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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

UFS responds on the outcome of the court case in the alleged attack by Cobus Muller and Charl Blom on Gwebu
2014-09-09

The management of the University of the Free State (UFS) acknowledges the finding issued on 4 September 2014 by the South African Human Rights Commission (SAHRC) that it was “unable to find any corroborating evidence to make a conclusive finding of racism and violation of human rights” in the Muzi Gwebu case.

The university management also takes cognisance of the ruling in the Bloemfontein Regional Court by Regional Magistrate Rasheed Matthews today (9 September 2014) that both Cobus Muller and Charl Blom are found not guilty on all the charges which included reckless driving, crimen injuria, attempted murder and assault (Muller), and a charge of assault (Blom). We note the Magistrate’s concerns about “inconsistencies in the evidence and exaggerations”, that the complainant “displayed hostility throughout the trial” and that he was “not a reliable witness and is prejudiced.” And therefore, in the words of the Magistrate to the defendants, “I’ve decided to give you the benefit of the doubt.”

Both Muller and Blom were suspended from all campuses of the UFS on 19 February 2014 based on the evidence available at the time of reckless driving, assault and other charges. This evidence was further borne out by an internal investigation into the incident of 17 February 2014 on the Bloemfontein Campus. In the light of the evidence available to us at the time, and the volatile situation on campus in the days following the attack, the UFS management believes that it was the correct decision to suspend the students, given the serious nature of the charges, and pending a decision of the courts.

In the light of both the SAHRC ruling as the Regional Court ruling, the university management has decided to take the following steps:

1.    The suspensions of both Muller and Blom from all campuses of the university are lifted with immediate effect.

2.    Muller may attend a forthcoming graduation ceremony during which the degree BSc Construction Management will be officially conferred upon him. He completed all the requirements for the degree in 2013, but was not allowed to attend the graduation ceremony of 11 April 2014 due to his suspension and the fact that the criminal charges were still pending.

3.    Blom may return to the university to complete his studies.

4.    The UFS is in discussion with the parents of one of the students and, if required, would also meet with legal counsel of the university, as well as those of students Muller and Blom to discuss any further steps given the outcome of the court case.

5.    In short, on grounds of the ruling by die SAHRC, as well as the Bloemfontein Regional Court, the university will not continue with its disciplinary action against Muller and Blom.

Prof Jonathan Jansen, Vice-Chancellor and Rector of the UFS said: “This has been a very difficult time for the university and I am pleased to record that throughout the crisis, the student body on the Bloemfontein Campus showed remarkable restraint and discipline, confirming also the broad, non-racial character of the peaceful protests that followed. Our student body has matured and our campus cultures are much more inclusive and transformed as a result of the quality and depth of student leadership over the past few years. The new Student Representative Council (SRC) is a splendid example of this – with the first black woman President (Mosa Leteane) and the first blind woman SRC student leader (Louzanne Coetzee).”

“I am pleased that the matter is now behind us and, again, we rest with the decisions of the Commission and the Courts as final,” he said.

Prof Jansen also apologised on behalf of the UFS to Cobus Muller and Charl Blom, their parents, and their families, for the disruption that the suspension brought in their lives and for the stress they had to bear during this difficult period. “For that, I am truly sorry,” he said.


Issued by: Lacea Loader (Director: Communication and Brand Management)
Tel: +27 (0) 51 401 2584 | +27 (0) 83 645 2454
E-mail: news@ufs.ac.za

 

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