Health Policy Project

The Health Policy Project has ended, but work continues under a new USAID five-year project, Health Policy Plus (HP+).


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Midwives: We’re the Change Makers!

White Ribbon Alliance

By Lennie Kamwendo
Health Services Commissioner, Malawi and former president of the Association of Malawian Midwives
Chair of the Board of Trustees, White Ribbon Alliance, Malawi

PRAGUE, Czech RepublicIt is with great pleasure that I return to the ICM (the International Confederation of Midwives) to be greeted by so many familiar faces and importantly, so many new faces. The energy of this conference drives my belief that we can be the change we want to see in midwifery worldwide, we are the agents of that change, and we must continue to call attention to the scandal that so many women in this world still do not have access to a midwife.

Midwives are the cornerstone to safe birth, healthy and happy mothers, and newborns. We must show the world that ours is the right profession to invest in if we want to see longer-term social and economic advancement.

White Ribbon Alliance supports national alliances internationally to advocate for improved maternal health care services with support from the USAID-funded Health Policy Project. In Malawi, advocacy by White Ribbon Alliance has contributed to progress in the promotion of midwifery. We have pushed hard for our government to put policies in place to support midwifery and midwives. But having the policy is only half of the battle. This is why we are working to make sure citizens in our country know their rights and can advocate to our government for better support and recognition of the profession of midwifery.

In my country, midwives must train as nurses first and then chose midwifery; we have no direct entry options even though this is now in the pipeline. The White Ribbon Alliance for Safe Motherhood in Malawi wants to see the introduction of direct-entry midwifery happen sooner than later. We believe that this will ensure that only those who truly desire to be midwives will be trained as such. They will be deployed to maternity units and communities where midwifery services are needed. In fact, it is more cost effective to train people for a specific function rather than train people as nurses and midwives when they will not work in areas of maternal health.

We see that those nurses who choose midwifery do not then have a defined career path – unlike nurses with post-registration community health nursing and psychiatric nursing. This is an unexplained injustice that negatively affects health professionals who are key to the survival of mothers and their newborns.

We are calling for midwives to get the respect they deserve, and we have seen quick progress. We have already succeeded in changing the title of the Directorate of Nursing at the Ministry of Health, which is now designated as the Directorate of Nursing and Midwifery. We have also succeeded in having all Colleges of Nursing designated as Colleges of Nursing and Midwifery, but we still have to change one college, that of the Kamuzu College of Nursing, our centre of excellence and a constituent college of the University of Malawi.

We are petitioning our new government to provide the resources to address the huge gap in midwives. We know the World Health Organization standard is to have one midwife for every seven pregnant women; however in Malawi, every midwife is responsible for 245 women – an impossible burden.

If we do not raise our voices, we will not make faster progress. Something we see in Malawi, that I know is common across many countries, is that people can be afraid to confront authority. There is an entrenched fear of standing up and demanding our rights as citizens.  We at White Ribbon Alliance work to tackle this head on through solidarity and support to communities so that health workers can step up and be counted.

As we hurtle towards the 2015 deadline of the Millennium Development Goals, we must ask ourselves, have we done enough as midwives to push our governments for more investment? What more can we do, right now, today? I implore each and every midwife to know the facts. Know what your government has promised and make sure you hold them to account. We as midwives commit to deliver women in a safe environment, with respect and dignity. Our governments must commit to deliver the support and finances to allow this to happen.

Read more about HPP's work on midwifery

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The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project's HIV-related activities are supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). It is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (previously Futures Institute), Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and White Ribbon Alliance for Safe Motherhood (WRA). The information provided on this Web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.

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