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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

ANC is not a party of the people - Mbeki
2010-08-30

 

 

“The unions in this country do not understand the political economy of South Africa. They think that the ANC is the party of the people. The ANC is the party of the black middle class. The fact that the masses vote for it does not mean they control it. The policies of the ANC favour the black middle class and the established businesses. They do not favour the working class.”

This was said by renowned economic and political commentator Mr Moeletsi Mbeki, brother of former president Thabo Mbeki, during a guest lecture he recently presented to Economics students of the University of the Free State (UFS) in Bloemfontein.

“You just have to look at the types of houses that the ANC government builds for ordinary South Africans,” he said.

“If you had a party that was a pro-working class party it would not have built these so-called RDP houses that are being built by the ANC government. The unions have all along been under the illusion that the ANC is the government of the working class and (Zwelinzima) Vavi and them are now beginning to realise that this is not the case.

“The public-sector workers are in a special dilemma. They think the ANC is their ally but at the same time they feel they are not getting any benefits out of this alliance. Therefore you are beginning to get a very acrimonious environment emerging between the public-sector unions and the government.”

Regarding the current issue of the Protection of Information Bill and the proposed media tribunal that have brought the media and the government onto a collision course, Mbeki said the ANC government was trying to muzzle the media because it wanted to safeguard corruption within government.

“The question of freedom of information is very closely linked to the rise in corruption in the government,” he said.

“What the politicians are doing is that they are trying to hide that corruption. The media in this country have been playing a very critical role in exposing cases of corruption. That is why Vavi now has bodyguards.”

He said he recently met Vavi, the General Secretary of Cosatu, surrounded by four bodyguards. He said Vavi told him that he was getting death threats because he was opposing corruption in government.

Mbeki said the economic policies of South Africa were the “worst in the world” because they benefited people who were already rich and militated against the emergence of entrepreneurs.

“In fact, one of the serious downsides of Black Economic Empowerment (BEE) is that it takes people who should normally be entrepreneurs and who should be creating new companies and new jobs, out of that space and just makes them wealthy. BEE has been a disaster because it created this massive economic inequality; it created this class of idle rich who have tons of money but do nothing,” he added.

He said the under-investment in the economy was having dire consequences in terms of unemployment and poverty. He said this, coupled with the growth of consumption that Black Nationalism was driving, was actually driving down the ability of the economy to absorb labour.

“What really lies at the bottom of our economic problems in South Africa is that we have too much of a one-party dominance of our political system. We need more competition in our political system and until we realise the policies of the ANC are not going to change,” he said.

Mbeki’s guest lecture was on the topic: Architects of Poverty: Why African capitalism needs changing.

Media Release
Issued by: Mangaliso Radebe
Assistant Director: Media Liaison 
Tel:   051 401 2828
Cell:  078 460 3320
E-mail:  radebemt@ufs.ac.za  
30 August 2010

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