AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED

FIFTH I N T E R N A T I O N A L CONFERENCE O N MATERNAL A N D NEONATAL HEALTH

Theme: Practical Issues in Safe Motherood N o v e m b e r 27-30, 1994 - Dhaka, Bang ladesh

Mother and Child International (MCI) is an organisa- tion which has one prime objective - - to prevent the 500,000 maternal and 4.3 million neonatal deaths occurring globally every year. The loss of these lives, described by Dr P Senanayake, a representative from the International Planned Parenthood Federation, is the final result of women and children travelling down a road to death, over which they have little control.

In many regions of the world, the passage down this road for females is predetermined and begins on the day they are born. Due to poor social status, insufficient income and the cultural expectations placed upon women, they are often unable to access education or health care services.

'The Mother-Baby Package - - A Safe Motherhood Planning Guide' (World Health Organisation 1994), was presented at the conference. The goals of the package are the same as those of the 'Safe Motherhood Initiative' (WHO 1984). However, the 'Mother-Baby Package' (WHO 1994) is a tool, through which, the goals of the 'Safe Motherhood Initiative' (WHO 1984), can be achieved.

The package is based around the four pillars of safe motherhood, which aim to ensure the provision of services such as: family planning, clean and safe delivery, antenatal care and emergency obstetric care. The package also addresses the importance of primary health care and equity for women. The package offers women and children, through the development of health programs, an exit from the road to death.

The difficulty and complexity of providing the basic services outlined in the 'Mother-Baby Package' (WHO 1994), emerged as a concept early in the conference. How can quality maternity care be provided to women when health care facilities just do not exist? For many women in rural areas, the nearest medical centre is simply too far away. The means of transport available would most likely be either a tractor or an ox cart. Women would then need to travel over rugged roads, which may even

be non-existent. If an obstetric emergency such as a postpartum haemorrhage occurred, the distance, the lack of facilities and poor transport would form a fatal triad. This general insufficiency of facilities is analagous to a lack of exit lanes from the fatal freeway to death.

A c o m m o n problem in developing countries is the facilities may be present, but inadequate staffing and equipment renders these centres useless. One speaker cited the example of three dentist surgeries he visited. They were supposedly providing care for a communi ty in Africa. One surgery had a dentist, but no chair. The second had a chair, but no dentist. The third, a dentist and a chair, but no running water. It seems problems of under-serviced and under- staffed facilities exist within maternity services. The exits may be there for the commuter, on the road to death, but they are not functional.

A system of 'vertical' provision of maternity care exists in developing countries; that is, the obstetrician at the top, and the client at the bottom. This results in a one way system of information delivery and care provision. More importantly, this seems to cause a reluctance in women to use existing facilities.

Contributing to this reluctance, are the social distances women must overcome to receive care. Women feel intimidated by and socially inferior, to their educated care providers. Therefore, women tended to choose a carer who was on her own social level, was more likely to provide a two way system of information exchange and was a member of her village communi ty who could provide much needed support.

The importance of friendly, empathetic and cul- turally sensitive staff at the health care facilities was highlighted. Health care workers should be aiming to decrease this social distance felt by women. In doing this, health care workers would act as the sign posts, showing women the exit lanes from the road to death.

SEPTEMBER 1995 ACMIJOURNAL PAGE 5

AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED

Tertiary educated midwives are an essential com- ponen t in ensuring these exits are functional and usable for women. Midwives are identified in the 'Mother-Baby Package' (WHO 1994) as the health care providers most suited to providing maternity services. The difficulties in establishing midwifery educat ion programs in developing countries are c o m p o u n d e d by the stigma and low status of materni ty care provision. Birth products are believed, in many countries, to be polluted and unclean. Midwifery is the work of chosen women , usually titled 'traditional birth attendants; w h o are part of the lowest echelons of society.

Traditional birth attendants are paid according to the means of the family, and in some countries, according to the sex of the baby. A traditional birth attendant's low status in society can make the referral of w o m e n to a health facility difficult.

For these reasons, it seems the health care authori- ties, and the general population, have difficulty in understanding the concept of an educated, profes- sional midwife. A midwife's potential to decrease maternal and neonatal mortality rates and the neces- sity to prioritise the establishment of training facilities has not been recognised. This was further suppor ted by the lack of midwifery representation at the conference. Critical issues, affecting the delivery of midwifery health care services in developing countries such as: the cause of insufficient numbers of tertiary educated midwives, whether there were plans to develop or expand existing tertiary midwifery education programs and whether funding for such programs had recently been considered by either non governmental organi- sations or the government , was not discussed. Practical problems, such as the potential for lack of interest by suitable midwifery students, due to the stigma attached (which was discussed earlier) in being a midwife in a developing country had also not been addressed.

