Investing in Ethnic Midwives to Protect Maternal Health, UNFPA

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Vida at her working place with other colleagues and a young mother.

Op-ed in line with UNFPA’s report. 

Vida is a 28-year-old midwife from the Akha community who is proud of her role in ensuring women in Lao PDR realize positive maternal health outcomes. Based at Long District hospital in Luang Namtha province, this Akha midwife graduated from the Oudomxay UNFPA-MOH supported midwifery program in 2017.

In Laos, supporting the training and deployment of midwives from ethnic groups is a key component of UNFPA’s wide-ranging engagement in midwifery program that recognizes the significant role of midwives in saving lives and changing harmful norms, they are even more critical due to impact of COVID-19 on health services.

“In the past, Akha women gave birth without assistance and they did not come to the health center. As most of the pregnancies and births were unattended among Akha women, there was a high risk of complications” said Vida. “But since we have Akha midwives, Akha clients are comfortable to come and seek support”.

This positive trend is a result of newly-trained ethnic midwives returning to their home villages to support their communities. Their cultural insights combined with newly-learnt skills adhering to international standards means they are trusted and well placed to deliver essential maternal health care to ethnic mothers who traditionally would face health risks, especially during delivery.

UNFPA and MOH backed interventions have played a significant role in reducing maternal mortality as well as ensuring safe pregnancies, childbirth and family planning in Lao PDR during the past decade.

Together with district teams, Vida conducts health education outreach in villages surrounding Long District hospital to provide information and mobilize women to visit health facilities. Now, many women come to seek healthcare at such facilities and are less reluctant to seek guidance on birth spacing and contraceptives.

“For example, every time I provide health education, I also encourage them [Akha ethnic women] to exclusively breastfeed for at least six months,” said Vida, who reported that many ethnic mothers in the past were reluctant to breastfeed as they juggle motherhood with cultivating crops in the field, and didn’t know about the health benefits of breastfeeding for the infant and the mother.

Raising awareness on the importance of antenatal care to ensure health and safety of mothers and babies is a key task for Vida and other ethnic midwives.

“I encourage women to make at least four antenatal care visits [international standards are 8 ANC visits per pregnancy] and give birth at health facilities to keep mothers and babies safe. The proudest moment for me is to see women giving birth at a health facility assisted by qualified health personnel, so they don’t suffer any complications,” said Vida.

To provide a full spectrum of care, counseling for youth and adolescents is delivered as part of family planning services. Vida encourages women to learn more about long-acting reversible contraceptives. More couples are seeking long-acting methods such as injectables and implants so that women do not need to travel to the health facility often.

Midwives like Vida are being gradually deployed all over Lao PDR for community awareness raising. Their role is crucial in applying skills acquired through the midwifery courses adapted to international standards through MOH and UNFPA collaboration.

While development of midwifery capacity has benefited women and children in Lao PDR in the past decade, midwives such as Vida still face challenges in countering harmful cultural practices for childbirth and child care, such as dietary restrictions, roasting (lying on a bed above a fire) for 15 days after giving birth and the belief that giving birth to twins is bad luck.

Following training, Vida and other midwives are connected to a midwifery helpline where they can access peer support, to discuss difficult cases and develop response strategies.

UNFPA is supporting Lao PDR to realize its commitment to the 25th anniversary of the International Conference on Population and Development (ICPD25) to have at least one midwife per health facility. The support includes training, curricula development and equipping health facilities.

The Maternal Health Trust Fund, KOFIH and Luxembourg, the midwifery program is accelerating the role of midwives in saving lives and changing harmful norms and practices.

According to the State of the World Midwifery Report 2021, investing in midwives is cost-effective as a fully educated and trained midwife can provide about 90 percent of essential reproductive maternal neonatal child adolescent health care.