Monday, June 20, 2011

Midwifery in Arab/ Middle East Countries

UN just published State of World` s Midwifery 2011, covering some 58 countries in all regions of the world.
"Increasing women's access to quality midwifery has become a focus of global efforts to realize the right of every woman to the best possible health care during pregnancy and childbirth"

I would like to focus on Middle East/ Arab countries. Reports are available from following countries:
1. UAE

"It is clear the women do not know what a midwife is and many women think that they are safer with care from a doctor. Based on the results of this research a marketing strategy has been developed to promote the role of the midwife as the expert in normal birth and work has begun both with the medical profession and women to improve the profile and status of midwifery in the UAE"

2. Gulf Countries

"If only considering the percentage of deliveries attended by skilled health personnel and the maternal mortality ratio, the nearly 22 Arab States can be divided into three groups (Table 1). The first, where both indicators are balanced, contains small, rich Gulf countries as well as middle-income countries such as Tunisia, where the government has adopted a holistic, multi-disciplinary health strategy including the investment in training and empowering midwives. Also in this group are countries such as Palestine, where despite an instable and insecure environment, important and well-structured NGO interventions ensure good maternal health care. In the second group, both indicators are high and this can be explained by geographical, social, cultural and economic factors including the weak quality of maternal health services, as in Djibouti, and over-medicalization and low profile of midwifery as in Lebanon and until recently in the United Arab Emirates. The third group has countries where the percentage of births attended by skilled health personnel is low and the maternal mortality ratio is high. In addition to other factors, the situation in most countries in this group (including Morocco, Sudan and Yemen) can be linked to the lack of availability, accessibility and affordability of maternal services in remote and rural areas"


"Nursing and midwifery faculties across the country have been training midwives since 1984, granting them either an associate or a bachelor’s degree (although the associate degree was discontinued in 2006). Midwives holding a bachelor’s degree can pursue their education in two different subcategories, midwifery or maternal and child health. Those that go on to earn a master’s degree often teach in universities.  It is possible for midwives to obtain a PhD in Midwifery. In Iran, job opportunities for midwives are limited and many are either unemployed or working in jobs irrelevant to their field of study. In addition to job scarcity, midwives face a number of challenges, such as the lack of proper job descriptions at their workplaces, the discrepancy between midwifery training and the demands of the job, and the lack of a support system enabling midwives to work effectively."

4. Tunisia

"Since achieving independence in 1956, Tunisia’s maternal health indicators have improved steadily. According to the most recent national estimates provided by the Ministry of Health (2008), the maternal mortality ratio is 36.5 per 100,000 live births. Coverage of antenatal care (at least one visit) reached 96% in 2006 and a skilled birth attendant was present at 94.5% of births. With a ratio of 7 midwives per 1,000 women of reproductive age, midwives’ contribution to these health gains have been significant.

5. Marocco
"Morocco has nearly completed the transition from high to low fertility. Contraceptive use has increased significantly. Large differences exist between urban and rural access to health care and skilled birth attendants. Gender disparities persist and efforts are in place to improve the status of women. A reduction in the maternal mortality ratio of an estimated 60 percent has been achieved in the past 20 years. The 2008-2012 strategic plan focuses on reproductive health. The policy for maternal and newborn health makes facility-based birth free of charge (including caesareans). The policy aims at strengthening the referral system; improving provision of essential drugs, blood and equipment; and improving access in rural areas. Measures to strengthen the competencies of the midwifery workforce are underway. These include a review of the curriculum and an increase in the hours of classroom instruction in the current education programmes. The Midwives Association can play an important role in advancing regulation to promote the autonomy of the midwifery workforce."  

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