Opinion: How to provide short- and long-term protection for women affected by COVID-19

The current COVID-19 outbreak continues to cripple health services worldwide. As the World Health Organization has widely publicized, an estimated shortage of 350,000 midwives globally meant midwives were already under pressure even before the pandemic kicked in. Midwives now strive to balance disease prevention with the continuation of midwife-led continuity of care for women and their babies.

The challenges presented by this balancing act were evident during the recent Global Nursing & Midwifery Triad Meetings, where Sally Pairman, chief executive of the International Confederation of Midwives, discussed how midwives are eager for increased involvementin global conversations pertaining to maternal health.

In our respective roles as ICM president, global goodwill ambassador, and young midwife leader, we have listened to midwives carefully to understand their current challenges and continue to advocate on their behalf within regional, national, and international circles. We have drawn on experiences from Nigeria and Pakistan — the respective home countries of Toyin and Neha — to highlight the current state of midwifery.

These front-line experiences are reflected in ICM’s global calls to action for governments, decision-makers, donors, and health institutions to ensure the protection of midwives, women, and newborns during the COVID-19 pandemic and beyond.

A midwife attends to a newborn at a clinic in Uganda. Photo by: The White Ribbon Alliance / CC BY-NC-ND

The following calls to action emerged:

1. Recognize midwives as essential workers and give them PPE

Many midwives in countries around the world are not recognized as essential health workers and are denied access to personal protective equipment as a result. This reality is playing out in Nigeria, where unprotected midwives have been infected, while in Pakistan our fellow midwives are having to turn away women who are coronavirus-positive or presumed positive, out of understandable concern for their own health and safety.

Comparably, Nigerian and Pakistani women have been terrified of the threat of the virus, resulting in skipped antenatal and postnatal appointments and home deliveries aided by untrained birth attendants who lack adequate information to make informed decisions about their care.

2. Protect women’s rights to a positive birthing experience

As a predominantly female workforce, midwives face the same gender inequalities that put women and girls at the highest risk during any crisis, with increases in gender-based violence, deprioritization and defunding of essential health and social services, and inherent biases within institutions and systems that see the female workforce operating in unpaid, unsafe environments.

3. Support midwives in continuing to help women — even during pandemics

When staff and services are under extreme stress, there is a real risk of increasing avoidable harm, including a heightened risk of infection, disrespect, morbidity, and mortality — all indicators of a reduction in quality of care. As we already face the reality that at least 800 women per day are dying from preventable causes related to pregnancy and childbirth globally, the continuation of near-normal care for women should be prioritized to ensure we do not reverse progress made in lowering maternal death rates in the past decade.

4. Stop the redeployment of midwives and ensure the quality of midwifery

In countries around the world, midwives are being redeployed outside of their scope of practice to care for coronavirus-positive patients. Midwives in Pakistan, for example, have reduced their maternal health responsibilities in favor of performing COVID-19 testing and other pandemic-related tasks.

5. Include midwives in policy, decision-making, planning, and response to COVID-19

The redeployment of midwives typifies the broader issue of midwives being excluded from decision-making processes around maternal health services. This is a long-standing trend that has been exacerbated by the current pandemic. If midwives had been included in policy, decision-making, planning, and response to COVID-19 early on, they might not have been deployed to other sectors and the provision of male PPE for a female workforce would have been avoided — fostering safer, more effective care.

6. Prioritize women’s sexual health and reproductive services

It is equally important to center women’s voices during this time when their sexual and reproductive rights are being ignored. Around the world, midwives are noting that a shortage of health care workers, a reduction in pharmaceutical supplies, and depleting health finances have contributed to a disruption or stoppage of essential health services. In Pakistan, for example, many women haven’t been able to access basic reproductive services such as family planning support and post-abortion care, resulting in an increase in unwanted pregnancies.

We must come together to collectively call on governments to invest more in midwives globally and include midwives and women in global health leadership and decision-making. ICM’s calls to action seek to spell out how governments and decision-makers can make this a reality. Resilience is a common characteristic of midwives, but we must still ensure this is the last time the world is caught unprepared for a global health crisis such as this one.

Visit the Duty of Care series for more coverage on how health systems can function better so that health care workers are supported and protected. You can join the conversation using the hashtag #DutyOfCare.

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