The dilemma of pregnant women and male midwives
A male midwife carries an inspection on a pregnant woman during an antenatal visit to a health centre. Photo by Gawaya Tegulle
By Gawaya Tegulle
Monday, April 29
Midwives are mostly women and since they deal
with issues related to pregnancy, expectant mothers are usually
comfortable being handled by them. But with men also becoming nurses and
midwives, it poses unique challenges.
The women of Agung Village, Todora Parish, Anaka
Sub-County in Nwoya District must think twice or plan ahead of schedule
when they will go into labour, because they are not at liberty to
entertain labour pains at any time.
With only one health worker within a radius of
30km, who is both nurse and midwife, and has other important duties (all
of them legitimate) to attend to, the choice of when to go into labour
is completely out of the women’s hands. And for good measure the
nurse-cum-midwife is a man.
Mr Wildred Adot carries the weight and
hopes of an entire village on his shoulders. In essence he is the health
centre and when he is away, the entire Todora Health Centre II is
effectively “under look”.
As an Enrolled
Comprehensive Nurse, Adot is trained and equipped to administer
antenatal care, family planning service, delivery, post-natal care and
general treatment. But he too gets ill and fails to report for duty from
time to time. When that happens, the entire hinterland must wait for
him to get better, or look for alternatives a long distance away.
Not a good option in a rural area where roads are
bad and travel does not come cheap, especially when you have a pregnant
woman on your hands who must get to the labour suite very quickly.
fact that he is a man does complicate things quite a bit, because many
women have a problem with this. However, the ladies have no choice as he
is a ‘monopoly’ of sorts, they have nowhere else to go.
Today is a day for
antenatal visit at the health centre. Martha, a middle-aged mother is
awaiting her turn but she is clearly apprehensive and shares her
concern. “I am a grown up woman, how can I be touched by a young man
like this one? How will I come here to deliver when I have to open my
legs before a man who is not my husband?” she asks. Then, a look of
resignation crosses her face. “There are things that can only be told to
a woman, not a man. But I have no choice, as the other place I could
have gone to is far off and I do not have the money or energy to go
there,” she concludes.
At that moment
she is called in to the examination room. Hand on hips, look of despair
on her face, she gets up and reluctantly walks onto the bed, and lies
down with a sigh. Of the women waiting, three or four others express
similar reservations but still stay in the line, knowing their options
Male midwives appear to be a sensitive issue in
the Greater North and no matter how efficient they may be, it does seem
to be making the lives of many pregnant women quite difficult.
many of them, it is the ultimate humiliation. Another reason why some
continue to prefer Traditional Birth Attendants (TBAs), never mind that
they were disbanded by government or that it is a risky venture.
Diana Nassozi, a
Community Resource Person (CRP) in Oyam District, narrates that at the
Health Centre II in Adyegi Parish, apart from having no maternity ward,
which is a big problem in itself, it has a male midwife whom some women
fear to approach. In an area where certain traditions are firmly
entrenched, many women will still think twice about being naked before a
man other than their husband.
“Some women fear him, so they have to go to Aber
Missionary Hospital, which is far away and moreover where they also have
to pay,” says Nassozi. “The HC II next to them is free of charge, but
they’d rather pay at the missionary hospital than undress before a male
Grace Aloka, a CRP in Aber, Oyam District, says
some women like the male midwives for one good reason: “They handle
women with a lot of love and care. They do not abuse the mothers and
they are very gentle.”
But this seems to be
the exception rather than the rule. The scenario calls for a
gender-sensitive approach to health staffing, especially in rural areas
where health workers are few and women often have no choice.
In attempt to stem the crisis occasioned by
shortage of health workers, some NGOs have invested in some of the
communities. The Health Rights Action Group (HAG) and the Action Group
for Health, Human Rights and HIV/Aids (AGHA) have began working with the
District Local Governments, health centres and local communities in
four districts of Greater North – Amuru, Nwoya, Oyam and Soroti.
One of the innovations has involved
the use of CRPs, who are selected from Village Health Teams (VHTs) and
given special training to help in outreaches to pregnant women, at least
once or twice every month. The VHTs are established by national policy
and do exist – at least in theory – in every village. It is out of these
that HAG and AGHA have trained CRPs and facilitated them to reach out
to certain health categories, especially pregnant women.
In the village of Agung, HAG and AGHA
pay for a midwife (female) from Anaka Hospital–the biggest hospital for
miles around–to attend these outreaches and talk to the pregnant women
and offer antenatal advice after thorough checks.
This not only alleviates the burden that Mr. Adot
has to shoulder everyday, it also helps those who are shy to attend
antenatal care administered by a man to get reprieve. The monthly
outreaches take place in various locations in the district; like Alero,
Koch Goma, Purongo and Anaka - but not everywhere, owing to limited
funds available to the NGOs. HAG and AGHA facilitate qualified midwives
to attend to women in or near their homes.