To reduce maternal deaths, look to midwives

GISENYI, Rwanda – “Mothers and babies lose their lives due to complications that could have been prevented,” Burcard Umuhoza, 28, told UNFPA in a frank conversation about the trials he faces as a midwife in the Gisenyi District Hospital in Rwanda.

“A challenge that hurts a lot is that some women choose to deliver their babies at home, and when they experience complications, they rush to hospital, when their condition is critical,” he said, adding, “My worst moment is to see a mother dying, despite all interventions.”

Fortunately, these deaths have become less common in recent years.

In 2000, as part of the Millennium Development Goals, countries around the world committed to reducing their maternal mortality rates by at least 75 per cent by 2015. Rwanda is one of only nine countries to have achieved this goal.

Midwives like Mr. Umuhoza have played a key role in this accomplishment. On 5 May, the world celebrates the International Day of the Midwife, which recognizes the critical need for these professionals around the world.


Mr. Umuhoza examines a pregnant woman with a during an antenatal care appointment. © UNFPA Rwanda/Maureen Twahirwa 

For example, there is always a midwife on standby in the maternity ward to address possible complications, Mr. Umuhoza said. “A midwife is always alert, even when there is no patient in the labour room, like a soldier even during times of peace.”

Unacceptably high maternal death

Still, the maternal death rate in Rwanda remains unacceptably high.

A woman in Rwanda has a 1 in 85 chance of dying of pregnancy-related causes in her lifetime, according to the 2015 Trends in Maternal Mortality report. By comparison, a woman in Norway faces a 1 in 11,500 chance of dying from such causes.

And there are not enough health workers trained in essential midwifery skills to meet the country’s need for sexual and reproductive health care. According to the 2014 State of World’s Midwifery report, only 59 per cent of Rwanda’s midwifery needs are being met by the country’s existing health workforce.

UNFPA is working to boost the number of competent midwives in Rwanda and elsewhere by strengthening midwifery education, regulation and associations. UNFPA also provides material support to health facilities.

For example, at Gisenyi District Hospital, where Mr. Umuhoza works, UNFPA provides supplies and equipment, and also supports training through the country’s Midwifery Association.

But more support is needed.

“Midwifery is a calling that requires patience, passion and continuous professional development,” Mr. Umuhoza said. Yet “midwives are underpaid compared to other professions, and the low number of midwives makes the workload heavy and stressful.”

Making the job worthwhile

Their work is not limited to expectant mothers. Midwives also provide sexual and reproductive health information, family planning counselling, antenatal care, newborn and postpartum services, and they help to combat HIV. 

In providing all this care, they must also be sensitive to the needs and feelings of their patients.

“A mother’s trust in a midwife is the first medicine for a successful delivery,” Mr. Umuhoza said, noting that, as a male midwife, he has to work extra hard to gain women’s trust.

Despite these challenges, his work is rewarding, he said.

“Just days ago, a woman in labour told me, ‘Doctor, if I and my newborn baby survive, I will give you a cow,’” he recounted, “but in reality she had not even a rabbit back home. Amazing!”

Moments like these make his work worthwhile.

“It is a proud privilege for me to be part of a team that saves the lives of women and their newborns,” he said.

– Maureen Twahirw