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20 December 2021 | Story Elsabé Brits
Dr Elgonda Bekker, from the University of the Free State (UFS), completed her doctoral degree in nursing in 2020, with a practical, transformative thesis to improve the education of midwives in the country.

Midwives who are properly trained and acknowledged for their skill and experience do not only save lives but make a huge contribution to maternal health in South Africa. However, there is a dire need for professional midwives and competent educators. 

Dr Elgonda Bekker, from the University of the Free State (UFS), completed her doctoral degree in nursing in 2020, with the title: Competencies of South African midwifery educators: a transformative framework. It is a practical, transformative thesis to improve the education of midwives in the country. Sadly, just months after she received her degree she passed away. Yet, her colleagues at the School of Nursing at the UFS continue to build on the foundation she laid.  

Too much too soon, too little too late 

The World Health Organisation (WHO) states that 10-15% of births may need intervention through caesarean section. A recent analysis, however, found that private hospitals had a caesarean section rate of 73.6%, compared to 26% in the public sector.

Although the public sector rate is higher than the WHO target, the private sector rate is not justifiable, Bekker writes. The case fatality rate for mothers who died after a caesarean section had been performed showed an increase. That is one of the statements indicating that not all medical interventions are of benefit to mothers.

A focus on too much too soon or too little too late in the Lancet series on midwifery of 2014 indicated the need for better-quality care. In South Africa both manifest because of the disparity between private and public healthcare. According to Bekker’s research, the high caesarean section rate in the private sector is a classic example of over-medicalisation of obstetric care, whereas the public healthcare system follows a midwifery-led model of care.

“Midwives are a vital solution to correct this disparity. Competent midwives, educated to standards, can prevent interventions without indication, provide service in rural settings and advocate for the rights of the childbearing family,” she wrote.

Midwifery is a disempowered profession 

Winnie Moroa Motlolometsi, a midwifery educator, explains that professional nurses in the country have a dual registration with the South African Nursing Council as a nurse-midwife. This leads to many qualified midwives not necessarily practising as midwives. It is therefore very difficult to calculate the number of practising midwives. 

Furthermore, the conflation of nursing and midwifery requires training as a generalist practitioner. Depending on the institution where they are trained, professional nurses may or may not comply with the International Confederation of Midwives’ Global Standards for education and regulation of the midwifery profession. 

Nevertheless, according to Dr Bekker’s research, midwifery is a disempowered profession, because the global guiding documents are neither considered by the regulatory authority nor the National Department of Health. There is a triple gap for competencies, coverage, and access: 

  • Insufficient numbers of competent midwives 

  • .. who can cover maternal health services 

  •  …who render services that address the needs of women 

There is a dire need for competent midwives in the country, but the predicament is that whilst midwifery educators are qualified, they are not necessarily clinical specialists, which ultimately jeopardises the quality of maternal healthcare. 

What was also clear from Bekker’s research is that although South Africa has a progressive constitution, gender equality has not materialised on grassroots level. Violence is ever present. Women are viewed as weaker, vulnerable, and less suited for the workplace. Nonconformity to sexual gender norms, based on cultural or religious bias, creates conflict for some women.  

Dr Deidre van Jaarsveldt, senior lecturer in the School of Nursing at the UFS, said Bekker’s study highlighted that feminism is a strengthening agency for women. In this study it was important to frame the context of midwifery as a disempowered, woman-led profession, caring for women who are still finding themselves in a society where there is gender inequality. 

The research indicated that there were many challenges: 

  • Lack of autonomy for midwives 

  • Non-compliance with the global midwifery standards 

  • Conflation of nursing and midwifery 

  • Midwifery regulated by non-midwives 

  • Lack of direct entry into midwifery education in the country 

  • High litigation in maternal and child healthcare – there is fearfulness among practitioners and reluctance to work within the midwifery profession 

In practice it is difficult to distinguish midwifery specialists from nurses who are practising as generalists and are expected to offer maternal healthcare services. If something goes wrong, the midwifery profession is held accountable, but practising midwives were not necessarily involved. 

Reproductive, Maternal, Newborn and Child Health Hub 

There is a dire need for midwifery to become an autonomous profession guided by global standards. Membership should be based on advanced qualifications, which strengthen midwifery as a speciality. This can only be attained through education and maintained by a regulatory body, as well as the de-conflation of midwifery from nursing. When this happens, midwives will know who the actual midwives are and be able to hold one another accountable, Motlolometsi adds. 

Dr Bekker advocated for the “decolonising” of midwifery, which means restoring the knowledge to the profession. To allow midwives to receive quality education, midwifery should become an independent profession that is guided by global standards and regulated by midwives.  

