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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

Access to the Bloemfontein Campus
2015-04-02

Access Control Made Easy

The first phase of access control at the University of the Free State (UFS) was implemented in August 2014. The aim of this initiative is to tighten security measures on the Bloemfontein Campus.
 
Since November 2014, access control has been implemented at all five gates on the Bloemfontein Campus. These are:

  • The Main gate in Nelson Mandela Drive (Gate 1)
  • The gate in DF Malherbe Drive (Gate 5)
  • The gate in Wynand Mouton Drive (Gate 3) 
  • The gate in Furstenburg Street (Gate 4)
  • The gate in Badenhorst Street (Gate 2)

Here is some useful information about the access control system:

1. Remember your access card when you enter the campus

Dual-function cards (with distance reader compatibility) will make your movement through the gates more convenient. The university’s access system works automatically with remote or swipe action. Please make sure that you drive close to the reader or, better still, get the dual-frequency card to manage the distance between your vehicle and the remote card reader.

As of 23 March 2015, the extra security staff, who have been assisting at the gates since the implementation of access control on the Bloemfontein Campus, are no longer manning the card readers at the gates. Therefore, persons without cards will be able to enter the campus only at the one gate in DF Malherbe Drive where the Visitors Centre is situated. They will be referred to the Visitors Centre, where a day visitor’s card will be issued to them. You will need to produce a formal identification document (e.g. ID book, driver's licence).

Security will continue their normal duties at the guardhouses for the various gates on the campus.

2. Where do I get an access card?

You can apply at the university’s Visitors Centre front desk by producing your positive identification (ID book/passport/driver’s licence) and proof of payment for your access card.

You will then be directed to the Thakaneng Bridge where you will be able to collect your access card.

  • Go to the Cashier on the Thakaneng Bridge and pay your R65 for the dual-frequency card
  • Take your receipt, together with your existing card (if you have one), to the Card Division on the Thakaneng Bridge (next to Mellins Optometrists)
  • A new photo will be taken of you at the Card Office for your new card. Your new card will then be issued immediately.

Currently, there is a sufficient stock of the dual-frequency cards available at the Card Division on the Thakaneng Bridge.
 
Alternatively, you can apply online for your access card: http://apps.ufs.ac.za/cardapplication/application.aspx

Make sure you have the following documents ready to attach when completing the online form:

  • Copy of positive identification: ID/Driver's Licence/Passport
  • Signed declaration (http://supportservices.ufs.ac.za/dl/Userfiles/Documents/00007/4668_eng.pdf) by your service provider/employer (if you are a service provider) or a letter of confirmation from your spouse/partner/relative/coach/relevant UFS staff member or student in cases where you have to visit, pick-up or drop off your spouse/partner/relative frequently on the UFS Bloemfontein Campus.

Cost: R65 for a long-term card and free of charge for short-term visits and conference delegates. Pay at the Cashier on the Thakaneng Bridge or at Absa Bank, Account Number: 1 570 8500 71, Ref: 1 413 07670 0198.

3. Cutoff Date: 7 April 2015

After 7 April 2015, no pedestrian or motorist will be able to enter the campus without a valid access card. Persons without access cards will have to enter the campus at the gate in DF Malherbe Drive where the Visitors Centre is situated. You will then be referred to the Visitors Centre where you will have to apply for a day visitor’s card. It is important to note that no one will be able to enter the campus at the Visitors Centre without a formal identification document (e.g. ID book, driver's licence).

4. Dual-frequency card simplifies access to the campus

It is important to have your card ready on entering the campus.

This card will simplify access to the campus considerably, as the card reader will read the card when it is held in a vertical position at the driver’s side window in the direction of the distance reader. Please do not place the card on the dashboard. There is an antenna wire in the card. If the card is placed on the dashboard, you are not exposing the card surface to the reader, and that might influence the antenna’s response to the reader.

Remember, the distance between the reader and the boom is only a few metres.  If you approach the reader at a ’high’ speed, you are not allowing the system to identify your card, match it to the entry in the database, check if you are ‘legal’, and then send a signal to open the boom. 

All five gates are equipped with distance readers. Within the next three weeks, two extra distance readers will also be installed at the Main Gate in Nelson Mandela Drive.
 
Please note that the dual-frequency card is needed only when you enter the campus with a vehicle and you want to activate the distance reader. All the older cards will continue to work at the tag readers. 

5. Use alternative gates

At times, some of the gates carry more traffic than others, especially with the peak morning and afternoon traffic. Gates with less traffic include:

  • The gate in Badenhorst Street
  • The gate in DF Malherbe Drive
  • The gate in Nelson Mandela Drive

You are welcome to make use of one of these alternative gates.

6. Pedestrians

No pedestrian will be able to enter the Bloemfontein Campus without a valid access card. If you have left your card at home or have lost it, you should enter the campus at the gate in DF Malherbe Drive where the Visitors Centre is situated. You will be referred to the Visitors Centre where you can apply for a day visitor’s card. You will still need to produce a formal identification document (e.g. ID book, driver's licence).

7. More information

Email: visitorscentre@ufs.ac.za
Visitors Centre front desk: Tel: +27 51 401 7766 (Mondays-Fridays 07:45-16:30)
Card Division: Tel: +27 51 401 2799 (Mondays-Fridays 07:45-16:30)
Protection Services duty room: +27 51 401 2634 (24 hours)

 

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