“I Will Stay Here Under Any Circumstances – Even If It Costs My Life”: Why MENA Midwives Are So Much More Than Just Healthcare Providers
Bazaar Arabia takes a closer look how midwifery plays a crucial, yet undervalued, role in women’s healthcare throughout the region…
Giving birth is one of the most vulnerable things a woman can do in her lifetime. An experience that unites women around the world, entering the covenant of motherhood requires enduring one of nature’s most intense initiation rites. Physically demanding and profoundly emotional, the act of growing and bearing new life is a journey no woman should have to embark on alone – which is precisely why the practice of midwifery can be traced back for centuries.
From the Paleolithic era (40,000 B.C.) to ancient Egypt, Greece and Rome (3500 300 B.C.), early civilizations understood the importance of a profession that supported women and maternal health; but a shift in school of thought throughout the Middle Ages, coupled with the rise of modern medicine in Western countries in the 18th and 19th century, saw physicians step into the role of primary caregiver. As societies views on midwifery changed, the practice became less commonplace – until the 1960s, when family-centred maternity care and formal education for nurse midwives was introduced into the field of obstetrics.
The 21st-century woman has many options when it comes to her health, family planning and bearing children; but opting for an OBGYN is still very much the default around the world, including within the Arab states. Ultimately, it comes down to awareness and attitudes towards the profession of midwifery.
“People tend to associate midwifery with nursing. The distinction is very ambiguous,” notes Dr. Atf Gherissi, a United Nations Population Fund (UNFPA) supported Midwife Educator and Researcher based in Tunisia. “Even in countries where you have one profile like Tunisia and Lebanon, it is still not clear because there is neither a definition nor a scope of practice.” Having participated in numerous UNFPA-backed missions throughout the Arab world, she highlights a common cross-border issue: it is not always clear who is a midwife and how midwifery is different from the practice of nursing. Though some countries have regulatory and licensing systems, distinct policies and processes for midwives are not always clear nor are they consistent – and it’s this ambiguity that leads to public reluctance and the view that midwife care is subordinate to that of a doctor.
Many are working tirelessly to change these attitudes and further the profession throughout the region by establishing training programmes and lobbying governments for support – and Dr. Gherissi is very much part of this cause. “In 2021, the Council of Arab Ministers for Health decided, under the lead of League of Arab States, to develop a regional framework for nursing and midwifery,” she says, highlighting how this groundbreaking achievement could be the catalyst for change for midwifery in the region, creating a clear framework and definition regarding a midwife’s scope of work. “This framework was adopted and validated by the Council in May 2022, alongside the World Health Assembly in Geneva.” This means more support and assistance for creating education programmes for midwives, training centres and community awareness about the profession.
So, how exactly is a midwife different from a doctor or a nurse? Though there is overlap in some skillsets, training and disciplines shared with other health professions, midwives work in partnership with the women they care for; they specialise in promoting personal capabilities and holistic care alongside the family’s needs. It’s very much a role that does not start and end with childbirth. According to the International Confederation of Midwives – an organisation that supports and strengthens the professional association of the practice on a global scale – midwifery aims to optimise the normal biological, psychological, social and cultural processes of childbirth and early life of the newborn, working to empower the mother throughout her journey. Midwives work alongside other health professionals as necessary to meet each woman’s individual needs – which is precisely why Fatima Rahal looked to midwifery when starting a family of her own.
“I had a deep and enduring connection with my midwife, who was a crucial source of support and guidance,” recounts the 51-year-old mother of two from Lebanon, highlighting the special relationship. “I believed that my midwife was not just a healthcare provider, but a trusted friend who had been there for me during some of the most important moments of my life.” Even after having her children she routinely continued to pay her midwife a visit for check-ups and pap smears.
While Fatima’s positive birth story is a case study for those reluctant to consider midwifery as an option when giving birth, the role of the midwife is so much more than one of simply providing comfort to expectant mothers. According to UNFPA, a recent study from 88 countries that account for the vast majority of the world’s maternal and neonatal deaths and stillbirths concluded that universal coverage of midwife-delivered interventions could avert two-thirds of these deaths – saving 4.3 million lives per year by 2035 (Algeria, Djibouti, Egypt, Iraq, Morocco, Somalia, Sudan, and Yemen were included within the study). Midwives working in developing countries are lifesavers, beacons of hope and reassurance when conflict is rife.
Sister Insaf is a UNFPA-supported midwife from Sudan – and very proud of the work she does. “I really love this profession. I love being the person who helps bring new life into the world. To me assisting in childbirth is a rewarding activity,” she says.
Many countries throughout the region are affected by humanitarian crises, some more severe than others, but this shouldn’t undermine the fact that women and girls still need access to reproductive healthcare. According to UNFPA they’re often the first demographic to be overlooked in humanitarian preparedness and response – and this is when a midwife’s role becomes one of great importance. Midwives are more likely than any other healthcare professional to remain on ground when a crisis breaks out, providing vital care during a country’s darkest days.
“I will stay here and help under any circumstances even if it costs my life, because I believe that my humanitarian duty is not to leave anyone behind, no matter how bad the situation could be,” Sister Insaf says, revealing her devotion to her profession and the women she cares for. “I am here in Khartoum helping everyone and I will stay in Khartoum.” She highlights how the number of midwives dramatically decreased in the city, as many have had to leave due to the war, but some have stayed behind and are still working “day and night to save lives.”
The scope of work midwives take on is quite unlike that of any other profession. And though attitudes throughout the region are changing, a strong shift in perception does take time – and that needs to be driven by the professionals. “The future holds a lot of hope for midwifery in the region. It all depends on midwives themselves first and the countries second,” notes Dr Gherissi.
When asked if the next generation here in the region is interested in learning about the profession and pursuing it as a career, her answer is complex. “Midwives should change their way of thinking [of themselves] and give a good image of the profession to young people to attract them,” she says, “The reality is that they are very reluctant. In Tunisia, students are told by midwives during their training that they should have chosen to be doctors instead.”
“Women can be the best allies to midwives, like in the UK or in Quebec,” Dr Gherissi says, giving an example of how sentiments abroad towards the profession differ when compared to the ones close to home. “In the MENA region, [we’re] still very shy. We don’t have this alliance, but we can encourage it by being self-confident and proud to be midwives… stronger together and united to give a better image of the profession.”
From Harper’s Bazaar Arabia’s June 2023 issue.
