The Honourable Minister of Health, Dr. Aaron Motsoaledi

The Honourable Minister of Health, Dr. Aaron Motsoaledi

Chief Operations Officer, Department of Health, Ms. Nomvuyeni Dladla

SOMSA President, Ms. Deliwe Nyathikazi

SOMSA Deputy President, Ms. Nokuzola Mzolo

Programme Director and Chairperson of Gauteng Midwives, Ms. Nomusa Ramela

SOMSA Executive Committee

Senior Officials representing Government Departments at national, Provincial and local levels

Representatives of various nursing and midwifery institutions

Representatives of Academic Institutions, Civil Organizations and Non-Governmental Organizations;

Members of the Media;

Distinguished Ladies and Gentlemen;

Dumela;

A very special good morning to you all!

I thank the SOMSA 2012 organising committeeand the SOMSA Executive Members for inviting me to speak at this 10th Annual Congress of the Society of Midwives. For this opportunity I am extremely honored.

I congratulate you on the theme of this year’s Annual Congress: “A new dawn in midwifery: seeking new approaches towards 2015 and beyond”.

I sincerely thank the Minister for making the time in his busy schedule to officiate at the congress. This attests to the level of importance that Government from Ministerial level places on midwifery as a profession.

SOMSA President and SOMSA Members,

The international development community has already begun dialogue and consultative processes towards defining the post 2015 sustainable development agenda. It is therefore noteworthy that SOMSA has chosen its annual congress theme in such a way that it would enablemidwives of South Africa to make a meaningful contribution to shapingtheglobal development discourse post 2015.

South Africa has made significant progress towards achievement of the MDGs especially in primary education enrollments and combating HIV and AIDS. The recently released preliminarycensus data, demonstrates improved service delivery. More South Africans have access to piped water, sanitation, electricity and other social basic services. In addition, household incomes have increased across the board. This progress is well noted; however progresstowards achievement of MDG4 – reduction in child mortality and MDG5 – improved maternal health, remains uneven at best. The one MDG that in many developing countries is least on track is MDG5.

And therefore yes, rightly so, we should be defining a new dawn for midwifery and thinking ahead to the future post 2015.

It is my plea, however, that as we look ahead we should not stop trying to accelerate actiontowards improved child and maternal health in the three years that we have left till 2015.

We have seen in a number of countries including in SSA and South Asia that with the right investments, comprehensive commitment and equitable distribution in resources, maternal and neonatal mortality can be turned around significantly in a few years.

UNFPA sees improving maternal health as a central pillar in any country’s poverty reduction efforts and women, as the most important role player in efforts to reach sustainable development. And therefore the commitment to ensure that giving birth is not a matter of life or death must be the call we make to all leaders and policy makers. And midwives,who we know have significant monopoly over attainment of this MDG, must continue to be the first among others to champion the cause; to lead the crusade.

At the national CARMMA launch in Durban in May this year, Minister Motsoaledi emphasized that no woman should die while giving life – a statement that now represents the rally cry for the African Union CARMMA campaign.

Distinguished SOMSA members,

Clearly in the 21 century, when we have been able to do so much in science and medicine, and when there is increasing attention around women’s and children’s health, it is not that we do not know what we have to do – I argue that it is more that we are not doing it with the urgency, equity and scale that is needed to get the results.

The United Nations and the global community of practice has strong consensus that by ensuring every woman has access to a basic package of sexual and reproductive health including voluntary family planning, skilled attendance at birth, backed by emergency obstetric care and safe and proper management of abortion and post abortion care, we can reduce deaths due to pregnancy and childbirth by 75 percent.

In July this year as a way of addressing the unmet need for family planning, UNFPA, DFID, the Bill and Melinda Gates Foundation and other partners organized an international summit to raise money to make voluntary family planning availability to an additional 120 million women and adolescent girls in developing countries by 2020.

Family planning is central to many of the international community’s goals – to improve the health of mothers and children, to promote gender equality, to increase access to education, to enable young people to fully participate in their economies and communities, and to reduce poverty. It must therefore be fully integrated into all current and future development initiatives, including the global sustainable development framework that will build on the Millennium Development Goals after 2015.

With specific reference to midwives, we see that the number of maternal deaths is highest in countries where women are least likely to have skilled attendance at child birth. Therefore for a country to reduce maternal and newborn deaths and illnesses, one of the most important investments it has to make is in its professional health care workforce, to ensure skilled care particularly quality midwifery care during labor and delivery.

Today, we estimate that 35 per cent of pregnant women in developing countries do not have contact with health personnel prior to giving birth. More than one in three women in developing countries give birth alone – or with only relatives, and in some of the poorest and least developed countries, as few as 13 per cent of all deliveries get assisted by a midwife or a health worker with midwifery skills.

While 91 percent of all deliveries are said to be assisted by skilled health personnel in South Africa, there are significant regional and quality variations. The estimated workforce shortfall to attain 95 percent skilled birth attendance by 2015 is between 700 and 1,000. And with reference to the HRH Strategy for the Health Sector:

2012/13–2016/17, it will not be till 2020 that South Africa will have enough midwifery personnel to deliver for the population.

Further, it has been shown that both midwifery personnel and services are unequally distributed – between countries as well as within countries, with the shortage of health workers especially nurses and midwives being more pronounced in rural and hardship areas.

Last year in its first every State of the World’s Midwifery Report – “Delivering Health, Saving lives”, UNFPA estimated a global shortfall of about 350,000 professional midwives if we are to reach MDG 5 by 2015.

