In honor of International Day of the Midwife last week (May 5th) and International Nurses Day (today), Monica Onyango, MHTF Editorial Committee member, reflects on the role of midwives and nurses in Southern Sudan. Monica Onyango is a nurse midwife and holds a PhD in Nursing and an MPH in International Health. She teaches courses on the management of disasters and complex humanitarian emergencies and sexual and reproductive health in disaster settings at Boston University. She has extensive experience working in reproductive health and maternal and child health in Angola, Kenya, and Southern Sudan. Her recent research concerns women’s experiences with abortion complications, post abortion care and male involvement in reproductive health. The MHTF invites you to read her reflection—and learn about the essential role nurses and midwives play in providing care to pregnant women in Southern Sudan.

Situations of complex humanitarian emergencies differ significantly depending on the location and context. Affected populations rely on help from outside the community because most often they cannot cope with the prevailing circumstances. Midwives are among the health professionals who provide care early during a humanitarian emergency and stay on for the long term. Women and children become significantly at risk of various reproductive morbidities during crises and are of greatest concern to midwives.

Although the midwifery week has past, I would like to bring attention to the midwives’ role in the provision of maternal and neonatal health in South Sudan, a region recovering from 21 years of civil war between the North and South which ended in 2005. The war left South Sudan with some of the worst health indicators and acute shortage of experienced technical personnel. The maternal mortality ratio is estimated at 2,040/100,000 live births, currently one of the highest in the world.

I have worked in South Sudan as a nurse midwife on and off since 1992.  Some of my best and worst experiences have been in this region. Obviously, my best experiences have been conducting deliveries and having a live healthy baby and a healthy mother as outcomes. The worst have included receiving a woman with an obstructed labor who dies shortly after admission because she did not arrive at the health facility on time; or she arrived on time and there were no resources and/or expertise to deal with her situation. Other cultural factors such as polygamy and early marriages of girls in this part of Sudan also tend to marginalize women and negatively affect reproductive outcomes.

The nurse midwifery profession in South Sudan is in its nascent stages.  During the war we trained traditional birth attendants (TBAs) to play a significant role in the provision of maternal and neonatal services at all levels of the health care system. As TBAs are being phased out, there is a 18 month midwifery certificate training at five schools.  Additionally, since 2007, the Ministry of Health and United Nations Population Fund coordinate a one month training of different cadres of health professionals on Emergency Obstetric & Neonatal Care. These training are supposed to fill the void and bring skilled care closer to the women and newborns.  However, these are still just stop-gaps and the numbers of professional midwives able to provide the required basic emergency obstetric care is extremely limited.

It is encouraging that the Government of South Sudan has acknowledged that investing in professional midwives is fundamental to improving maternal and neonatal health and reducing the high morbidity and mortality levels.  The present situation in South Sudan arguably is in need of skilled workers in all sectors of the health system. However, during this restructuring period, establishment of the nurse midwifery professional bodies and associations should be accelerated. Nurse midwives play an important role in women’s access to reproductive and maternal health services all over the world especially at the periphery of the health care system where there are no doctors. Midwives are more so needed in South Sudan where over 90 percent of the population lives in rural areas. To this end, the global nursing community through the international council of nurses also has a duty in the development of the nursing profession in South Sudan. After all the nursing philosophy of caring for individuals, families and communities in need places us in a better position to be actively involved with populations affected by armed conflict and post conflict situations.

Click here to read Monica Onyango’s full bio.