Vietnam urged to improve midwifery services

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Up to 1,000 women die every day as a result of pregnancy-related complications globally, and 5,500 newborns die in the first week of life because of a lack of adequate medical care


A midwife examines a pregnant woman in the south-central province of Ninh Thuan. The United Nations has called on Vietnam to invest more into training midwives to reduce the maternal and newborn mortality rates.

Twenty five years ago, Chamale Thi Cuc was born in a forest, where her mother was assisted by a traditional birth attendant.

"At that time, there was no commune health station," said the Raglai woman from the south-central Ninh Thuan Province's Ma Du Village.

Things have slightly improved for Cuc.

Five years ago, she delivered her first baby at home. "A commune health station existed, but we barely knew about the services provided, and this is the reason I delivered at home."

Last year, Cuc delivered her second child at the communal health station and was attended by two midwives based in the same village. The midwives graduated from a training program for ethnic minority women supported by the United Nations Population Fund (UNFPA).

The midwives visited Cuc's household regularly during her pregnancy for health examinations, and to persuade her to give birth at the medical station where she could be supplied with better services.

Cuc's story, reported by UNFPA, is an example of the improvements made in maternal healthcare in Vietnam's remote regions in the past decades.

However, experts continue to urge more investment to train midwives and for better awareness in the community about accessing maternal healthcare services to reduce "needless" fatalities among mothers and newborns.

"During the past 20 years, Vietnam has achieved great progress in reducing maternal, newborn and child mortality by improving access to and the quality of reproductive, maternal newborn care services," said Wu Guogao, officer-in-charge of the World Health Organization (WHO) in Vietnam.

"Despite this, work is still needed to improve midwifery coverage and competencies," he told an audience at the launch of the State of the World's Midwifery 2011 in Hanoi on Thursday (November 10).

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Citing the report, Guogao said there are gaps in regulations, education and policies relating to recruitment, employment, and retention of the midwifery workforce in Vietnam that need to be filled.

"I would like to encourage the Health Ministry to continue these ongoing efforts, and to integrate skilled birth attendant issues including midwifery into all related programs and action plans," he said.

According to the State of the World's Midwifery 2011 conducted in 58 developing countries including Vietnam, up to 358,000 maternal deaths could be avoided each year if midwifery services are upgraded by 2015.

Some two million newborns die within the first 24 hours of life, and there are 2.6 million stillbirths, all because of inadequate or insufficient healthcare, the report found.

The report warned that unless an additional 112,000 midwives are trained, deployed and retained in supportive environments, 38 out of 58 countries surveyed might not meet their target to achieve 95 percent coverage of births by skilled attendants by 2015, as required by the UN Millennium Development Goal (MDG) on maternal health. MDGs, a set of targets for education, poverty, health and other areas, were established with the hope that participating nations will achieve the goals by 2015.

"Every day, 1,000 women die as a result of pregnancy-related complications, and an additional 5,500 newborns die in the first week of life because of a lack of adequate medical care," said Bruce Campbell, UNFPA Representative in Vietnam.

"The current global shortage of some 350,000 professional midwives means that women and their newborns die from complications that could have been easily prevented by a health worker, in the right place, at the right time, and with the right skills, the right equipment and the right support," he said.

"The report clearly states that investing in human resources for health is one of the soundest investments a country can make. And, in the context of Vietnam, where we still have significant gaps in midwifery capacity, strong and continued support and commitment from the government and other partners will be required to improve the status and capacity of midwifery," Campbell added.

In Vietnam, half of all children were delivered by non-skilled professionals in rural areas in 1997. The number was reduced by half in 2002, according to the report.

Luu Thi Hong, deputy director of the Health Ministry's Maternal and Child Health Department, pointed out weaknesses in training midwives in Vietnam, including a short training curriculum, inappropriate student/teacher ratio, and lack of a competency-based training approach.

"A majority of teachers are doctors, and very few of them have a midwifery background," she said. Hong also said there has been a lack of policies to retain midwives working at mountainous and remote regions, or favoring local midwives there.

A review of skilled birth attendants presented at the event showed 90 out of 232 midwives had not received pre-service training in all 30 skills required for skilled birth attendants.

A 2010 assessment of the reproductive health system found Vietnam has 24,721 midwives. Only approximately 7 percent of them graduated from a college, while 91.4 percent completed secondary school, and 1.2 percent only completed primary school.

"Midwives with insufficient skills may not perform [well when managing] obstetric complications, and they may [have a negative] influence [on] saving mothers' and babies' lives," Hong warned.

Deputy health minister Nguyen Viet Tien said midwifery and midwifery practice play a crucial role in Vietnam's maternal and newborn healthcare system.

"A skilled midwifery workforce, the majority of skilled birth attendants, with high competencies, motivated and supported by the healthcare system, is key to successfully reducing maternal and newborn mortality," he said.

Tien said there remains "a large gap" in maternal mortality between and among regions, and newborn fatalities are relatively high.

"Home delivery or giving birth without the attendance of trained health staff is common in ethnic minority regions, remote areas," he said.

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