Today, local birth attendants are providing the majori ty of maternity care. One of the professional midwife's most important roles is the education and supervision of the ' trained' birth attendants. These women are replacing the traditional birth attendants, in providing semi-skilled village level maternity care, including delivery. The trained birth attendant should not be seen as a substitute for the professional

midwife. However, for the majority of w o m e n at present, the trained birth attendants are the only means of escaping a woman's pilgrimage to death. The trained birth attendant 's experience, and potential to ne twork at village level, should be utilised as a means to counteract the current hierarchical system of vertical health care delivery. The professional communi ty midwife should act as a facilitator. Through education, safe and effective practice can occur, thereby increasing a trained birth attendant's status and patronage. By working together, the professional midwife, the trained birth attendant and the village people themselves can achieve co-operative communi ty based health care.

Mother and Child International, previously known as the International Association for Maternal and Neonatal Health (IAMENEH), functions as a b o d y which reviews projects designed to achieve their objective - - to decrease maternal and neonatal mortality. The organisation acts as an agency b e t w e e n na t i ona l s e c t i o n s and f u n d i n g organisations.

A general assembly was held on the day prior to c o m m e n c e m e n t of the conference. It was observed there was lack of national section representation f rom many developed countries - - particularly the UK and USA. However, Australia was also not represented, as there is not a national section in existence. It was suggested by the Malaysian representative that minimal interest may be due to the lower maternal and neonatal mortality rates in these countries. The authors would suggest that whilst such horrendous maternal and neonatal mortality rates (such as those cited earlier) exist, midwives and all allied health professionals must work together to eradicate this problem. This can begin to be achieved through world-wide interest and hence, the presence of national sections at such conferences.

For these reasons, the authors propose that an Australian group of midwives apply for national sect ion representat ion of Mother and Child International.

If any group is interested in this cause and organisation, please contact: Mother and Child International, Mrs Gerda Santschi, Ch. Grande Gorge 16, 1255 Veyrier, Switzerland. Telephone/Fax (41 22) 784 0658.

PAGE 6 ACMIJOURNAL SEPTEMBER 1995

AUSTRALIAN COLLEGE OF MIDWIVES INCORPORATED

F E L L O W S H I P t o t h e

A U S T R A L I A N C O L L E G E O F M I D W I V E S

Members o f the College are invited to apply for Fellowship.

Applicat ions c lose May 31, 1996.

Information on the Fellowship criteria and the application form may be

obtained from:

Executive Officer, ACMI Suite 23

431 St Kilda Road Melbourne Victoria 3004 Telephone (03) 9804 5071 Facsimile (03) 9866 1370

A U S T R A L I A N M I D W I F E R Y S C H O L A R S H I P F O U N D A T I O N

Applications close March 31, 1996

Midwives seeking information about the Australian Midwifery Scholarship Foundation grants may contact:

Executive Officer, ACMI Telephone (03) 9804 5071

Applications may be obtained by writing to:

The Secretary Australian Midwifery Scholarship

Foundation Suite 23

431 St Kilda Road Melbourne Victoria 3004

F E L L O W S H I P A U S T R A L I A N C O L L E G E

O F M I D W I V E S

The fol lowing members were admit ted to Fellowship, at an informal ceremony conducted at the Extraordinary General Meeting held March I7, I995:

Judi Brown, Rosemary Conroy, Diane Cutts, Judith D'Elmaine, Jillian Thompson, Carol Thorogood, Lorraine Wilson and Chin Wong.

The Interim Censor Board members were Judi Brown, Diane Cutts, Judith D'Elmaine, Jillian Thompson and Chin Wong. Judith D'Elmaine was elected Censor-in-Chief and the committee then duly processed the applications received for Fellowship following the call for applications published in the Journal.

The fo l lowing members will be admit ted to Fellowship at the Inaugural Oration and Investiture o f Fellows to be held on September II, I995:

Christine Adams, Lesley Barclay, Marie Barton, Patricia Brodie, Helen Callaghan, Betty Clarke, Nan Cook, Jenifer Cooling, Joanne Davies, Sandra Emerson, Raelene George, Pauline Glover, Pauline Green, Ann Grieve, Pamela Hayes, Helene Johns, Margaret Lambert, Maggie Lecky-Thompson, Rhodanthe Lipsett, Netta McArthur, Patricia McDonald, Margaret Peters, Diane Phillips, Janette Robinson, Maralyn Rowley, Anne Saxton, Elaine Smallbane, Valerie Smith, Rosemary Stehbens, Jennifer Sullivan, Christine Thompson, Beth Waddington and Joan Webster.

Congratulations are extended to these members.

SEPTEMBER 1995 ACM1JOURNAL PAGE 7