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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

UV belê in gehalte met strategiese fokusgroepe - Volksblad
2006-02-09

Verslaggewer
DIE Universiteit van die Vrystaat (UV) gaan vanjaar R10 miljoen beskikbaar stel om sekere van sy akademiese en navorsingsaktiwiteite in strategiese fokusgroepe te bedryf.

 

Volgens prof. Frederick Fourie, rektor en visekanselier van die UV, is hierdie ’n belegging in gehalte wat sal help om die UV nasionaal en internasionaal van ander universiteite in die wêreld te onderskei.

Tydens die amptelike opening van die UV verlede week het Fourie beklemtoon dat die strategiese fokusgroepe veel meer behels as net ’n herorganisering van gevestigde navorsingsgebiede.

“Sulke fokusgroepe behels ’n gefokusde deskundigheidsgebied en nie slegs navorsing nie, maar ook sterk voorgraadse en veral nagraadse onderrig en ’n potensieel sterk wetenskaplike grondslag vir samelewingsdiens.

“Strategiese fokusgroepe sal georganiseer word op die grondslag dat hierdie kennisgebiede op kort termyn die vlagskepe van die UV kan word. Dit beteken dat hierdie die gebiede is waarin die UV nou of in die toekoms waarskynlik ’n kompeterende voorsprong sal hê.”
Hy het gesê dit is belangrik dat die UV hom in die volgende fase van sy ontwikkeling posisioneer, nie net as ’n goeie onderrig- en navorsingsuniversiteit nie, maar ook as ’n universiteit wat in strategies belangrike kennisgebiede uitblink. Dit is noodsaaklik om energie en hulpbronne so te rig.

Nie alle akademiese en navorsingsaktiwiteite gaan egter hierdeur geraak word nie. ’n Breë ondersteuningsgrondslag is die afgelope paar jaar geskep vir uitnemende navorsing deur alle akademiese personeellede in hul eie navorsingsgebiede. Dié inisiatief sal naas die nuwe fokusgroepinisiatief steeds voortgaan.

Fourie sê die strategiese fokusgroepbenadering sal in lyn wees met die benadering wat ontwerp word deur die Nasionale Navorsingsraad (NNR) om nasionale prioriteite in berekening te bring. Breedweg is die vyf strategiese gebiede vir die UV voorlopig die volgende:
1. Voedselproduksie, voedselgehalte en voedselsekuriteit vir Afrika.
2. Ontwikkeling en streeksontwikkeling binne die Afrika-konteks.
3. Maatskaplike transformasie binne die Suider-Afrikaanse en Afrika-konteks.
4. Waterhulpbron- en ekostelselbestuur.
5. Tegnologie vir die toekoms. (’n Aparte fokusgroep rakende die chemiese nywerheid kan dalk bepaal word).

“Binne elk van hierdie gebiede kan ’n aantal nisgebiede geïdentifiseer word. Die fokusgebiede dek sowel die geestes- as die natuurwetenskappe, maar uiteraard kan en moet dit nie alles vir almal probeer wees nie,” sê Fourie.

Die presiese formulering en inhoud van die fokus- en nisgebiede sal nog bepaal word tydens gesprekke op die kampus. Dit sal met die hulp van kundiges buite die UV geskied.
Hy sê dit het sin dat ’n mediumgrootte universiteit soos die UV sy menslike hulpbronne, infrastruktuur, finansiële hulpbronne en intellektuele kundigheid sal konsentreer om te verseker dat ’n bydrae gelewer word tot Bloemfontein, die Vrystaat, die land en die Afrika-vasteland.

Hy sê van die uitvloeisels kan ’n belangrike impak op nywerheidsontwikkeling hê, byvoorbeeld in die chemiese bedryf, en dit mag ook ’n grondslag skep vir samewerking met provinsiale, nasionale en internasionale vennote.

Behalwe die R10 miljoen vir die vestiging van die fokusgroepe is daar die afgelope paar jaar groot bedrae beskikbaar gestel vir talle projekte om gehalte in onderrig en leer, in navorsing en ander gebiede te verbeter.

Berig verskyn in Volksblad - Dinsdag, 7 Februarie 2006

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