The benefits associated with eating placenta are thought to be the result of the nutrients
The benefits associated with eating placenta are thought to be the result of the nutrients

The onset of labour marks the end of pregnancy and heralds what for many women living in rural areas is a treacherous and anxious filled time. While to the global community South Africa bears the status of a middle income country, it is still dealing with deep inequalities. While urban living guarantees women access to hospitals with good maternity wards, rural areas can sometimes paint a considerably different picture. 

Delivering a child in South Africa can vary, depending on where you are geographically located. South Africa, like a number of countries in Africa, is facing a shortage of highly skilled healthcare professionals. Midwives are no exception. As a result, the continent continues to tragically lose its mothers during pregnancy and at child birth. 

Over the past two decades South Africa has put a lot of effort towards improving the welfare of mothers and their children by providing free primary healthcare services for pregnant women and children under the age of six.  

On this International Day of Midwives – the United Nations Population Fund (UNFPA), African Medical and Research Foundation (AMREF) and Society of Midwives of South Africa (Somsa) celebrate the work of midwives in contributing to the miracle of birth – and for the myriad other things they do every day to contribute to the wellbeing of mothers and children around the world. The tireless work of midwives is also a crucial step towards achieving millennium development goal four, (reducing child mortality) and goal 5 (improving maternal health including targets to ensure a reduction in maternal deaths and universal access to reproductive health by 2015 and beyond).

South Africa should also join in marking this International Day of Midwives, especially having managed to drastically reduce the transmission of HIV from mother to child. Midwives have played a significant role in this initiative and it is through their tireless efforts that these gains have been made. 

Acknowledgement and commendation should be given to the health minister for the priority he has given to women and children's health and to the health department for its efforts to improve maternal and child health including through the establishment of important task teams that have added significant knowledge and expertise to addressing the health challenge – expert teams such as the national committee on confidential inquiries into maternal deaths, the committee on morbidity and mortality in children, the national perinatal mortality committee and the committee tasked with the development of the nursing compact.

Midwives needed in rural areas
But despite these huge investments from government, there are still several notable results which can be drawn from the health data advisory and coordination committee (HDACC) report, released by the ministry of health in 2012. According to the report, South Africa's maternal mortality ratio stands at 310 per 100 000 live births. The report further states that the neonatal mortality ratio stood at 14 per 1 000 live births. While for South Africa the situation is compounded by high HIV infection rates among pregnant women, this data also points towards the need to strengthen the quality of midwifery care particularly within the rural areas.  

The question then needs to be asked, how can South Africa improve the health of its women and young people and reduce maternal mortality and morbidity in line with national and global priorities? Novel and innovative approaches are needed, some requiring more effort than others. The Eastern Cape and a few other provinces, have established maternity waiting homes near hospitals in rural areas. These waiting homes allow pregnant women who live in remote areas and who are considered high risk cases during pregnancy and delivery to come closer to hospital services, considering that facilities in their communities that may be able to manage pregnancy or delivery complications may be many kilometers away.

UNFPA and Somsa concur that the provision of contraceptive services plays an important factor in improving maternal health, stating that midwives play a vital role in reducing the mortality rate of children and increasing access to universal access to reproductive health care services.  About 222–million women globally want to delay or avoid pregnancies but lack the modern means to do so. It is estimated that 80% of unintended pregnancies in developing countries occur to women who have an unmet need for contraception. South Africa has recently revised its contraceptive and fertility planning policy and is presently rolling out important refresher training programmes for health workers on the revised policy. 

During the 29th ICM triennial congress held in June 2011 in South Africa, midwives adopted the Global Standards in Midwifery Education, the Global Standards in Midwifery Regulation as well as the member association competency assessment tool. A model midwifery curriculum has also been developed. These documents have all been designed to assist countries to either adopt or use in their own settings. Amref in its SU4AM campaign has set the goal of training 15 000 midwives by 2015 in sub– Saharan African countries. Currently 2 850 midwives are in training with support from the organisation in various African countries.

Continentally, the United Nations continues to support concerted action towards improving maternal and newborn health and survival through the implementation of the Campaign for Accelerated Reduction of Maternal Mortality in Africa. This initiative, spearheaded by the African Union, aspires towards the goal that no woman should die while giving birth. 

On this year's International Day of Midwives UNFPA, Amref and Somsa reaffirm continued support and partnership with government and various stakeholders in ensuring that through the support for professional competent midwives, no woman should die while giving birth.

This is a joint opinion piece by the UNFPA (United Nations Population Fund), Amref (African Medical and Research Foundation) and the Society of Midwives of South Africa (Somsa).