Beyond the numbers -- midwives not only have to be available, but they have to have the right skills, the right infrastructure, health technology, equipment and medicines and supplies, and the right support, mentoring and supervision to be able to deliver the right to health.

I personally believe Midwives are the true yet silent heroes behind the success we see and the main life line we have to meeting the health MDGtargets by 2015.

And so SOMSA is right, there needs to be a new dawn rising for midwives, a turning point, where with the global and political commitments to women and children’s health, we can sincerely translate the recognition of our situation, and the opportunities that are available, into tangible programmes of the scale and urgency that will prevent disabilities and save lives.

The Triennial Congress of the International Confederation of Midwives that was held in Durban, South Africa last year provided a high profile platform for midwives to come together to highlight global inequalities in maternal mortality and demonstrate the difference that they make. By the next Triennial Congress in June 2014 in Prague, midwives of South Africa would not only be able to speak to the progress made since Durban but what should be the defining frame going into 2015 and beyond.

As I conclude, I would like to share with you from UNFPA’s perspective a few thoughts on how we can collectively advocate for the investment in midwives and how this then can deliver results for women and children.

Firstly - Strengthening Midwifery Societies and Associations

Midwives in any given country need the collective force of their profession gathered in a strong association to reach both their individual and collective goals. We therefore urge you to use the existing tools developed by the International Confederation of Midwives and others to assess the capacity of SOMSA and to ensure that as you renew you vision and the strategic positioning of the Society, you build in efficiency, effectiveness and accountability.

This brings me to my second point – accountability.

We can’t continue holding our government or leaders accountable for the welfare of women and children, if we don’t also hold ourselves personally accountable. We have to ensure that through our various health practices, both public and private, we provide the access and quality of care that is desperately needed and that is every patient’s right – whether young or old, whether rich or poor; whether citizen or immigrant; whether disabled or abled - care that is respectful of the dignity and sanctity of life and that does not discriminate. This is the professional and ethical oath that we, as health professional must continue to take seriously.

It is important that we underscore that choosing midwifery as a profession means a choice to selflessly serve. I have read the constitution of SOMSA and I was particularly drawn to Objective 2: “Develop and promote an adequate, efficient and effective midwifery service in South Africa”. If this is one of the objectives of the Society, we need to take time to reflect on the extent to which the current state of midwifery in the country speaks to this objective. I have been in South Africa now for 4 months and a consistent message I have heard is around the attitude of nurses and midwives and particularly towards young clients and adolescents who are pregnant.

If we have value and moral judgements around young people’s sexuality how do we begin to effectively raise young people’s interest in midwifery through the manner we conduct business at the hospitals and clinics in which we serve. It is up to us to make midwifery a career of choice for young people.

Thirdly, positioning midwives and midwifery education and training within national and sector development frameworks, strategies, plans and budgets.

Governments must include midwifery services when costing health plans and when setting performance indicators and targets. The South African government recognizes and states in its National HRH strategy that there are insufficient professional nurses, trained midwives and PHC trained nurses in the public health service to implement the re-engineered PHC system including as part of the critical district specialist clinical teams. It commits to training additional graduates and attracting qualified nurses back to the profession. It is important that investment be made to nurse training institutions and around nurse midwife tutors for pre service, in service and continuous education efforts.

Lobbying and advocating for specific focus on education of midwives and others with midwifery competencies is possible if we can determine specifically what is the current situation and capacity gaps of midwives in South Africa bench marked to international standards. UNFPA in a number of countries has helped to define the situation of midwifery and midwifery curriculummaking this available for better targeted advocacy and planning for expansion and scaling-up of the number of midwives and quality of midwifery care.

However, training, deployment and retention are not the only issue.

And this brings me to my fourth and final point:- registration, regulation, accreditation, proper delegation of authority and supportive supervision of midwives. This is equally as important in ensuring that midwives have appropriate employment protection, remuneration, incentives and motivation.

Madam President

The returns on investment in skilled birth attendants with midwifery skills are large. When empowered and authorized with all essential lifesaving competencies, midwives can help avert some 80-90 percent of all maternal deaths. They also play a critical role in newborn care and in averting the deaths of newborns, as well as in detecting HIV infections in pregnant and non-pregnant women. Midwives can help address critical family planning needs in communities not only as service providers but as counselors who are trusted members in the societies.

Distinguished members,

UNFPA has been working with ICM and with midwife associations and societies in almost all countries it has presence (over 120) to promote midwifery practices and support trainings of health workers in various aspects of maternal care including lifesaving skills. In 2008, UNFPA launched a joint programme with ICM entitled “Investing in Midwives”. Among other things, this programme supports midwifery schools, strengthening of midwives’ competencies and skills, strengthening midwifery societies and associations to promote the profession and attract young graduates into the profession and support to high level political advocacy to ensure suitable legislation and regulations in the field of midwifery.

Madam President, SOMSA members,

A gathering like this that brings together experts in the field of midwifery is only as good as what happens after. I am confident that in your deliberations in the course of the next few days, indeed a new dawn for enhanced midwifery will be defined.

UNFPA strongly commits to the strengthened collaboration and partnership with the Government of South Africa and SOMSA that will enable us to all work more effectively together and to achieve a world where every pregnancy is wanted and planned; every childbirth is safe and every young person’s potential is fulfilled.

I wish you much success in your deliberations.

I thank you for your attention.

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