Supplied – Sarah StewartMaternal health is crucial for Pakistan, a country with one of the highest levels of infant mortality in the world.
A large part of good maternal health is having births supervised by a trained birth attendant: in many cases, a midwife. The only problem with this is the difficulty of implementing a system. Midwifery programs are globally hit-and-miss, and a University of Alberta study trying to figure out what makes these programs go one way or the other.
A recent study focused on maternal health in Pakistan, where a system of community midwives (CMWs) has been implemented, but has yet to be proven successful. Mumtaz Zubia, associate professor of Global Health at the U of A’s School of Public Health, went to the communities themselves to study the successes of Pakistan’s CMW system.
Zubia researches global maternal health to find ways to provide services to marginalized, poor women in low-income countries. The program works closely with governments to identify in what ways gender and poverty affect maternal health. Poverty, she found, was the key external factor in Pakistan. This study was researched from weeks of living in communities, which gave the subjects a voice, she said.
“(Women of low socioeconomic status’) voices aren’t being heard,” Zubia said. “Which is why this research is useful.”
Midwives need proper training and support to establish themselves provide services, Zubia said. She found only eight of the 38 midwives were successful, meaning they established a practice within their community. This number was low, but the information those eight CMWs still provided insight to the study.
The study found successful midwives shared a few things in common: they were smart, they were respectful towards whom they were providing care, and they had a mind for business. They knew how to communicate in different situations, but also connect with their communities.
They made sure they were available when they were needed — which is essential for night-time births. From the business side, those that started clinics and partnered with other health professionals has success in establishing themselves.
Research was done by living in villages for months and collecting data directly from the people, as has been done for a number of studies in global maternal health. This kind of research gives the people a voice because of the researchers’ close contact with the communities, Zubia said. This included interviews and focus discussions with midwives and community members, as well as shadowing midwives on the job.
In Pakistan, midwifery is considered a “dirty” profession, which leads to difficulties in finding people to train as midwives. This is starting to change, but still a process, Zubia said. Local women are trained to deliver babies, but aren’t required to. Many just train to receive the stipend that is given to all CMWs. Pakistan is a tough place to be a midwife, Zubia said. Maternal health is typically dominated by physicians, and until recently midwifery wasn’t even acknowledged as a profession.
“The next best thing is to provide a skilled birth attendant,” Zubia said.
Physicians are hard to appoint to low income areas, but births still need to be supervised. The CMW program’s aim was to increase the number of supervised births in rural areas up from 44 per cent. Before 2006, over half of rural births proceeded without a trained professional on site. The CMW program has received plenty of funding, but implementation has been challenging, Zubia said. This problem exists partially because of the disconnect between what’s happening in government offices and what’s happening on the ground.
“People have an idea of the way they think things should work, then they write it out.,” Zubia said.
“They really don’t take into account the reality of the front line worker who’s interacting with the patient.”
Zubia’s program of research in Global Maternal Health is ongoing. Progress is happening, and part of that comes from on-the-ground research that gives rural communities a voice, she said.
“I just want women to have safe childbirth,” Zubia said.
