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Dr Elgonda Bekker
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 changes format of graduation ceremony
2011-04-17

 

The highest number of qualifications in the history of the University of the Free State (UFS) will be awarded at the autumn diploma and graduation ceremony from 9-11 May 2011, which will be held in the Callie Human Centre on our Main Campus in Bloemfontein.

From this year, the format of the ceremony will change to make it more visible to students and the public. For the first time, all the doctoral and master’s degrees from each respective faculty will be conferred during one ceremony on 11 May 2011, instead of each faculty handling these qualifications individually. Another change in the format is that the procession will gather on the Red Square in front of the Main Building and move to the Callie Human Centre from there. Both academic staff and graduands will partake in the procession.

A total of 3 674 qualifications will be conferred during this year’s graduation ceremony, including 629 diplomas, 2 613 Bachelors and honours degrees, 372 master’s degrees and 58 doctorates.

An honorary doctorate in Drama and Theatre Arts will also be awarded to theatre stalwart Mr Pieter Fourie. He is one of the most acclaimed Afrikaans playwrights in South Africa and probably the only person to have left his mark as an actor, director, artistic director and writer.

Mr Fourie was awarded the Gerhard Beukes prize for drama , was honoured for his contribution to the arts by the South African Academy for Science and Arts and was appointed as trustee of the Arts and Culture Trust of the State President in 1997. He has also served as a committee member of the South African Academy for Science and Arts.

Mr. Fourie has also been the proud recipient of the Hertzog prize for drama, two FNB-Vita awards and a Fleur Du Cap award.
 

The full programme for the respective ceremonies is as follows:

  • Monday, 9 May 2011:

At 08:30, certificates and diplomas, excluding PGED and PGES, will be awarded to graduates from the Faculty of Education and at 12:00 PGED, PGED and B and honours degrees will be awarded to students from the same faculty. At 15:30 on the same day, certificates and B and honours degrees will be awarded to students in the Faculty of the Humanities.

At 19:00, the Faculties of Education, the Humanities and Economic and Management Sciences will have their prize-giving ceremonies for outstanding achievers.

  • Tuesday, 10 May 2011:

At 08:30, students in the Faculty of Economic and Management Sciences will graduate and at and 12:00 the Faculty of Natural and Agricultural Science will join them. This includes students in BML, B.Admin., B.Pub. and related honours degrees. At 15:30, 503 students from the Faculty of Natural and Agricultural Sciences will receive their certificates, diplomas and B and honours degrees.

At 19:00, the Faculties of Health Sciences, Natural and Agriculture Sciences, Law and Theology will have their prize-giving ceremonies.

  • Wednesday, 11 May 2011:

The Faculty of Health Sciences, the Faculty of Law and the Faculty of Theology will be awarding their certificates, diplomas and B and honours degrees at 08:30. At 12:00, all faculties will award a total of 372 master’s degrees and at 15:30 a total of 58 doctorates will be conferred.

The Chancellor’s Dinner will take place in the Centenary Complex on the Main Campus of the UFS at 19:00.

The graduation ceremony of our Qwaqwa Campus will take place in the Rolihlahla Mandela Hall on the Qwaqwa Campus on 7 May 2011 at 10:00. All the faculties at this campus will confer their degrees, certificates and diplomas at this ceremony.
 


Media Release
21 April 2011
Issued by: Lacea Loader
Director: Strategic Communication
Tel: 051 401 2584
Cell: 083 645 2454
E-mail: news@ufs.ac.za

 

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