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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

‘Sola Scriptura’ — Does Scripture still reign as authority?
2017-02-21

Description: Theology Open Day Tags: Theology Open Day

Thania Labuschagne, Nico Oosthuizen, and
Suthea van der Westhuizen.
Photo: Supplied


Reformation 500: Sola Scriptura [scriptural authority] and contemporary conflicts of interpretation was the theme for the Faculty of Theology and Religion’s official opening and annual Open Day on the Bloemfontein Campus of the University of the Free State (UFS). The faculty was recently renamed to be more inclusive of other denominations, as well as to be sensitive to the impact religion has on society, both in the past and presently.

In his welcoming address to first-year students, Prof Fanie Snyman, Dean of the Faculty of Theology and Religion, said, “I hope that you indulge in the theological dish served to you, and that it will create in you a deep hunger to know more.”

One first-year, Neo Kgaje, had this to say, “I first wanted to do Archaeology, but then I decided to follow my calling as a missionary and study Theology. I would like to serve in my own community in Botshabelo.”

Thania Labuschagne, former chairperson of the Sola Gratia student association, said, “The annual opening is always very special for me. We become part of a family here.” Her message for first-years was, “Maintain your passion for what you do. Make sure of your calling, and everything else will fall into place.”

Prizes awarded
Prizes were awarded to several students who excelled in the previous year. The best third-year student in 2016 was Suthea van der Westhuizen; best fourth-year BTh student, Thania Labuschagne; and Nico Oosthuizen was recognised as the best Master of Divinity in the fifth year.

The Director of Shepherd Centre for spiritual leaders, Dr Gerhard Botha, awarded certificates for the completion of a 9-module short learning programme presented by the centre.

"May you hunger to know more"—
Prof Fanie Snyman, Dean of the
Faculty of Theology and Religion

Current affairs addressed through scriptural analysis
While acknowledging that the debates around the authority of Scripture are complex and not easily resolved, Prof Hendrik Bosman from the Faculty of Theology at Stellenbosch University (SU) argued that it is an indispensable precept of Christian theology. However, it can no longer be taken as a given, since the authority of Scripture is increasingly vulnerable. He said, “Sceptic academics and critical theologians are challenging the more traditional ways of accepting the authority of Scripture.”

Prof Bosman highlighted the negative impact that certain claims of scriptural authority have had on the marginalised and vulnerable groups in society — “the suffering endured by people of colour, Jews, the LGBTQI community, and women due to prejudice and hatred. … [When reading the Bible], one must also be held accountable by the marginalised and the vulnerable in society.”

Prof Juliana Claassens (Faculty of Theology, SU) presented Beyond Revenge: Responsible Bible Reading Practices in a Traumatised Land. “As a community of believers who hold dear the principle of Sola Scriptura, what do we do with texts that revel in the downfall of the enemy and propagate revenge as a viable solution to the hurt and pain people are experiencing?”

Prof Claassens continued, “This question is particularly relevant given the deep wounds that many in this beautiful country of ours carry. … There is thus a real danger that expressions of violence survive and grow ever stronger with each utterance, until the violent ideas they propagate are considered to be normal.” Her recommendation? “Foster communities of care, focused on breaking down walls, instead of erecting them.”

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