Strategy for improving maternal and child health in South Asia

In several South Asian countries, midwifery is not an established profession. As a result, complications in both mothers and newborns are extremely common. Malin Bogren has been commissioned by the UN to work in Nepal, Afghanistan and Bangladesh. In her thesis, she presents a strategy on how the midwifery profession can be established in low-income countries - and in this way, improve the health of mothers and newborns.

The goal of increased maternal survival is one of the UN's Millennium Development Goals with the lowest degree of fulfillment.

An important strategy for improving maternal and child health is well-educated midwives. However, in many of the low-income countries, the profession does not even exist or competence is insufficient - something that contributes to complications and injuries to both the delivering mother and the newborn child.

Mapped the situation

Since 2007, doctoral candidate Malin Bogren has received different assignments in South Asia from the UN. In her thesis that is being presented at Sahlgrenska Academy, University of Gothenburg, she has mapped the midwifery situation in Afghanistan, Bangladesh, Butan, India, Nepal and Pakistan - all countries with a high maternal mortality ratio.

In none of these countries does midwifery fulfill the criteria for being an independent profession. In Nepal, educated midwives as per international standards are entirely lacking.

"There, nurses conduct midwifery work without any formal competence," says Malin Bogren.

Supporting profession establishment

Through questionnaires and individual interviews with key persons, observations at delivery wards and analyses of policy documents, Malin Bogren has formulated a strategy for supporting the establishment of a competent midwife profession in Nepal - a strategy that can also help with establishment in other developing countries.

"Midwifery in South Asia lacks national legislation that recognizes midwifery as an independent profession. The most important recommendations for improving the midwife profession in the studied countries are, therefore, legislative development and a comprehensive approach to strengthening the formal educational preparation for both midwifery students and midwifery teachers, which then raises the profession's status," Malin Bogren.

Close and open collaboration

It is a long road, but according to Malin Bogren, not an impossible one. Different political interests and priorities, competing interest from the nursing profession and different opinions as to what academic level midwifery should be put at, are some of the barriers. But, to succeed requires a close and open collaboration and communication between the decision makers, civil society, academia and the donors.

"My thesis provides recommendations for different levels of decision makers, civil society, academia and donors. Hopefully, this information can help to establish midwifery as a profession in South Asia and thus improve and promote maternal and newborn health."