Train midwives in Madagascar to fill a dangerous gap in maternal health care – Madagascar


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ANTANANARIVO / Madagascar – “It wasn’t until I found myself alongside my classmates in the delivery room, cheering on an anxious expectant mother as she gave birth to a baby boy, that I realized how valuable this work can be. “

For Tahiana Rakotovao, 24, the lifelong dream of becoming a midwife came closer to reality during her studies at the Interregional Paramedic Ambulance Training Institute (IFIRP) of Madagascar, in the capital Antananarivo. .

Speaking from her practical experience, she recalls: “A woman came into labor and we were part of the team supporting the senior midwife on duty. When the patient was examined, the midwife realized that the baby was in breech – with her feet facing the birth canal instead of the head.

A breech birth can lead to life-threatening hardship for mother and baby, so having an experienced midwife to help is essential. Madagascar currently has a qualified midwife for 7,000 inhabitants, less than half of the minimum recommended by the WHO.

This critical shortage puts the safety of new and expecting mothers at risk, with an average of seven women and three adolescent girls dying every day in Madagascar from complications related to pregnancy and childbirth. Less than half of all births are attended by skilled health personnel and 60 percent are home births because many women cannot afford to access or afford quality maternal health care .

Learn to correct the imbalance

Each year, around thirty students are admitted for a three-year training course in midwifery in each of the six public institutes in Madagascar. While there are also over 100 licensed private midwifery training schools, it can be difficult to assess the quality of training because their curricula are not standardized.

Since 2018, UNFPA has worked with the government to support training programs for more than 800 female midwifery students at three public institutes and one private school, helping to ensure that graduates are qualified according to international standards. Students have better access to classroom learning materials through rehabilitated labs, anatomical model supplies, and an expanded digital library with a wide range of personalized online courses.

Previously, government programs recruited midwives directly from national civil service training schools, but funding cuts mean they now have to find employment themselves.

Liliane Ravelnarivo, head of the training department at IFIRP, says that while much is being done to improve the situation, the needs remain enormous. Students lack amenities such as computers and a fast internet connection, while newly graduated midwives face scarce employment opportunities after graduation. “Previously, government programs recruited midwives directly from national civil service training schools, but funding cuts mean they now have to find jobs themselves,” said Ravelnarivo.

Midwives save lives

Despite the difficult circumstances, Domoina Andrianjanahary, 23, another final year student at IFIRP, says witnessing the plight of women giving birth has fueled her ambitions. “I want to open a clinic in my native village, located about 120 kilometers from the capital, to help the most vulnerable to access services such as prenatal consultations, contraception and vaccinations. Many women live in remote areas with no health facilities nearby, so they often cannot get to the hospital on time, putting the lives of both mother and baby at risk.

To date, UNFPA has supported the recruitment and deployment of 157 midwives in 52 emergency obstetric and neonatal care centers and 13 primary health centers in remote and hard-to-reach areas of Madagascar.

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