirth, and in the important days and weeks after birth.

The basic services midwives routinely provide to protect the health of the mother and baby include:

  • Caring for women during pregnancy, childbirth and the postnatal period
  • Treating complications due to miscarriages and/or unsafe abortions
  • Providing newborn care
  • Providing pre-pregnancy advice and health education
  • Recognizing and addressing problems in the woman and newborn before, during and after childbirth
  • Offering general health information, including reproductive health care and family planning
  • Assisting women to successfully breastfeed
  • Referring women and newborns for higher level care when complications arise during and pregnancy and childbirth their scope of practice and capabilities
  • Providing additional health services in communities such as immunizations and treatment of common illnesses

MOMS: Midwives and others with midwifery skills

UNFPA has begun using the expression ‘midwives and others with midwifery skills (MOMS)’, to mean ‘skilled birth attendant’. This change reflects a recognition of the unique skills, roles and responsibilities midwives bring to delivery care, and to the central role that midwives play in making motherhood safer.

Maternal mortality and morbidity cannot be reduced without midwives and others with midwifery skills. Yet the numbers of these skilled providers have not significantly increased, and have even started to decline in some countries, because of migration, deaths from AIDS-related illnesses, and dissatisfaction with pay and working conditions.

Midwives, who are overwhelmingly women, typically endure low status, poor pay and a lack of support despite the enormous responsibility they bear. Those who work within communities at the primary care level, where they are needed most, often receive the least respect and support from the health system.

Gender biases frequently contribute to the problems facing midwives.

When they are properly trained, empowered and supported, midwives in the community offer the most cost-effective and high-quality path to universal access to maternal health care. Yet midwives are in short supply in many developing countries – WHO estimates some 350,000 are urgently needed worldwide. In particular, countries with high rates of maternal mortality need assistance to recruit, train and support professional midwives.

The goal of the Midwives Programme is to improve skilled attendance at birth in low-resource settings by developing a sustainable midwifery workforce. The programme is creating a “critical mass” of midwifery advisors (CMAs) who are indentifying gaps in midwifery education, regulation and professional associations. The CMAs are working with governments at the national and regional levels to develop policies and programmes to address these gaps in order to elevate the availability and quality of care provided by midwives.






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