Opinion-editorial marking the International Day of the Midwife, 5 May 2021 by UNFPA Representative in Syria, Dr. Iyad Nasr
During the 10- years of the crisis in Syria, along with the covid-19 pandemic, mothers continue to give birth and new life begins. The people in need are facing impediments in accessing basic health services, especially specialized and much needed reproductive health services including Emergency Obstetric Care. The health system in the country are facing protracted challenges including the destruction of 50% of the health facilities, depleted local markets of reproductive health commodities, and the migration of the perish of health staff due to the crisis. The delivery of quality reproductive health services requires qualified staff including midwives.
Midwives play a crucial role in the health and wellbeing of a mother and their new-born in outreach mobile teams, clinics and hospitals. They are key and instrumental health professionals not only for the current time but for the future generation. Safe delivery leads to health generations and safe motherhood. The midwives are key to the delivery of quality reproductive health services including safe delivery especially in remote and rural areas in complementarity way with other social and livelihood services. They also play a critical role in the realization of the 2030 Agenda for Sustainable Development, accelerating the International Conference for Population & Data (ICPD) Programme of Action in Syria.
In Syria today, on International Day of the Midwife, we recognize, thanks and acknowledgement to all the midwives in the country who are putting their lives at risk, to provide pregnant and new mothers with the care that they require and need. Equipped with gloves, masks, goggles, and gowns, these midwives are our heroes. They are combating COVID-19 within a protracted crisis context to ensure that no mother dies while giving life.
Currently, 10 nursing schools are functioning under the supervision of Ministry of Health (MOH) in Syrian Governorates. Around, 4070 midwives are working in the public sector in all Syrian governorates (CBS, 2021); the majority of midwives work in the central cities. Based on the recent reports of the MOH, these schools graduate around 300 nurses and 45 midwifes per year. Despite the limited data on the status of midwives, the fact that they are inequitably distributed all over Syrian governorates cannot be challenged.
Thanks to UNFPA’s donors and the support of the MoH and local NGOs, UNFPA Country office is providing the health facilities with reproductive health equipment and supplies including Covid-19 protection kits, build the capacity of health workforces on RH issues including midwifery subjects and rehabilitation of the health facilities. Moreover, UNFPA is working with the MoH to adapt, update and adopt the national curriculum for Non Physician clinicians, including nurse and midwives, and to develop training toolkit packages for academic and practical training, which can be subject for potential accreditation.
With the midwives’ commitment, maternal mortality did not deteriorate and has remained stagnant in Syria to be around 58 per 100,000 live births. When a crisis strikes, skilled birth attendance and emergency obstetric care become even more important, especially in a country such as Syria that is marked with a high population growth rate at around 2.9% per year.
Having said this, the way ahead of us is still long to address several challenges that are faced by the midwifery domain including that there are more than one modular or system for midwives training, limited coordination and monitoring of the midwifery work, different “not positive’ community perspectives on midwifery work, and lack of sound referral system. There is still a room for improvement, including clear career development, conducive environments, opportunity for higher education, and clear accountability. Midwives must be recognized as separate from nurses, and as accountable and autonomous professionals, providing sexual and reproductive health services and information. It is critical that midwives have access to Protective Personal Equipment (PPE) to operate in a safe and enabling environment. It is also critical that women continue to feel safe and get the proper support in hospitals, and that safe deliveries are maintained also under these unprecedented and difficult circumstances.
Yusra Malel, Head of Midwifery Syndicate in Syria, highlighted in this occasion that Syrian midwives are appreciated nationally, regionally and globally. Despite all the challenges including the low salaries, they are working for long hours to save lives before, during and after the deliveries. She emphasized that “All midwives sacrifice a lot during the crisis and Covid -19 pandemic, but serving a vulnerable deprived woman brings us a great happiness. Reflecting on the determination of the midwives I can say that Hope Emerges from the Womb of Pain”.
While we are witnessing the international Day of the Midwife, we call on all the stakeholders including donors, developmental and humanitarian actors to continue supporting the health system in Syria. Despite the many challenge it faces, it is trying its utmost to respond better during COVID-19 and work on the deployment of midwives across the country to provide life-saving services.