New Midwifery Association in Rwanda!

Josephine from Rwanda on the left

The Strengthening Midwifery Symposium had 4 key areas that were addressed: Competency, Education, Regulation and Professional Associations. Prakasamma from India told of the newish Society of Midwives of India (SOMI). It is only 9 years old and they have already had 7 successful conferences. Other areas, such as Nepal and Bhutan, have smaller organizations that are just getting off the ground. In many parts of the world, midwives remain invisible because they do not have professional organizations to represent them. The midwives are "hidden" within the nursing associations. So, we talked about how midwifery globally can be strengthened by the midwives forming their own societies.
My new friend Josephine from Rwanda was inspired. She is from the ministry of health, but she is also a midwife. She told me that after the genocide, they had to start from zero. On our last day there, we were having breakfast and she decided to form the first midwifery association of Rwanda. We actually were trying to decide what it would be called!! It is so inspiring to see women finding their place in the world. I told her that I would be happy to help in whatever way I could.
So today, I received my first email from Rwanda, this is what she said:

"Greetings from Rwanda!
I have passed the message to the midwives I work with, they are very ready to start the midwifery association and move forward."

Wow! Just like that, a midwifery association is born! Congratulations to Josephine and the midwives of Rwanda. I will keep you posted.

Sara from Uganda and Josephine from Rwanda

Hope is better than nothing

I keep thinking about Sara from Uganda. She runs a 15-bed clinic along with 2 other midwives. She receives $5 per delivery. Some women come for prenatal care and not too many people come postpartum. Once a healthy baby is born, most of her clients feel they don't need to return.

Sara came all the way to Washington, DC to represent the Ugandan Midwifery Association at the Symposium to Strengthen Midwifery. She received a scholarship to attend Women Deliver. The UMA has over 2000 midwives and was started in 1948 when the government tried to make midwives retire at 55. You can imagine what the midwives said to that! So they formed an organization to better represent themselves to the powers that be. Sara says the UMA is the best midwifery organization in the world.

When the Symposium was almost over, Sara was discouraged and asked me what would happen on the ground. On my last day with Sara, we were walking from store after I had bought chocolate for her to take home to her children. She was hopeful, particularly because I had just made a blog for her that morning. She wants to use the blog to tell the stories of maternal death in Uganda. She wants to post about the midwifery meetings they will have. She has a new vehicle for communication. She is going home with SOMETHING already in her pocket. She says that hope is better than nothing. She says that she has a new friend, she has a blog, and that she knows that she is not forgotten. That the women of Uganda are not forgotten. Sara decided to call her blog, Women for Survival.

Women for Survival

I keep thinking about Sara and our fast friendship. I am thinking about our partnership and how one-on-one we can help each other strengthen midwifery. I know so well how the Bay Area's midwifery community has grown simply because of the one-on-one support we give each other. Why can't we do that across the global? I guess I'm saying there's no reason why not.

Call to Action

Prakasamma from India passing out white ribbons before an introductory ceremony to remember the women who died.

Precious from South Africa calling to get midwives off of the sidelines.

5:05 am

The Call to Action is to strengthen midwifery as a key component to achieving the Millenium Development Goals 4, 5 and 6. These MDGs are the focus of our symposium. In September, 2000, the Millennium Declaration was ratified by 189 heads of state at the United Nations Millennium Summit. This declaration outlined eight broad goals. The Millennium Development Goals (MDGs) represent a global commitment by all nations who signed the Declaration to reduce poverty and improve lives. MDGs 4, 5 and 6 pertain to the health of mothers and children.

MDG 4 is: Reduce by two thirds, between 1990 and 2015, the under-five mortality rate.

MDG 5 is: Reduce by two thirds, between 1990 and 2015, the maternal mortality ratio.

MDG 6 is: Have halted by 2015 and begun to reverse the spread of HIV and AIDS.

