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| Some shots from our short 2 day trek in the Annapurna Region |
As we have been sharing little nuggets of information about midwifery, childbirth, and women's rights in Nepal, we thought we should backtrack and share a short summary of the status of midwifery in Nepal.
The association of midwives of Nepal (MIDSON) was formed in 2010.
Midwives are not yet recognized in Nepal. Midwifery services are provided by nurse-midwives regulated by the Nepal Nursing Council. And most care providers delivering babies are nurses or doctors. The goal of MIDSON is to advocate for more midwives through education and advocacy of the midwifery profession.
How can midwives make a difference in Nepal?
- Midwives with the education outlined by the International Confederation of Midwives are experts in normal, physiological birth.
- Midwives provide care during pregnancy, labour, birth, and postpartum.
- Midwives provide respectful care with the philosophy of informed choice discussions.
- Midwives usually provide continuity of care, meaning they meet and know their clients and their unique needs before they are in labour.
The MIDSON mission statement is:
"Striving for healthy women, healthy babies and a healthy nation by strengthening the midwifery profession."
The MIDSON website talks in detail about midwifery in Nepal.
- From 1996-2006 there was a civil war in Nepal between Maoist rebels and the government. Because of this the health care system in Nepal is poor.
- Women are still viewed as lower status than men.
- In the 1990's the Nepal health system invested in training of Auxillary Nurse Midwives (ANMs) and Maternal and Child Health Workers (MCHW).
- Beginning in 2006 the Nepal Government trained thousands of nurses ANM's and physicians as Skilled Birth Attendants (SBA's) in order to provide safer childbirth in rural and urban areas. One of the main challenged has the continued education of SBA's and being able to train enough SBA's to a level of competency.
- Currently there are two Bachelor of Midwifery educational programs in Nepal.
- There are four more programs currently being developed.
- One of the concerns with some of these programs are that they are more of a nursing curriculum than midwifery specific.
The women of Nepal have made great strides towards more reproductive rights over the past decade. Abortion was legalized in 2002 and is a major contributor to the reduction in the MMR from 548 maternal deaths per 100,000 in 2002 to 258 maternal deaths per 100,000 in 2015. The other factors that have contributed to the MMR reduction include: the construction of roads, empowerment of women during the tie of the maoist insurrection, and the Aama Program of Nepal that provides women with monetary incentives for attending antenatal appointments and for travel to a facility-based birth.
For more information you can check out the following websites:
Although there are still so many barriers to women accessing safe effective health care in Nepal, there have been many successful initiatives. We saw first hand how the education around family planning and legalization of abortion has been successful in some communities. Our observation was in the public Baglung hospital. A young, illiterate woman from a poor family traveled over several days to access a medical abortion. She was counselled on her options and was provided with both a safe medical abortion and a hormonal contraceptive transplant that is effective for 5 years. The nurse that was providing her care is an Auxiliary Nurse Midwife with the additional SBA training. We worked closely with her during our time in Baglung. She is a very smart, compassionate, motivated individual who has well served her community with her government funded training.
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| More pictures from our trek to show you the state of roads and the mere vastness of rural Nepal. |
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