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EAU Community Midwives

Improving Maternal and Child Health Systems in Developing Countries

April 2017

Fifteen years of brutal civil war has left Somaliland without trained medical professionals and has decimated  the country’s health facilities. The hospitals that have survived operate with limited equipment and constantly battle power, water, and supply outages. Notably, a skilled birth attendant accompanies only 9% of childbearing women in Somaliland. Nearly 7% of newborns die within their first year. As such, community midwives- public health professionals trained in basic emergency obstetric care- play a pivotal role in reducing maternal and newborn deaths, particularly when educated to international standards and integrated into fully-functioning health systems. In developing countries like Somaliland, they often provide primary care for poor and rural populations, including immunizations, education, diagnosis and treatment of common illnesses, and referrals for more complex conditions.

In response to these challenges in Somaliland, Edna Adan Ismail – native Somalilander, midwife, former First Lady, United Nations diplomat, and Foreign Minister of Somaliland – built the nonprofit Edna Adan University Hospital in the capital city of Hargeisa. Since opening in 2002, the hospital has managed more than 17,000 births and is diversifying into new surgical procedures, outpatient treatment, and fistula surgery. Lifesaving equipment improvements have been provided, including an ICU medical ventilator, all-terrain ambulance, batteries for solar panels, and refurbishment of the post-surgical recovery unit.

Edna Adan Maternity Hospital also trains midwives, thereby providing lifesaving care for women and children across Somaliland. Training began in 2014 in Berbera and Gabilay, towns located just outside the capital of Hargeisa, where 38 midwives successfully completed the program. A second cohort began training in 2016 and the program has expanded into more remote areas.  The program provides health care services, education, and training for women, affording them job skills and new economic opportunity.

Even the most skilled midwife can be stymied by a lack of equipment and supplies. A CFP-funded program with Direct Relief provides supplies for midwives in the form of a comprehensive Midwife Kit, the first ever formally endorsed as the global standard. Each kit contains essential tools--sutures, IV sets, delivery instruments, neonatal resuscitation bags, and more--to perform 50 facility-based deliveries. Kits also include pharmaceuticals to manage postpartum hemorrhage, eclampsia, and umbilical cord care.

Midwives provide as much as 87% of care needed by Somaliland’s pregnant women. The result of these programs is sustainable and dramatically-improved maternal and child health care. With support from outside funders like CFP, maternal and newborn mortality within the first 24 hours of birth is reduced--of particular importance  in remote areas where hospitals and clinics are scarce.