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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

Dialogue between Science and Society series looks at forgiveness and reconciliation
2013-03-24

 

Taking part in the discussion on forgiveness and living reconciliation, were from left: Olga Macingwane, a survivor of the Worcester bombing of 1993; Dr Juliet Rogers, a Scholar on Remorse from the University of Melbourne in Australia and Dr Deon Snyman, Chairperson of the Worcester Hope and Reconciliation Process.
Photo: Mandi Bezuidenhout
24 March 2013

How do you, as a mother who lost her only daughter, forgive the man who claimed responsibility for the attack that killed her?  How do you forget his crime while travelling with him across the world?  

These were some of the questions posed to Jeanette Fourie at a Dialogue between Science and Society series on forgiveness and living reconciliation. Jeanette, whose daughter Lyndi was killed in an attack on the Heidelberg Pub in Cape Town in 1993, was one of three people telling their stories of forgiveness while dealing with traumatic experiences. 

Sitting next to Letlapa Mphahlele, the man who owned up to the attack that killed her daughter, Jeanette spoke about their story of forgiveness traveling the world together, spreading the message of forgiveness and conciliation. 

"Don't ever think you can forget, because that’s not possible. What you do with the pain is to find peace, and that's what forgiveness does. Forgiveness allows you to stop all the dialogue in your head on why he did it. You don't forget, you confront it and you deal with it." 

Letlapa, Director of Operations of Apla, the military wing of the PAC at the time of Lyndi's death, spoke about dealing with the response to his crime. "Sometimes you wish that you were not forgiven, because now you have the great burden of proving that you are worthy of forgiveness."

Also telling her story of forgiveness was Olga Macingwane, a survivor of the Worcester bombing of 1993 in which four people were killed and sixty-seven others injured. Four people were sent to prison. In 2009 Olga met one of the perpetrators, Stefaans Coetzee, and what came out of that meeting, is her story. 

"When I met Stefaans I was very angry, but when you sit down with somebody and listen to him or her, you find out what the reasons were that made him or her do something. I can say that I forgave him." 

Facilitating the conversation, Prof Pumla Gobodo-Madikizela, Senior Research Professor on Trauma, Forgiveness and Reconciliation, said the seminar was meant to get in touch with the truth that forgiveness is possible. 

"Before we had the Truth and Reconciliation Commission (TRC) in South Africa, the experts always said that forgiveness was not possible in these stories of the past. And then the TRC came into life as a response to mass atrocities. For the first time in the history of these traumatic experiences, of political traumas, we witness something that we have never seen.  Even us on the TRC, although it was framed as reconciliation, we never imagined there would actually be stories of forgiveness emerging out of that process, and then we witness that this too is possible." 

Others who took part in the two-hour-long seminar, were Dr Juliet Rogers, a Scholar on Remorse from the University of Melbourne in Australia and Dr Deon Snyman, Chairperson of the Worcester Hope and Reconciliation Process. They spoke about the dynamics behind the processes of engagement between victims/ survivors and perpetrators. 

The Dialogue between Science and Society series was co-hosted by the Institute for Reconciliation and Social Justice. 

 

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