Midwives at heart of Somalia’s new reproductive health strategy

May 2013

A reproductive health programme in Somalia is breaking new ground in rapidly expanding access to birth spacing services, safe childbirth, antenatal and postnatal care.

By 2010, two decades of internal conflict and famine and a collapsed health sector had left 80% of Somalia’s population without access to basic health services. The prospect of giving birth in the presence of a trained midwife or of accessing family planning – or “birth spacing” – services was thus a distant dream for the vast majority of Somali women, and one in 14 pregnancies ended with the mother dying.

A group of Somali women engaging in an educational session about reproductive health.
PSI Somalia

Spacing births more widely can dramatically reduce maternal mortality and improve the chances that children will survive. Dr Nima Hassan, a surgeon in Banadir Hospital in Mogadishu describes an all-too frequent Somali tragedy: “One patient died last year when she was in labour with her twelfth child. I warned her she would have problems and she shouldn’t get pregnant again, but her husband put pressure on her to get pregnant and her body couldn’t cope.”

But as Somalia’s new government begins to rebuild public health services, a number of women are beginning to realize that dream.

New programme to improve access to reproductive health services

The first step was to establish a Somali Reproductive Health National Strategy and Action Plan 2010-2015. The plan focuses on three priorities: birth spacing, safe delivery, and addressing harmful practices like female genital mutilation.

“The numbers may look modest, but after two decades of the total absence of any such health efforts, they represent a breakthrough.”

Dr Humayun Rizwan, WHO Primary Health Care doctor

WHO has been working with a consortium of international NGOs, the United Nations Population Fund (UNFPA) and UNICEF to support the three zonal health authorities, and the new Directorate of Health under the Ministry of Human Development and Public Service, in creating and implementing the plan.

In these early stages, all partners have focused on increasing the number of trained midwives and improving access to birth spacing services.

There is a clear link between the two objectives. Skilled birth attendants not only play a critical role in ensuring safe childbirth, they also have an unparalleled opportunity to talk to women in safety and privacy about reproductive health, and to advise them how to space their children using modern methods.

Training midwives

Training has been a key element of the plan. In 2012 WHO has trained 200 birth attendants on clean and safe delivery and early referral in South Central Somalia. Another 200 health workers, mostly midwives, were trained in Basic and Comprehensive Emergency Obstetric Care.

A group of Somali women engaging in an educational session about reproductive health.
PSI Somalia

UNFPA has established seven midwifery schools, graduating 125 new community midwives so far. Population Services International (PSI) and other NGOs have trained more than 500 health workers, such as skilled birth attendants and junior doctors working in public health facilities, to provide information about birth spacing.

PSI and health authorities have also led the distribution of modern birth spacing methods through more than 300 private pharmacies in Somaliland, and trained pharmacy and public health centre staff to provide counselling.

In Somaliland, where the work on birth spacing was first spearheaded in 2010 because it was the first region to become accessible as conflict receded, more than 18 000 women have obtained essential reproductive health information in “interpersonal communication” sessions. More than 1300 women have now started using modern methods to space their families and thus improve their own health and that of their children.

“The numbers may look modest, but after two decades of the total absence of any such health efforts, they represent a breakthrough,” says Dr Humayun Rizwan, a WHO Primary Health Care doctor.

Challenges ahead

Much progress has been made, but Somalia still has a long way to go to offer all Somalis who want them access to birth spacing services, the presence of midwives at childbirth, and antenatal and postnatal care.

WHO continues to support the health authorities in establishing and implementing policies to make birth spacing and other reproductive health services possible.

WHO’s representative for Somalia, Dr Marthe Everard, says, “The improvement in Somali women’s access to midwives for all essential reproductive health services, including birth spacing, is part of an immense effort to improve these particular services and strengthen health systems in general. Somali Health Authorities are committed to expanding these services. WHO and its UN and NGO partners are at their side to make this happen.”

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