A mother in West Bengal, northeast India, with her new-born baby. Getting pregnant women to the hospital is not enough; there must be trained staff there 24 hours a day.
Photo: Parth Sanyal/Reuters/Scanpix
Better trained midwives reduce maternal mortality
Countries around the world have agreed to reduce maternal mortality by 75 per cent between 1990 and 2015 as part of the fifth UN-mandated Millennium Development Goal. But maternal mortality has not fallen at all in low-income countries for the last 20 years. It is the single Millennium Development Goal that has not shown any progress so far.
A lack of political will and effective contributions is exposing the majority of women around the world to major risks.
Kyllike Christensson, a midwife and professor in reproductive health at Karolinska Institutet, says: “Imagine if 15,000 men around the world died every day – those in power would never accept that. That’s why this is principally a question of democracy and equality.”
In cooperation with Sida and the Swedish Association of Midwives, Karolinska Institutet is responsible for running a training programme for midwives in India. About 100,000 women die every year there due to pregnancy and childbirth complications.
Maternal mortality: a measure of women’s value
Society’s view of the value of women is often reflected in how much a country chooses to invest in maternal health care and safe abortions.
“Women are still subordinate in India and a woman’s life is simply not valued as highly as a man’s,” Christensson says.
In India, there are no professionally trained midwives to look after complicated births. Those who work as midwives often have too little clinical experience and are of low-ranking status among other health-care staff.
In the Sida-sponsored project, 15 midwife teachers have been selected for further training in Sweden and India. These master trainers have in turn trained 144 midwife teachers in four states and they will then pass their knowledge on in educating other midwives.
Midwives’ status must be raised
Christensson compares the situation in India to Sweden’s experience during the second half of the 19th century, which saw a huge reduction in the number of deaths due to maternal mortality.
“At that time, there was an increase in professionally trained midwives,” she says. “Every parish was required to have at least one midwife by law. Today, Sweden’s maternal mortality rate is the lowest in the world.”
According to Christensson, reaching the Millennium Development Goal of reducing maternal mortality is a priority and the country is placing a particular focus on increasing the number of childbirths in clinics and hospitals. But getting pregnant women to the hospital is not enough; there must be trained staff there 24 hours a day who can handle complicated childbirths.
The project also includes lobbying to improve maternal care and safer childbirths. Talks at state level have been held and some state governments have taken responsibility for the projects. The Swedish Association of Midwives is also working to improve the status of midwifery and to strengthen the Society of Midwives India (SOMI).
How Sida works to reduce maternal mortality
Sida is investing SEK 20 million over four years in training midwife teachers and for the construction of a midwife association in India. The project is run in four states: Gujarat, Andhra Pradesh, West Bengal and Tamil Nadu. Sweden is also investing an extra SEK 100 million from its 2009 development aid budget to reduce maternal mortality in other parts of the world. The investment will complement the contributions of almost SEK 4 billion that Sweden is already making to give more people access to health and medical care.