Midwife shortage linked to high infant, maternal mortality rates

–Ramsammy disputes stats

Guyana still has much to do in lowering infant and maternal mortality rates and high priority should be placed on strengthening the midwifery workforce, the State of the World’s Midwifery Report has said.

The report, titled ‘Delivering Health, Saving Lives,’ was launched here on Wednesday at Cara Lodge, where a copy was presented to Minister of Health Dr Leslie Ramsammy. The report stated that Guyana has a ratio of 2.8 midwives, nurses and doctors per 1,000 persons. Also, there are just two obstetricians in the country, although there are 452 general practitioners with some midwifery competencies. The midwifery workforce consists of 400 midwives, including nurses/midwives, with another 60 community health workers with some midwifery training. There is no registry of licensed midwives and the vacancy rate for midwifery faculty is high.

However, the report said it was recognised that high priority is being given to addressing maternal health gaps and that the country’s maternal and newborn health policy aims at strengthening the midwifery workforce. “A two-year direct-entry programme focused on graduating midwives for rural areas is implemented in three public schools in Guyana,” it noted.

Among the recommendations for Guyana is that policies be put in place that would provide adequate skilled human resources, adequate infrastructure, communication tools and referral systems.

The need for improvements in the professional attitudes of health care providers was identified. The need for the provision of packages attractive enough to ensure that midwives remain in Guyana, since the most qualified and experienced are always the first to leave, was also noted.

The report said that there had been a decrease in maternal mortality in the 1990s, but then there was an increase in the 2000 to 2008 period. A graph showing trends in maternal mortality revealed that in 1990, Guyana’s ratio was 310 deaths per 100,000 live births. By 1995, this had dropped to 250, then to 120 in 2000. However, by 2005, maternal deaths per 100,000 live births ratio had risen again to 190 and to a whopping 270 in 2008. In order to meet the Millennium Development Goal target, the ratio should be at 78 per 100,000 live births by 2015.

According to the country indicators for last year cited in the report, Guyana’s crude birth rate per 1,000 persons was 18; births per year were stated as 14,000 and the number of maternal deaths was given as 37.

Ramsammy, commenting on the report, said effort was focused on the very small percent of deaths in Guyana, while not enough was said about the many midwives who work tirelessly to ensure deliveries are safe.

Pointing to the figure given for maternal deaths last year, he expressed perplexity in identifying the sources used in gathering that information. He said he was concerned that no one approached his ministry to assist when all the material needed is readily available there. This, he said, is as a result of the ministry ensuring that information is documented in a timely manner.

He did, however, acknowledge that while it is unacceptable for any clinic in Guyana to be without basic antenatal equipment, such as a baby scale, for example, this has been the case. He promised that he will advise government of the need to establish a review policy progress committee that will correct deficits identified in the report.

Ramsammy also said that the word ‘midwifery’ and the term ‘saving lives’ always go hand in hand, and the fact that men and women in Guyana work with “uncountable constraints” and have overcome mighty odds, must be recognised.

The State of the World Midwifery Report is a comprehensive analysis of midwifery services and is issued in 58 countries, where needs are greatest, particularly low-income countries such as Guyana.

The report includes a series of recommendations made to governments, regulatory bodies, educational institutions, professional associations and international organisations that can help to remedy problems. Its compilation has gained the support of 30 partners, including the Pan American Health Organisation (PAHO), United Nations Population Fund (UNFPA), United Nations Children Fund (UNICEF), United States Agency for International Development (USAID), and the African Development Bank Group.

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