Ariadna Capasso is senior technical advisor for the FCI Program of Management Sciences for Health (MSH). This post originally appeared on the MSH Health Impact Blog.
Over the past year, Tijuana, Mexico, has seen an influx of U.S.-bound Haitian migrants fleeing communities left in disrepair from the 2010 earthquake and further devastated by Hurricane Matthew in October 2016. These migrants often begin their journey in Latin America and trek through multiple countries and hostile terrain only to find they cannot enter the U.S. once at the border. Among the stalled Haitian migrants living in makeshift shelters as they contemplate their next steps, pregnant women face another uncertainty: whether they or their baby will languish during pregnancy and childbirth without access to skilled maternal and newborn health care. Recognizing this health crisis, a group of midwives, Parteras Fronterizas (Borderland Midwives in English), arrived on the scene to provide antenatal and safe childbirth care, with help from women who translated from Spanish or English to Haitian Creole.
Parteras Fronterizas embodies the reason we celebrate the International Day of the Midwife–to honor the many midwives around the world who work on the frontlines to deliver high-quality, respectful care to women and newborns during pregnancy and childbirth. At the Third Regional Forum of the Mexican Midwifery Association in late April 2017, traditional and professional midwives, medical doctors, health managers, doulas and midwifery students gathered together to share midwifery practices and strategies for advancing the midwifery profession in Mexico.
Since ancestral times, traditional midwives have played a central role in assisting women at home during childbirth, but few professional midwives deliver babies in the public health sector.
Professional midwives who do practice in the public health sector often perform nurses’ functions and some lack the basic midwifery competencies recommended by the International Confederation of Midwives.
The first schools of professional midwifery in Mexico were created in 1833, but with the advent of gynecology and obstetrics in the late nineteenth century, pregnancy and childbirth became the realm of doctors, relegating midwives to the domain of supportive functions. As doctors are traditionally men and nurses and midwives are traditionally women, these gendered divisions in the health sector workforce signify gendered power differentials in how health providers are regarded and supported by their colleagues and the public.
Recently, the Mexican government has focused on returning the responsibility of skilled birth attendance to primary and secondary care facilities and in strengthening the midwifery profession. The Mexican government aims to improve the quality and coverage of maternal health services, reduce the Cesarean section rate (which ranges from over 40% in public facilities to 80% in private facilities) and relieve the demand for maternity services in hospitals. A large civil society movement, including users of health services and midwives, favor this trend toward humanized and respectful childbirth with the view that birth is a natural process that only requires medical intervention when complications arise.
Management Sciences for Health (MSH) contributes to this national initiative to strengthen professional midwifery through a grant from the John D. and Catherine T. MacArthur Foundation to develop advocacy tools and build the advocacy capacity of midwives and midwifery supporters. At the Third Regional Forum of the Mexican Midwifery Association, I led an advocacy workshop with Ivelise Segovia from UNFPA.
Although workshop participants represented diverse cultural perspectives and roles, several trends emerged from our dynamic discussion. Participants envisioned the following changes:
Midwives can grow professionally. Midwives want to attend births in the public health sector. They want to feel valued and earn recognition for their contributions to respectful, safe maternity care that is free from violence and discrimination.
Health facilities and staff support labor and delivery. Midwives want hospitals and other health facilities to dedicate more space to maternity care. They want to see doctors value midwifery and the importance of respectful maternity care.
People have access to information about pregnancy and childbirth. Midwives want pregnancy and childbirth to be seen as a normal, healthy process. Women should be empowered with information about birth options so they can make their own decisions.
To achieve these desired changes, the advocacy workshop participants identified the following objectives and strategies:
RAISE THE VISIBILITY OF MIDWIFERY-LED CARE.
- Strengthen the legislative framework that supports midwifery-led care through public demonstrations and direct discussions with legislators.
- Create videos for social media and pitch stories to the press to raise public awareness of the critical role midwives play in maternal and newborn health care.
FACILITATE THE WORK OF TRADITIONAL MIDWIVES.
- Bring together traditional midwives and doctors so they can work together when complications arise.
- Inform women about the role and knowledge of midwives.
INCREASE RECOGNITION OF MIDWIFERY AS A VALID PROFESSION.
- Strengthen the capacity to network. While the Mexican Midwifery Association is key to this process, midwives’ networks are fragmented, so midwives still lack a group identity. Through a strengthened sense of unity, local midwifery associations can be stronger and more effective advocates.
- Build evidence for midwifery by documenting changes in health facilities and then use this evidence to advocate for supportive midwifery policies.
Advancing the midwifery profession will help Mexico achieve its goal to ensure every woman has access to respectful, high-quality pregnancy and childbirth services. At the midwifery conference, I met a few Parteras Fronterizas as well as a number of other impassioned, driven and committed professionals of all ages, from 75-year-old midwives to midwifery students in their 20s. When I left, I felt inspired and even more convinced that these midwifery professionals will help Mexico achieve its maternal health objectives.
Midwifery in Mexico: The John D. and Catherine T. MacArthur Foundation commissioned a baseline study on the state of professional midwifery in Mexico, encompassing five key components for the institutionalization of midwifery: 1) legal and normative framework; 2) actors who define the public agenda; 3) midwifery training programs; 4) employment opportunities in health facilities; and 5) midwifery and the quality of care.