Project Syndicate (USA): protection of mothers and midwives during the pandemic

The Hague/Washington, DC — while the world is struggling to control covid-19, global human resources for health are increasingly under pressure, and obstetric care to women exposed to more risk than ever.

The current crisis is ultimately weakens the ability of medical institutions as lack of staff and resources exerts strong pressure on services. The heartbreaking messages of midwives, located on the first line, highlighted problems in the field of human rights, excessive medicalization of childbirth and increasing stress, both for them and for pregnant women. In the battle for the containment covid-19 caring for future mothers departed on the second plan.

Midwives are vital to the health and protection of women during childbirth. In 2017, approximately 295 thousand women worldwide died from complications related to pregnancy or childbirth — the vast majority of them in low and middle income. Most of these deaths could have been prevented. During the current emergency situation in the area of health, we must ensure that the obstetric community as much as possible.

Currently, midwives in all regions face an acute shortage of personal protective equipment (PPE) and other means of infection control, including disinfectants for the hands, and this means that they must take painful and dramatic decisions. Should they risk the health of their families, taking care of women during childbirth? They must provide assistance without PPE, given that they can’t stand a safe distance from women under their custody? It is better in any case to provide normal care, even risking to infect his patients?

In addition, there is growing evidence that excessive medicalization of childbirth during a pandemic has increased. The world Health Organization recommends a caesarean only if it is justified from a medical point of view, however, health professionals and the General medical community is concerned about the increasing number of unnecessary and inappropriate procedures of this kind. This disturbing picture suggests weakening the rights of women to make informed decisions about birth and their overall health.

In cases when women are given the space for decision-making, they prefer to give birth at home with the support of a midwife or in a clinic under the guidance of midwives, not in hospital. These changes reflect not only the fear of covid-19, but also the realization by many women that they may choose a more decentralized services that meet their needs. In the case when the pregnancy is low risk, national governments should support this decision.

But the decentralization of childbirth puts your tasks. In particular, we must provide adequate resources for her support, and also to respect and recognize the work done on the house to ensure the safety of pregnant women. The increase associated with the pandemic problems regarding the pregnancy did the role of midwives in providing prenatal care even more important. However, in many cases in-home services do not recognize and do not pay, and eventually they have even with a shortage of personal protective equipment that puts at risk as midwives and patients.

Many were shocked by the lack of basic resources and inadequate capacity of our health systems in the face of global pandemics. But these gaps should not surprise. Medical personnel are overworked and underpaid him, he does not have enough training opportunities, and it is subject to restrictive measures. For example, midwives often do not recognize medical workers of the first line.

These problems are even more acute in the obstetric community, which long before the pandemic, struggled to gain recognition as an independent profession — and to access funding, resources and training that accompany this profession. And today, the inability to invest in maternity service and it is fair to pay women for their contribution to the health sector has weakened the global response to covid-19 and put women at greater risk of infection, especially in countries with income levels below average. There are traditional birth attendants trained and equipped with basic equipment, but they are not considered part of the paid workforce in health care. As a result, they do not receive adequate PPE, but at the same time can’t afford to stop working during a pandemic.

To ensure the safety of midwives, when they provide medical care to women, governments, international donor agencies and charitable organizations should make the funding of maternity services a priority. This includes support at community level that is critical at a time when the number of services in institutions is declining. Without such support midwives will not be able to provide assistance to the most vulnerable.

The international community should support women’s health staff and allocate funds directly to organizations that represent midwives as providers of health services for maternity protection the first line. We have to trust the women who are in the midst of medical services, have the right to use the funding at its discretion and to invest in ensuring the continued security of our societies.

Sally Pairman — chief Executive officer of the International Confederation of midwives.

Rupa Dhatt — founder of the organization “Women in global health”.