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20 December 2021 | Story Elsabé Brits
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

New multi-purpose residences open in January 2015
2014-06-18

The UFS is currently busy with exciting new accommodation developments on both the Bloemfontein and Qwaqwa Campuses.

This includes a new residence with a hotel and a conference/lecture hall on the western part of the Bloemfontein Campus and the building of another residence on the Qwaqwa Campus.

“We have done what was possible in our quest to maximise the number of beds available in the older residences on the Bloemfontein Campus,” says Quintin Koetaan, Senior Director: Housing and Residence Affairs at the UFS. “This we achieved by converting underutilised and unutilised dining halls and kitchens into bedrooms, which was totally insufficient to address the dire need for beds.”

“The new residence building will have different types of accommodation. I am very excited and look forward to the completion of this project. And this particular residence also brings a very exciting architectural design to the university environment.”

The residence, with multiple blocks for different accommodation, will be wheelchair friendly and numbering and signage will also be in braille. This futuristic-designed building will stand the test of time and will be provide student accommodation until 2030.The R60 million project is funded by the UFS and the Department of Higher Education and Training.

In step with international university accommodation trends – as with Yale's residential college system – this residence will house female first-years who will be mentored by postgraduate students. Postgraduates will be headhunted with the support of the Student Representative Council’s (SRC) postgraduate committee. These postgraduate students will represent all the faculties. Block A and B will accommodate 184 female first-years.

Each floor in this residence will have a study room, two lounges, a kitchen and a laundry for 25 students. Security will be very tight, with three levels of security: entrance to residence, corridor and individual bedroom door. There will also be perimeter camera surveillance and a security officer outside and inside the residence. 

 
Block C will accommodate postgraduate students. The ground floor will house eight single-bed roomed flats. The first floor will have 16 single rooms sharing a bathroom, kitchen and living room, as well as one double room with its own bathroom. The second floor will have 21 single rooms sharing a bathroom, kitchen and living room.

Block D will house 18 hotel-like en suites, with a dining room where breakfast will be served. The target market here will be visiting academics and other university-affiliated visitors. Prices will be competitive to those of local guesthouses and hotels.

Bookings have already opened. Guests will be able to book in and access the hotel desk 24/7. The dining room, accommodating up to 60 people, will not only be open for hotel guests, but also for postgraduate students and UFS staff. Bookings will therefore be essential.

The expansion of bed spaces also took place at the Qwaqwa Campus. In 2012 a 200-bed residence with a state of the art computer room was completed. As a follow-up to this development, another 248-bed residence is now being built. In this particular residence, there will be designated post-graduate accommodation for 48 students.

The project will be handed over at the end of October 2014, with the first intake planned for January 2015.

Another development at the Qwaqwa Campus is the Chancellor’s House Bed & Breakfast. This B&B, with its 5 en suite rooms, is open for business for all UFS staff.

 

For enquiries or bookings at this new accommodation facility, contact:

- Undergraduate (first-year ladies’ residence):
Monica Naidoo at +27(0)51 401 3455 or NaidooM@ufs.ac.za  

- Postgraduate:
Hein Badenhorst at +27(0)51 401 2602 or BadenH@ufs.ac.za  

- Hotel:
Ilze Nikolova at +27(0)51 401 9689 or NikolovaI@ufs.ac.za  

- Chancellor’s House Bed & Breakfast on Qwaqwa Campus:
Olga Molaudzi at +27(0)58 718 5030 or molaudziOD@qwa.ufs.ac.za

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