Africa: Why Midwives Should Stand Up and Fight for Women's Rights

opinion

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I urge midwives to stop being well behaved and to take on their duty to advocate for women's rights to a good birth

Franka Cadée is the President of the International Confederation of Midwives.

From Tanzania to the United States, a woman's right to choose, why, where, when and how she gives birth is being threatened globally. In the current climate, I find myself increasingly incensed by the state of the worlds inability to treasure childbirth and women's rights. The power a woman has over her body has become a political bargaining tool. Contraception and abortion have become words for the headlines and votes - but not options for women to decide for themselves. Whilst women's rights continue to erode globally, we need to protest and fight for our basic human rights.

In my profession as a midwife, I have seen women's rights, decisions and voices become secondary to those of healthcare professionals. Pregnant women have been turned into statistics, procedures and processes, and often have their voices ignored. Regularly women are being coerced into having too many medical interventions too soon, while other women, not infrequently enough and receive too little care too late [1]. Even while there are solutions and scientific evidence that highlight the importance of a good birth for a healthy sustainable future - millions of women are still not receiving it. [1-12]

Decision makers, dominant medical professionals and institutions are resisting implementing an evidence-based care model which has been proven to provide women with the best care. It is a simple matter of patriarchal power. They have prioritised institutionalisation and restrictive policies over humane care. The dominant perception is that by removing all potential risks and intervening regardless will result in good care. Healthcare professionals are using safety as an excuse to overrule a woman's right to choose. We need to empower women with accurate information so that they can make their own decisions - this is humane care.

All women and babies have the right to a good birth. A good birth is a birth where a woman receives unbiassed evidence-based information. Where a woman is supported to make her own decisions and can build a relationship of trust with a midwife who advocates for her, as well as having access to care from other medical professionals when and as appropriate.

A good birth is a birth where a woman knows she is in control and receives midwife-led continuity of care, be it during a home-birth or a caesarean section. Birth this way can be a transformative experience for her, her partner and her family. The evidence is explicit, being born this way gives us the best chances of being healthy and balanced human beings. Is this not a human right for every newborn to have the best start to life?

At a time when only a paradigm shift can turn this situation, it is an opportune time for me to call on all midwives to be bold and brave and to stand up as defenders of women's rights to quality midwifery care before, during and after birth. Midwives can no longer accept that women have to travel for hours to an institution without clean water or qualified healthcare personnel, whilst other women are being forcibly induced against their own will because medical professionals can exert their power and judgements over the basic rights of a woman. I urge midwives to stop being well behaved and to take on their duty to advocate for women's rights to a good birth.

Midwives, health care professionals and the world must reaffirm their commitment to a woman's rights to safe, good and respectful care because this is every woman's basic human right.

Mwaniki, M.K., Quality in provision of maternity services: the missing link in health-care investments in LMICs? The Lancet Global Health, 2016.

Kennedy, H.P., et al., Asking different questions: A call to action for research to improve the quality of care for every woman, every child. Birth, 2018. 0(0).

Van Lerberghe, W., et al., Country experience with strengthening of health systems and deployment of midwives in countries with high maternal mortality. The Lancet, 2014. 384(9949): p. 1215-1225.

Lawn, J.E., et al., Every Newborn: progress, priorities, and potential beyond survival. The Lancet, 2014. 384(9938): p. 189-205.

Lancet, Feminism is for everybody. 2019, Lancet. p. P493.

ten Hoope-Bender, P., et al., Improvement of maternal and newborn health through midwifery. The Lancet, 2014. 384(9949): p. 1226-1235.

ten Hoope-Bender, P., et al., Improvement of maternal and newborn health through midwifery. Lancet, 2014. 384.

Shamian, J., Interprofessional collaboration, the only way to save every woman and every child. Lancet, 2014. 384.

Renfrew, M., et al., Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. The Lancet, 2014. 384(9948): p. 1129-1145.

Renfrew, M.J., et al., Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care. Lancet, 2014. 384.

Renfrew, M., et al., Midwifery: An executive summary for The Lancet's series. Lancet, 2014. 20: p. 1-8.

Homer, C.S.E., et al., The projected effect of scaling up midwifery. The Lancet, 2014.

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