« Cameroon has no shortage of midwives, but it is misusing them. »
What are your thoughts on this year’s International Day of the Midwife theme, « One Million More Midwives, » in the Cameroonian context?
This is truly a welcome topic, because we’re already discussing it, at least in Cameroon. « One million more midwives »—what does that mean? It means that, despite recruitment efforts, there’s still a significant shortage of midwives in reproductive, maternal, newborn, child, and adolescent health services (RMNCH), meaning the services that are meant to support women, mothers, and young people. You know, sexual health—all these activities are carried out by midwives: prenatal care and the like. That’s why I’m talking about reproductive, maternal, child, and adolescent health services.
When you visit the different services, let me give you an example. I decided to conduct a study in a district of Yaoundé. After visiting thirty health facilities, we found only four midwives. Imagine, with the maternal, neonatal, infant, and child mortality rates, you can understand that most activities are carried out by midwives, because reproductive health is their specialty. That’s why, when you go to the services, you find nursing assistants and state-registered nurses. They aren’t turned away, but they must be supervised by the midwives.
So, we should have midwives in every maternal, child, and newborn (MCH) service to be able to monitor many things and be ready to refer patients with reproductive health problems. You understand, including gender-based violence. I remember doing this training and wanting to implement it in my institute, but it wasn’t very easy.
Even with the presence of a midwife, things need to be clear. The theme « One Million More Midwives » is relevant because, in most healthcare facilities, there are very few midwives qualified to manage reproductive health activities and interventions. If I were to tell you some of the stories, it would be very troubling.
Once, I was in a meeting with the Minister of Health. A woman was very upset because it was a meeting of midwives. She told us that at the General Hospital, in the delivery room, she gave birth alone. But when you speak, you implicate midwives. Are midwives actually the ones working in those positions? I’ll give you
my own example. I’m a qualified midwife with many specializations; I teach reproductive health subjects, but I don’t work in a reproductive health ward. I’m currently in surgery A.
Before surgery A, I was in the emergency room. Before the emergency room, I was in intensive care. You understand that I’m not the only one. Currently, we also have a midwife in the emergency room and a midwife in a surgical ward. So, the necessary resources aren’t being allocated to the relevant departments. I think there’s a misuse of midwives. Not only is the number of midwives who should be in these departments insufficient, but there’s also an inappropriate use of them.
I remember once going to the Maternal and Child Health Center (PMI). A doctor approached me about the high number of maternal deaths, especially among healthcare workers. He said, « Oh, what are you midwives doing? There are deaths. » I told him, « Doctor, calm down. » I think that’s the fight we’re waging against these maternal deaths. First, we need to assign midwives to appropriate positions so they can actually do their jobs.
At that point, we’ll know that at least there are midwives. But despite the few we’ve recruited, it’s still not enough. If you look at the ratio of midwives to women or children receiving care, it’s not there. There’s a lot to be done. That day, he said, « No, we need to do the math. » But is that up to us? No. That’s why « a million more midwives » is important, both in terms of quantity and quality.
We may have a shortage of midwives, but the fight we are waging in each center—personally, it’s our priority—is to train providers of maternal, child, and newborn (MCH) services, not just midwives, because that’s the current situation in Cameroon. Midwives are not currently working in MCH services. But we are committed to training the providers of these services, because the overall objective is to reduce maternal, infant, child, and neonatal mortality.
So, do you think Cameroon really lacks midwives or is it a problem of integration into the health system?
Cameroon has had no shortage of midwives since 2009, as I was part of the first cohort trained in reproductive health. It’s true that the development of training in Cameroon started with state-certified nurses specializing in obstetrics, then nurses specializing in reproductive health, and now midwives. But they all work in reproductive health. As for the number of midwives in Cameroon, there are enough, because schools train new ones every year.
According to the Ministry of Health, there are at least 54 midwifery schools.
Imagine: each year, at least 25 students graduate from each school, even if 5 fail. 54 schools multiplied by 20 is a lot. So, there isn’t a shortage of midwives in Cameroon, but rather a problem of integration, a problem of recruitment. Beyond recruitment, there’s also the issue of redeploying midwives to maternal, child, and newborn health services.
Madam, how is the midwife essential in reducing maternal and neonatal deaths?
That’s a very good question. It’s essential because it’s her specialty. She studied reproductive health. Everything related to preconception care—that is, before conception—the midwife will conduct a preconception consultation, order tests, and screen for any diseases that, during conception, could lead to birth defects or miscarriages.
This already reduces morbidity. Then, after preconception, there is conception itself. Midwives provide the vast majority – 99% – of prenatal consultations in Cameroon. Prenatal consultations allow for planning many things: preventative care, promotional care, curative care (if a pathology arises during pregnancy, it is treated). Finally, there is rehabilitation care. When complications occur, the midwife follows the woman until the end of the pregnancy, until labor begins.
Deaths can occur at all these stages. During prenatal care, a woman can develop a condition called eclampsia, which kills many babies. If treatment is not prompt, the woman can die. During labor, both the mother and the baby must be monitored. Labor monitoring is done using a tool called a partogram, which allows for early diagnosis. Early diagnosis means rapid treatment. If the healthcare team is available, qualified, and competent, diagnoses will be made early and treatments will be rapid, provided the necessary equipment and facilities are available.
Even if the available equipment isn’t sufficient, depending on the level of the healthcare system, everything is in place. At the local level, early diagnosis allows time for referral to a qualified facility with the necessary equipment and staff. Women’s health is crucial at every stage. After childbirth and labor monitoring, there’s the postpartum period, which is also very delicate.
At all these stages, a woman can die. You can see, therefore, that midwives are essential personnel for reducing maternal and neonatal mortality in Cameroon, because they work at all levels. Beyond conception and the postpartum period, they address gender-based violence, which is a major problem because it impacts both mortality and the mental health of the population.
Gender-based violence can affect anyone, regardless of age. Awareness and
advocacy help to reduce many of these incidents. These days, femicides are occurring all over Cameroon. We are considering how to address this. All of this is linked to gender-based violence.
We have learned about children with cerebral palsy. We would like to know if, with qualified midwives in appropriate positions, the birth rate of children with cerebral palsy could be reduced?
I think the answer is clear. I mentioned preconception consultations. Everything starts there. If this consultation hasn’t been missed and the various appointments are kept—especially the first consultation before 12 weeks—a lot can be said to the woman. She can follow the instructions, find ways to have ultrasounds, and screenings will be early.
Okay, madam. What message do you have for young Cameroonian women who are hesitant to become midwives?
You know, the young woman is hesitant because she doesn’t know what a midwife does. It’s a very noble profession. You have to do it with heart, with compassion. You don’t do this job for the money, because you can call a midwife anytime, anywhere. Even on the road, she can deliver a baby. Even at the market. She can handle many things, no matter where she is.
It’s a noble profession that requires love before one can practice it. To foster this, we need to raise awareness about the profession and promote it. We have an activity in the works: if we are given permission, we would like to organize a promotional event to raise awareness about the midwifery profession. You will see that we are increasingly trying to raise awareness, regardless of the strategy adopted, to promote this profession.
Because many people don’t know who a midwife is. It’s a profession in its own right. That’s why we’re advocating, and I’d like to take this opportunity to make this plea: that Cameroon recognize the midwifery profession as a professional body. A professional body—everywhere in the world, it’s a fully recognized professional body. A professional body means the Order of Midwives, and this will allow the profession to be properly regulated.
Interview by Elvis Serge NSAA
