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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

UFS satisfied with proceedings of EFF National People’s Assembly
2014-12-17

The University of the Free State (UFS) is happy about another successful hosting of a political party; this time, the Economic Freedom Fighters (EFF). In the recent past (December 2012), the UFS hosted the African National Congress (ANC) with the same energy, support and selfless commitment as with the EFF.

“The fact that the EFF paid the required amount for the use of the university’s venues in full before the congress commenced, bears testimony to this. For the past two months, the UFS’s working team worked closely with the EFF’s logistics team to thoroughly plan for a smooth and successful National People’s Assembly,” says Dr Choice Makhetha, Acting Rector of the UFS.

The hard work and commitment invested in the preparation process paid off. The 1st EFF National People’s Assembly, held 13-16 December 2014 on the Bloemfontein Campus, was a huge success.

“It is with great excitement that I can report that all premises of the UFS have been left the way they were found on arrival; no damage to any property and no littering.”

“Thank you to the UFS staff members who worked selflessly on a daily basis: the cleaning staff who started very early in the morning and went home very late at night; garden staff who made sure that the grounds were exceptionally clean every day and the flowers bright; student volunteers who worked shifts of over 24 hours on the first day, making sure that EFF delegates were checked into residences; staff members at the Visitors Centre who were ready to share information about the university and provide support to EFF delegates; staff members at the Odeion (which served as media centre) who ensured that the national and international media houses were comfortable and that the media conferences ran smoothly; safety and security personnel who provided protection for all the people on campus and also ensuring safety of the buildings; the health and safety officers supported by our partners from ER24 emergency services; and the South African Police Services (SAPS). To the electricians, the plumbers and other colleagues from Physical Resources who assisted with any task, even beyond the call of duty, we say thank you. For all the support and extra miles travelled – we appreciate your passion for the work you do; you are all very important to us at the UFS.”

“As the University of the Free State, we would like to express our gratitude to the leadership of the EFF, the delegates, guests and partners, as well as the media houses. The level of discipline among delegates was impressive. The UFS staff members appreciate the level of professionalism and respect shown by the EFF leadership and delegates. All the best for the future!,” says Dr Makhetha.

The UFS will continue to host political parties, interest groups, associations and more in their diversity, provided there is availability of venues, events are held outside the academic period and payment is received well ahead of hosting. As a public institution of higher learning, the university has a responsibility to promote democracy and help deepen the principles thereof. A university is a perfect platform for differing views and diverse political formations to find expression.

“To the UFS community, thank you for the trust you showed in the working team as it prepared to host the EFF’s 1st National People’s Assembly. To Mangaung Metropolitan Municipality and the Free State Province – we appreciate the support. As the University of the Free State, we know we can always count on you!”, says Dr Makhetha.  

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