Van Jaarsveldt says the School of Nursing at the UFS endeavours to offer quality midwifery education. Students learn in a high-tech simulated learning environment where they can become competent before working with actual mothers and babies. The educators are clinical experts, supported by a team of midwifery practitioners who act as preceptors for the students. 

Before her untimely death, Dr Bekker started establishing a Reproductive, Maternal, Newborn and Child Health Hub in the Faculty of Health Sciences, which is continuing under the leadership of Dr Cynthia Spies, supported by a team of interprofessional experts.  

“Through research and continuous improvement of education and practice, this group of professionals envisions optimising and strengthening reproductive, maternal, newborn, and child health competencies so that current maternal and child morbidity and mortality trends can improve resulting in surviving and thriving childrearing families.  

“The goal is to develop partnerships and opportunities for collaboration and research with colleagues in healthcare disciplines and to extend beyond healthcare to include innovative interdisciplinary partnerships,” says Spies. The objectives include:

  • Practice development with implementation of evidence-based practice and positive experience of the childbirth and child health continuum; 
  • Clinical competency development through training and the development of short learning programmes; 
  • Clinical research that addresses the current reproductive, maternal, neonatal and child health mortality, morbidity and health issues in central South Africa.

News Archive

UFS celebrates Africa Month
2017-05-24

 Description: ' Africa Month Tags: UFS celebrates Africa Month

Most of the international students at the UFS come from
the Southern African Development Community (SADC)
and other countries in Africa.

Photo: iStock

“Africa Month provides an opportunity
to every student and staff member to
commemorate African unity and celebrate
our rich cultural heritage, diversity,
energy and social dynamism.”

The University of the Free State (UFS) celebrates Africa Month to commemorate African unity and praise cultural heritage, as well as to take ownership of the future of the continent. According to Prof Heidi Hudson, Director of the Centre for Africa Studies, these are reasons to take part in the festivities.

Formation of Organisation of African Unity

Africa Day is the day on which Africa observes the creation of the Organisation of African Unity (OAU) on 25 May 1963. A total of 32 independent African states attended the formation.

The OAU’s aims were to promote unity and solidarity of the African states and act as a collective voice for the continent, in order to secure Africa’s long-term economic and political future and to rid it of remaining forms of colonialism. The OAU later gave birth to the African Union, which formally replaced the OAU in July 2002.

Prof Hudson says celebrating Africa Month forms part of her centre’s institutional mandate to promote an African focus in research, teaching, as well as public debate.

“Africa Month provides an opportunity to every student and staff member to commemorate African unity and celebrate our rich cultural heritage, diversity, energy and social dynamism. Secondly, by participating we all begin to take ownership of our future on this continent.”

She adds that Africa month provides a platform for reflecting on past experiences and achievements, as well as to critically assess the failures, challenges and the lessons learnt for the sake of a better future for the continent’s people.

Working relations across the continent

The UFS has working relations with universities, embassies and consulates in African countries such as Zimbabwe, Mozambique, Botswana, Zambia, Kenya, Namibia, Nigeria, Ghana, Uganda, and Tunisia.

Five cooperation agreements exist – they are with the Botho University (Botswana), Greater Zimbabwe University, Universidad Eduardo Mondlane (Mozambique), Trinity Theological Seminary Ghana, and Namibia Evangelical Theological Seminary.

According to Kanego Mokgosi, Senior Officer at Internationalisation, there are also working relations between the university and The Council for the Development of Social Science Research in Africa, Swedish International Development Agency and The United Nations Educational, Scientific and Cultural Organization. All of these focus on research development in Africa.

Most of the international students at the UFS come from the Southern African Development Community (SADC) and the continent. It hosts 1393 students from SADC countries.

“The UFS employs SADC protocol guidelines which, among others, enjoin SADC universities to admit at least 5% of their student population from the SADC region,” says Mokgosi.

Memorial Lecture by Dr Zeleza

On 24 May 2017 the Centre for Africa Studies hosted an Africa Day Memorial Lecture by Dr Paul Tiyambe Zeleza, the Vice Chancellor (President) of the United States International University Africa, Nairobi, Kenya.

The UFS library, in collaboration with the Department of English and the Office of International Affairs, also celebrated Africa Day on 25 May 2017. They hosted a conversation on the Land Debate in South Africa, together with the launch of a book titled White Narratives: The depiction of Post-2000 Land Invasions in Zimbabwe by Prof Irikidzayi Manase. He is an Associate Professor in the Department of English.

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