While reading The State of The Worlds Midwifery report there was mentions of the progress improved maternal health has had on countries. With better maternal health, in part due to midwives, economies have improved as well as other MDG’s. The report was mentioning some ways that midwives could continue to foster progress in nations that the MDG’s are aimed toward. One method for helping improvement mentioned was midwives having political standing. I think that would be a wonderful idea for there to be a group of people focused solely on policy and legislation for midwives and mothers. I think this group could focus on getting training to regions that practice midwifery in an unskilled manner, such as Guatemala. Providing instruments and education to places that need more skilled midwives or even education to places like that US that midwifery is still around and only beneficial to women and birth outcomes. That stated, I realize midwives have been around for quite some time and so has the government. I am not very savvy on how organizations like the one they have mentioned in the midwife report would start or carry on. So, I am wondering what has stopped this from not already being an established area of policy and what barriers would a coalition like this face? It is clear to see that midwives are beneficial to communities in more ways than just attending births. Also, on this report itself I think it is a wonderful publication and very important to show the strides the practice of midwifery makes in the world of health. I just wonder whom this publication goes out to, and are the parties that need to see it being made aware of the benefits that midwifery provides to a nation.
Birth and Global Health
While I agree that creating a WHO type Board or Council specifically for midwifery would help to promote and legitimize the practice in the international community, it is something that requires a moment of pause to look at the demands and implications of such an undertaking. Based on other classes I have taken and readings I have done, I think the following reasons may contribute to some of the barriers that have prevented the creation of a legislative midwifery council. In order to legitimize and professionalize midwifery, the Board would have to create a set of standards that a certified midwife would have to meet. As we talked about in class, these requirements could be very limiting and exclusive creating barriers that prevent midwifes that do not meet the requirements from practicing. A board like this would also require funding and research that proves the efficacy of midwifery programs and evidence based practices. Research is laborious and can be very expensive which could be a possible barrier as to why a board like this has not been established. While the existence of the State of the World’s Midwifery Report shows that there must be some amount of funding and resources going into this work, it is possible that at this point in time it is more feasible to keep the work under the purview of organizations such as the WHO and UNFPA instead of creating a separate Board. International boards like this are also often associated with a heavy Western influence on the decisions and policies that are made. For this reason it can sometimes be hard to encapsulate specific cultural intricacies and barriers in the program plans that are created at this level. This is a problem that many WHO programs face. They seem perfect on paper, but often are impossible to implement on the ground due to cultural differences, lack of resources, lack of commitment, and other problems. Unfortunately the creation of a midwifery board would not guarantee their programs will be or can be successful adopted around the globe. Also, I think it comes down to international priorities. Somewhere back around WWII the international community as a whole sort of got stuck on this idea of technological interventions that could save the world. We see this in the adaptation of DDT programs to combat malaria, and huge vaccination campaigns that feature top down implementation. Somewhere around 1970 there was a shift in ideology that began to push the use of horizontal bottom up health programs. It has been a slow change toward more community centered and low technology interventions, because they require more time, education and training than technological interventions do. For this reason it may just be that midwifery has not been a priority at the international level and so the necessity to create an internationally recognized midwifery board has simply not been put on the table.
I think those may be some of the barriers that have prevented the formation of such an organizational body. In order to overcome some of these barriers I think that (as you mentioned) reports such as the State of the World’s Midwifery must be disseminated to governments, health organizations, and medical workers around the globe so they can see all the positive impact that midwifery has. Advocacy for midwifery and skilled birth attendants must also increase globally, alleviating some of the tension that exists between midwifery and medical practice, and educating communities about the importance of having a midwife. These efforts should hopefully raise international awareness and help to show how effective and integral midwives are in meeting international health targets.
Hey, Ugochi. I agree with what you are saying and I think implementing a group that focuses on policy and education in the field of midwifery would be very beneficial. However, unfortunately as Brenna pointed out this is often very difficult and takes a great deal of time. Another barrier I think this type of program and spread of midwifery would meet would be a cultural barrier. As we saw from Kayley’s post there is a large misconception about midwives and their practice. While originally, midwives may have been used largely among the poor because they could not afford to have a hospital birth today they are used largely by affluent wealthy women. Even though the demographic of those who use midwives has changed the idea that home births are for the poor have not. Changing the general public’s idea and education about the training and educational requirements for midwives to practice would be very difficult, especially since this misconception is deeply rooted in culture.