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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

Giraffe research broadcast on National Geographic channel
2016-03-09

Description: Giraffe research  Tags: Giraffe research

A documentary focusing on the latest and most interesting research about giraffes was recently broadcasted on National Geographic. Dr Francois Deacon from the UFS Department of Animal, Wildlife and Grassland Sciences and the team of researchers working with him, were first in the world to equip giraffes with GPS collars, and to conduct research on them.

Research by Dr Francois Deacon, from the UFS Department of Animal, Wildlife and Grassland Sciences, involving the equipping of giraffes with GPS collars, was broadcast this week as part of a documentary (4 March 2016 and subsequent weeks) on National Geographic (Channel 182). The documentary is the first of two on his team's research.

Dr Deacon and the team of researchers working with him were the first in the world to equip giraffes with GPS collars, and to conduct research on this initiative. The group of researchers can now follow the animals night and day by means of the GPS collars, while monitoring their movements from a distance on a computer screen and seeing the world from a giraffe's perspective.

“The documentary focuses on the latest and interesting information about our research in different countries,” Dr Deacon said. Besides their local research on giraffes, he and his team also assist in other projects and research in Namibia, Botswana, Zambia, Kenya, the Democratic Republic of the Congo, and Uganda.

“There is much to learn from the documentary,” Dr Deacon said. Interesting facts from their research include herd interactions by individuals towards each other, bulls versus bulls, and cows versus calves. In the documentary, the viewer can also learn how giraffes use thermoregulation, their tongues, and roaming areas and distances; peculiar behaviour such as feeding on bones and soil; bulls fighting; how and when giraffes drink water; and the conservation and management of giraffes.
 
Focus is also placed on the manner in which the latest research plays a role in the better understanding of the animals.
 
According to Dr Deacon, this is the first documentary to focus on giraffe research on such a large scale. Marco Polo Films from Terra Mater are contracted by National Geographic to produce nature films – this was the hundredth nature film produced by them.
 
“There has never before been such a production about giraffes. It also attracted huge interest and reaction overseas, which will provide great exposure for our research and for the UFS.
 
“We believe that the media involvement will provide much more exposure to giraffes, which is a good thing, since they are facing extinction in Africa. The exposure can, in itself, lead to new research and has already started attracting international students to the UFS,” Dr Deacon said.
 
The second documentary will follow later this year. Iniosante, a film team from Texas, USA, is producing this film, which focuses on the extinction of giraffes. It is the same team responsible for the production Last of the Longnecks.



Additional resources:


-    Last of the Longnecks (trailer)
-    Giraffe – Up high and personal (National Geographic video)
-    Giraffe: African Giant (National Geographic video)
-    Giraffe – Up high and personal (article)

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