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Happy May 5th! Today is International Day of the Midwife, and Ausmed extends our celebration to every single midwife that has worked to support their community over the last year – your work is incredibly important, and today is a special day of the year.
In fact, IDoM is extra special this year because it’s the 100th anniversary of the International Confederacy of Midwives! Hundreds of midwifery associations across the globe use the confederacy to join together and discuss ideas, issues and achievements. Congratulations to everyone involved with the ICM.
Over the past few years, midwives have faced many challenges, especially in terms of the global pandemic. Throughout 2020, midwives and other maternity staff had to swap their traditional forms of practice for more modernised versions in order to remain in contact with patients during lockdowns: the use of social distancing, telehealth, and videos to explain body positioning was – and still is – common (UNRIC Brussels, 2020).
However, in addition to the pandemic, thousands of midwives in certain countries are also found facing something acutely dangerous, destructive and aggressive: armed conflict.
What support do midwives provide in conflict zones?
No matter where the conflict is located, midwives are a central pillar of medical support for communities surrounded by conflict. However, midwifery is often cast into the shadow of nursing efforts as a whole or even swept into silence by more media-heavy events such as military movements and refugee crises.
Before exploring why midwives are needed in conflict zones, we need to acknowledge that the work of midwives in a conflict zone is often different from the work of midwives in peaceful areas.
Midwives in conflict zones do not only focus on pregnant people and antenatal care: midwives treat and care for victims of sexual assault – a group that spikes in numbers during conflict (Mukwege, 2022) – and also provide general healthcare education.
Provide support for already-pregnant people
Currently, the Russo-Ukrainian War is devastating the second largest country in Europe: Ukraine. The UNFPA expects that around 80,000 people will give birth in Ukraine over the next three months (UNFPA, 2022). These babies are being birthed in underground metro stations, bomb shelters and basements (UNFPA, 2022).
Many hospitals and health services have been destroyed by bombs or had their staff relocated (Firth, 2022). As a result, these births are becoming increasingly life-threatening for the birthing parents as well as the babies. In response, the UNFPA has deployed healthcare professionals – including midwives – into Ukraine, while organisations such as Doctors Without Borders and UNICEF are providing huge amounts of much-needed supplies (Doctors Without Borders, 2022; Elder, 2022).
Provide support for survivors of sexual violence
There is little to no contraception available in conflict zones. During the 1994 Rwandan Genocide, for example, sexual violence was not just rife due to the lawlessness of the situation: sexual violence – particularly against Tutsi women – was also used as a means of furthering the overall political ambitions of the Hutu extremists (Nowrojee, 1996). As a result, survivors of these assaults are left reproductively injured or pregnant and often require immediate, life-saving medical support.
Sexual violence is defined in international law as a war crime, an act of genocide, and a crime against humanity (Nowrojee, 1996). However, these definitions don’t directly help people who experience sexual violence during armed conflict: this is where midwives come in.
Midwives utilise their understanding of reproductive organs and reproductive health to diminish the possibility of infection, and to determine if the survivor has contracted any sexually transmitted infections (Farrington, 2013). Midwives also routinely provide emotional support to survivors of sexual violence who may not have their support network available to them at the time.
Provide education to those who may need to evacuate
As we’ve seen with the Russo-Ukrainian War, refugee crises can force people to relocate to refugee camps thousands of kilometres from their homes. Depending on when they leave and their financial wellbeing, some have to walk that whole journey. In this case, pregnant people need to be taught how to support themselves through pregnancy and even birth in case they go into labour during transit.
“Some of the women said, ‘I'm going to be fleeing in the bush at a moment's notice and so if you can give me something that will help me for three months, a year, three years, then I feel more protected.'“ - Emily Slocum to NPR, midwife with Doctors Without Borders (Farrington, 2013)
In this sense, midwives – as well as any healthcare professional supporting someone with an ongoing condition – provide easily-understandable information to expecting parents who may have to give birth while on the run. In a way, this information is similar in structure to a birth plan.
Which organisations support midwifery in conflict zones?
There are many international aid and relief organisations that provide either specific or broad support to countries and areas experiencing conflict. Arguably the most well-known of these organisations are UNICEF and WHO.
Doctors Without Borders: Also known as Médecins Sans Frontières, this organisation provides medical support and relief to areas experiencing conflict or developmental issues.
What is being done to support midwifery and antenatal health in conflict zones?
In order to support midwifery in conflict zones, there are three main areas that have been – or are currently being – developed:
International policy: The United Nations Office of the High Commissioner for Human Rights has published a list of the sexual and reproductive rights that women are entitled to according to international humanitarian law: access them here (OHCHR, 2022).
Equipment availability: In 2008, UNICEF launched the ‘Midwifery Kit’. This is a small, portable kit that provides the equipment – some reusable, some not – required for obstetrics in ‘humanitarian’ areas. This kit can be used for around 50 ‘normal' deliveries or can be used for other purposes, such as episiotomies, eclampsia or hemorrhages (HNN Team, 2008).
Education: The Republic of South Sudan – which is currently experiencing civil unrest – has one of the highest maternal mortality rates in the world, while a quarter of South Sudanese children die of preventable illnesses before the age of five (International Medical Corps, 2022). In response to this, the International Medical Corps has built three midwifery and nursing colleges that have increased the number of midwives in the country by 2,242% (International Medical Corps, 2022).
Is there anything else to learn about this?
Always! This information only covers a small portion of the great work midwives are doing across the globe to help people experiencing active conflict.
To learn more about how midwives and obstetric aid are deployed, read these:
Once again, happy International Day of the Midwife for 2022! Whether they have faced the pandemic, armed conflict, or fallout from various other hurdles in the healthcare industry over the past year, every single midwife adds to a core component of not only healthcare but society as a whole.
As shown in this article, midwifery as a profession holds a strong core belief: every birth giver and baby deserves high-quality healthcare. We thank all the midwives out there for doing great work!
UNFPA, 2021. ‘Ukraine: Conflict compounds the vulnerabilities of women and girls as humanitarian needs spiral.’ United Nations Population Fund: War in Ukraine. Accessed 2 May 2022 via https://www.unfpa.org/ukraine-war