Nicaragua's Minister of Health Guillermo Gonzalez and Pirrko Hellsten midwife at the Karolinska hospital is discussing during the midwife conference.
Midwives gather for strength
At the inauguration Maria Tegborg, Sida’s Country Director in Managua, mentioned the recent Swedish initiative to further promote maternal health and reduce maternal mortality.
The initiative will also be focusing on Sexual and Reproductive Health and Rights, including abortion as women's rights, in the context of the MDG5 initiative. At the core of the agenda was learning from regional experiences of midwifery.
"I feel proud of being a midwife when discovering that all over the world we are giving the same fight to save the life of a woman", says Irma Rivera from Peru, one of the invited lecturers at the convention.
"In Peru midwifery exists since more than 180 years, now days with five year training at academic level. It is a legally recognised profession and almost 9 out of 10 births are assisted by a midwife", continues Irma.
Other invited lecturers from Chile, Spain, and Sweden gave similar testimonies.
Midwives still not recognised in Nicaragua
The experiences from the Nicaraguan midwives demonstrate how they struggle against practical as well as social and cultural obstacles in exercising their profession.
The profession as a midwife is still not recognised legally and they have to challenge established norms in society as well as in the health system. It is traditionally the medical doctors who assist deliveries.
Curiously Nicaragua has a very high share of caesarean sections. Through their training, the midwifes have been equipped with scientific knowledge and skills which favour the health and well being of the mother and the child before, during and after childbirth.
They have been trained to become gender aware and to involve the fathers in the health of the mother and new born child. Sometimes it is a matter of saving lives, but more often it is a matter of creating conditions for a healthy life.
Marianne Velandia, midwife and researcher at Karolinska Institutet – which assist with capacity strengthening and technical assistance within the midwife programme in Nicaragua – expressed a deep satisfaction.
"It is fantastic to hear the stories and understand that 500 trained midwives is a lot – they have really made a difference! Another satisfaction is to learn that they will continue with the training at several locations in the country and to see that they are getting organised", concluded Marianne.
One of the major achievements from the convention was the decision to get organised as midwives, or obstetrical nurses, increasing visibility and chances for political advocacy campaigns. Otilia Willis from Puerto Cabezas on the Nicaraguan Caribbean coast, summarise the lessons learnt from the convention,
“The most important is that we have founded our association and now to make advocacy for changing the law to legalise the work of obstetrical nurses, to authorise us to assist deliveries. Because today we are not, albeit doing it all the time.”
Facts and figures
- Nicaragua has committed to the Millennium Development Goals of reducing maternal mortality to 25 % of the rate in 1990.
Today the number is approximately 70/100.000
- Nicaragua is the country with highest maternal mortality rate in the Central American region
- Nicaragua has one of the highest rates of adolescent maternity in the whole Latin American region.
- 25 % of all maternal deaths occur with adolescents mothers.
Girls aged 15–20 are twice as likely to die in childbirth compared to women over twenty, while the risk for girls younger than 15 are five times higher.
The midwife training programme has a history stemming from the 80's when Swedish NGO “Svalorna” began training. Later that was followed in the 90's by Finland's support to specialised training of nurses, at the Infirmary Schools and over the last decade by Sida's support of the training. In the present term, 2005-2010, total budget amounts to some 27 million SEK, covering a one year specialisation as “obstetrical nurse” of 540 already graduated nurses, selected by their respective local health administrations, SILAIS.
Support is given to seven nursery schools in the country, technical advisory is provided by Sweden's Karolinska Institute.