« Since I arrived here, I have been 'overwhelmed' with work because I am alone at this duty station. Nonetheless I love my job and I am proud to be a midwife. »

Elysa RASOAVINJANAHARY is a midwife at the Beroy Health Centre II in the Atsimo Andrefana region in Madagascar. She has been working there since 2016 and each day is different, a reality she has already gotten used to. "This morning I was carrying out vaccination when a pregnant woman, at term and who was already on the point of giving birth was brought here to the health centre. I had to stop what I was doing to take care of her as a case of emergency. The baby came out deprived of oxygen, and I had to resuscitate the newborn. The resuscitation took quite a while. When everything was settled with the delivery, I resumed vaccination and other routine activities at the health centre. I’m happy because the baby survived, and is in good health with the mother. »

Midwives like Elysa save the lives of women and newborns in the ‘big Island’ every year. In Madagascar, the rate of deaths related to pregnancy and childbirth complications is very high, with an average of 10 women and girls losing their lives every day due to such-related complications. This high number of maternal deaths is as a result of insufficient and limited use of quality integrated reproductive health services. To address the issue and contribute to the reduction of maternal mortality, UNFPA has supported the Ministry of Public Health in recruiting midwives on contract basis to work in remote areas where maternal mortality is comparatively higher.

Since 2018, 132 midwives have been recruited in seven regions, notably; Atsimo Andrefana, Androy, Vatovavy Fitovinany, Analamanga, Atsinanana, Alaotra Mangoro and Haute Matsiatra. Among the 132 midwives, seventy have been integrated into public service.  

Midwives are also crucial to ensuring universal access to voluntary family planning. Family planning offers an array of benefits, including the improvement of maternal health and the survival of newborns as well as the promotion of social and economic development of families and communities.

At the health centre where Elysa works, the family planning (FP) service is open Monday to Friday and accessible to women of childbearing age. « But it is difficult to convince women to use family planning methods, especially to adopt long-term methods such as the implant and the intrauterine device (IUD). I have to devote my time to sensitising and counselling women who come to the Health Centre for family planning; and to fight against false rumours. »

She admits that it is quite an arduous task trying to change people's attitude and behaviour.  « At Often I have been faced with some women who are difficult to convince, but I have never given up, because the satisfaction of women in family planning is one of my missions as a midwife. » It is for this "sometimes difficult" nature of their work that the chairperson of the National Order of Midwives, Ms. Omega RANOROLALA, believes that the midwifery corps needs more training. « Let's support midwives so that they can improve their skills and know-how »

Elysa wishes to see more midwives deployed to her duty station and to other health centres across the country.

We are the primary actors in efforts to reduce the high mortality rate of women and children during childbirth.

« We are the primary actors in efforts to reduce the high mortality rate of women and children during childbirth. Primary actors because it is quite easy for the population to approach midwives », says the chairperson of the Association of Midwives, Ms. Voahangy RAMAHAVONJY, who fully understands the important work of her peers.

While the World Health Organisation, WHO, recommends one midwife for every 5,000 inhabitants, in Madagascar on a national scale, the ratio is one midwife for every 16,000 inhabitants, which clearly shows the gap in qualified personnel to provide adequate care to pregnant women.

For the Resident Representative of UNFPA, Koffi KOUAME, « the figures speak for themselves, the needs are many and, with concerted efforts, we can better invest in midwives, in their training. We need to provide them with an enabling environment so that they can fully do their work and continue to save lives. »