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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

Three receive PhD degrees in Architecture at Winter Graduation ceremony
2015-07-08

Dr Hendrik Auret, Dr Gerhard Bosman and Dr Madelein Stoffberg.
Photo: Leonie Bolleurs

Three graduates from the University of the Free State’s (UFS) Department of Architecture received their PhD degrees at the 2015 Winter Graduation ceremony on the Bloemfontein Campus. According to Prof Walter Peters from Architecture, this is the first time in the history of the UFS that three PhD degrees in Architecture have been awarded simultaneously. It is country-wide a rare occurrence for three PhDs to be awarded in Architecture at one graduation ceremony.

“Previously, the UFS has only ever awarded a single PhD in Architecture, and that was in 1987, to Leon Roodt, a former head of the department. The first UFS honorary doctorate in Architecture was conferred on Gerard Moerdijk, architect of the Afrikaner church and the Voortrekker Monument. Gawie Fagan and Prof Bannie Britz, late head of the Department of Architecture, were other recipients of an honorary doctorate in Architecture,” said Prof Peters.

At the 2015 Winter Graduation ceremony, the UFS conferred PhDs in Architecture on Hendrik Auret from Roodt Architects in Bloemfontein as well as on Gerhard Bosman, and Madelein Stoffberg from the UFS Department of Architecture.

Dr Hendrik Auret

As an Architecture student at the university, Dr Auret obtained the degree BArchStud in 2004, a BArchStud (Hons) in 2005, and a March (Prof) in 2006, all cum laude. His Master’s design dissertation was judged the best from all South African Architecture learning sites, earning him the coveted ‘Corobrik Architectural Student of the Year’ award.

The work of the Norwegian architect and theorist, Christian Norberg-Schulz, served as the basis of Dr Auret’s PhD thesis, Care, place and architecture: a critical reading of Christian Norberg-Schulz’s architectural interpretation of Martin Heidegger’s philosophy, which considered the cogency of Norberg-Schulz’s architectural ‘translation’ of the German philosopher Heidegger’s thinking.

Dr Gerhard Bosman

On obtaining his BArchStud. and BArch degrees at the university in 1993 and 1995 respectively, Dr Bosman immediately joined the part-time staff of the Department of Architecture. As a lecturer in Building Construction, he developed an interest in vernacular and indigenous methods and techniques. Consequently, he built the first family home in Bloemfontein, for his wife, Debbie, and their two children, of earth construction, which been previously but erroneously considered inferior.

Despite that negative perception, Dr Bosman persuade the university to allow him to undertake post-graduate studies at the International Center for Earth Architecture (CRATerre-ENSAG) within the Ecole d' Architecture de Grenoble, France, from which institution,he was awarded the DPEA-Architecture de Terre qualification in 2000. In 2001,Dr Bosman was appointed to the full-time staff.

In 2003, when the opportunity arose, he became involved with SANPAD, the South Africa-Netherlands Research Project on Alternatives in Development, which lead ultimately to his PhD thesis: The acceptability of earth-constructed houses in central areas of South Africa.

Dr Madelein Stoffberg

In 2005, Dr Stoffberg enrolled as an Architecture student at the UFS, obtaining her BArchStud degree in 2007, the BArchStud (Hons) in 2008 and the March (Prof) in 2009, the latter cum laude. Immediately on graduating, Dr Stoffberg was appointed to her position as a part-time junior lecturer in the Department of Architecture.

During her studies, her attention was drawn to the concept of the spatial triad of Henri Lefebvre. Fascinated with the conceptand by the development of community centres as a contemporary architectural typology, she began her PhD degree.  

Entitled Lived reality, perception and architecture: two community centres interrogated through the lens of Lefebvre’s spatial triad, Dr Stoffberg investigated the relationship between the spatial understanding of the project architect and the community of two completed buildings in Port Elizabeth. She established a mismatch in perception, representation, and use of space, which could be bridged, however, by way of a qualitative research approach, instead of a quantitative one.


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