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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 departments receive recognition for quality work from MACE
2017-12-07


 Description: 2017 MACE winners Tags: 2017 MACE winners 

The team from the Department of Communication and Brand Management,
UFS Marketing and Institutional Advancement who received awards at the
2017 Annual National MACE Congress.
Photo: Supplied

The Departments of Communication and Brand Management, UFS Marketing, and Institutional Advancement collectively won 16 awards during the 2017 Excellence Awards presented by the National Association of Marketing, Advancement, and Communication in Education (MACE), which took place in Johannesburg on 30 November 2017.  

Shared experiences and best practices 
The awards ceremony is part of the MACE Annual National Congress, which took place from 29 November to 1 December 2017 at the Wits School of Governance. The MACE Congress is a platform on which experts from the fields of marketing, advancement, and communication share experiences and best practices. This year’s programme included speakers such Basetsana Kumalo, CEO of Basetsana Woman Investment Holdings and a former Miss South Africa (1994), and first runner-up in the Miss World Pageant, Saint-Francis Tohlang, independent trend analyst and writer, Emma Sadleir, founder of the Digital Law Co and Leanne Manas, multiple award-winning TV presenter. 

Celebrating successes
Lacea Loader, Director of the Department of Communication and Brand Management at the University of the Free State, received an Award of Excellence Gold for the UFS Graduations Ceremonies Communication Strategy and an Award of Excellence for the UFS Rector’s inauguration and welcoming ceremonies. 

Mamosa Makaya, Deputy Director: Integrated Communication received two Merit Awards for, respectively, the Dumela newsletter and the Visitor’s Guide. Jóhann Thormählen, former employee in the department’s Internal Communication Unit, received an Award of Merit for the Wayde van Niekerk Campaign and an Award of Excellence Gold for the Student Newsletter. Thabo Kessah, also from Internal Communication, on the UFS Qwaqwa Campus, received an Award of Merit for the UFS Qwaqwa Campus Open Day video.  

"I am extremely proud of what we
have achieved this year and of
the quality and standard of the
work produced."

Martie Nortjé, Assistant Director of the Unit for Branding and Merchandise received an Award of Merit for KovsieGear Qwaqwa: Live the brand and set the trend. Leonie Bolleurs, Assistant Director of the Unit for Internal Communication received two Awards of Merit, for respectively, the UFS Schools Marketing Video and the UFS Corporate Profile and UFS Fingertips brochures. 

Ilze Bakkes from UFS Marketing received the Chairperson’s Award of Excellence for her entry, Top Achievers Early Bird Registration. The award is for the highest-scoring entry across all divisions. She also brought home the Award of Excellence Gold for Registration branding and communication – The Lighthouse Campaign, the Award of Excellence Gold for the Kick-Start Your “I-Want-To-B” Grade 9 Subject Choice Booklet and the Award of Excellence Gold for the Top Achievers Early Bird Registration project. Chantel Koller, also from UFS Marketing, received an Award of Merit for her Star of Stars Competition entry. 

The Institutional Advancement (IA): Alumni event planning committee received an Award of Excellence Gold for their entry: Chancellor’s Distinguished Alumni Awards Dinner. The committee consisted of Helen Namponya, Ntokozo Nkabinde, Tertia de Bruin, Nhlanhla Modzanane, and Elmada Kemp.

IABC Africa Award
“This is the second year in a row that the department has received so many accolades from its peers at MACE. I am extremely proud of what we have achieved this year and of the quality and standard of the work produced. The fact that we were also again acknowledged by the Africa Chapter of the International Association of Business Communicators (IABC) is also commendable,” said Loader. She is also the National Chairperson of MACE. 

Earlier this year, the Department of Communication and Brand Management received an IABC Africa Award of Excellence for the UFS 2017 Winter Graduation Ceremonies Communication Strategy from the International Association for Business Communicators (IABC). Loader collected the award during the Silver Quill Awards ceremony on 3 November 2017 in Cape Town.

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