The goals are powerful and necessary. The World Health Organization, represented here at the symposium, suggests that we need 334,000 more midwives worldwide in order to meet these goals. The White Ribbon Alliance, that draws attention to maternal mortality globally, states that less than half of the worlds childbearing women are attended by a skilled health worker. Please visit their website, and watch their 2 minute movie about birth and death.

Women Deliver begins today with plenary sessions moderated by Christiane Amanpour and Arriana Huffington. Women Deliver is about empowering women and girls, especially in our poorest countries. Studies show that when women's lives improve, the whole society improves. We can not empower women on this level without talking about reproductive health, safe birthing practices, birth control, and sexual health. Midwifery care has been recognized as part of the process to empower women and achieve the MDG goals.

Gera and I ready to roll.

Women Deliver

Sara from Uganda

Lamia from Sudan

11:19pm

I am finally sitting down at my computer with an Internet connection. Wow. It has been a busy 40 hours of networking, absorbing, thinking, "caring, sharing, and daring," as my new friend, Precious, from the South African Ministry of Health would say. I have been cracked open to the global realities of midwifery. We have been talking about decreasing maternal mortality for 2 days. The exhibit hall for Women Deliver, which will host 3000 people, is booth after booth of international organizations that are working to decrease the number of women DYING in childbirth. DYING. Not infant mortality. Not waterbirth. Not VBACs. WOMEN DYING. IN CHILDBIRTH. This is the issue.
I spoke with a man from Nigeria tonight. Nigeria has the second highest maternal mortality rate in the world. My new friend Josephine, from Rwanda, told me that after the genocide, they had to build midwifery from zero. My friend Sara from Uganda runs a birth clinic where she gets $5 per delivery. My heart is cracked wide to the realities of the world. These brave women who have come SO FAR to tell their stories and seek help from friendly nations. From Chad, Benin, Uganda, South Africa, Nepal, Bhutan, Malawi, Rwanda, Afghanistan, Pakistan, Palestine, India, Uruguay, Chile, Burkina Faso, Sudan. And those are only the ones I am remembering. 40 to 50 countries were represented.
I walked around the exhibit hall and slowly became overwhelmed. Booth after booth told the story of women dying in birth and how each organization was going to tackle the problem. By the time I got through the exhibit hall, I could barely breath. When I sat down, I was crying.

The symposium has been a success on many levels. But Sara from Uganda asks me, what will they do now? What can I expect when I go home? I tell her that tomorrow we will bring that question to the president of the International Confederation of Midwives. I know already in my heart that nothing will change right away. The channels are slow, going through governments and NGOs. The effect "on the ground" will not be felt for perhaps years to come. The Millenium Development Goals are supposed to be reached by 2015. Decreasing maternal mortality by 75%. The pressure is on, and there is hope in the air that much will happen by then.
For now, Sara will go home to her birth clinic-- knowing that she has spoken for the women of Uganda, wondering when change will come.

New friends from South Africa, Uganda and Rwanda

Symposium on Strengthening Midwifery

6:00 am

Dina and I are here in Washington, DC for the historic event entitled, A Symposium on Strengthening Midwifery. Gera Simkins, MANA president, is still sleeping but Dina and I are going over to the convention center early. Dina will be filming the event. I will be blogging more throughout the day about what this event is all about. Just to give you a taste, last night we had a quick check in with the president of the International Confederation of Midwives, Bridget Lynch. The president of FIGO, the world organization of Obstetricians and Gynecologists was there as well. He's from Egypt. There were also representatives from the United Nations Population Fund and Johns Hopkins. The agenda for today has introductions from the World Health Organization, UNICEF, The World Bank, Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO), the Swedish International Development Cooperation Agency (SIDA) and a government perspective from the State Minister of Health from Bangladesh. There will be around 200 people at this event with possible only 3 representatives from the United States' midwifery organizations (us and the ACNM.)
Don't know what to expect fully, but very excited. Stay tuned!