Traditional Midwives

Abstract

Developing nations are plagued by high maternal mortality rates, unwanted pregnancies, and family planning policies that aim to control population growth through sterilization and unsafe birth control drugs. In such harsh settings, traditional midwives are important and effective agents of women's wellness and family planning policy. This essay will evaluate the community roles of professional versus traditional midwives in rural Asia, including discussion regarding the meager respect afforded traditional midwives by physicians and clinic staff without acknowledging the work they accomplish with such limited resources. Analysis of the results of midwife training programs will compare government-sponsored programs' curricula to outreach education by colleagues from the international community, showing that these professional midwives provide methods for integrating traditional midwives into professional (hospital) circles as well as offering more realistic approaches to midwives in indigenous communities in the face of Western biomedicine's influx into government policy. Data will also be presented that suggests that maternal mortality rates are reduced as a result of pre- and post-partum care from midwives, and that education and home visits by midwives helps advance women's status by increasing their ability to regulate their fertility.

Professional versus Traditional Midwives

The international definition of midwife ratified by the World Health Organization (WHO) describes an individual who has completed a duly recognized program of study and is registered or legally licensed to practice midwifery in their country (WHO, 2000). This differs from most cultural definitions of a midwife. More often, midwives are any woman experienced in birth and recognized by her community to be a midwife. WHO calls these women Traditional Birthing Assistants (TBAs), and considers them care providers who fall outside the formal sector of skilled birth attendants. However, these women are experienced in maternal care and offer expertise to their clients. They are also accepted by their communities as able midwives and habitually afforded more trust than professionals.

Professional midwives in Northern nations receive eight or more years of education. Their practice is usually categorized as an alternative form of healthcare. In fact, an estimated two-thirds of all babies born globally are delivered by midwives, most of whom are traditional (Rogers & Solomon, 1975).

In developing nations, government programs have been implemented to train young women from urban settings in professional midwifery to ultimately work in rural communities. After completing the required two-year program, they are sent into cultures unlike their own to work in under-funded, ill-supplied clinics where medicines are sold out the back door to make up for the meager salaries earned. These young urban women expect to be treated with respect and see themselves as superior to TBAs (Davis-Floyd, 2000). However, community midwives are trusted and respected elders with experience in birth assistance, and most have children of their own. While most traditional midwives receive no formal education, many feel a spiritual calling to the role, and still some take over the position after the death of a mother or grandmother (Rogers & Solomon, 1975). While some undertake long apprenticeships, nearly all learn simply by attending many births (Davis-Floyd, 2000).

Family Planning and Western Medicine

In international discourse, the professional midwife community considers the current trend in family planning initiatives to have begun with United States Security Memorandum 200 (Lim & Zenack, 2000). When Henry Kissinger penned this bill in 1974, he produced a document of Malthusian alarmism, claiming that estimates on population increases would reach numbers beyond the capacity of the earth's ability to produce food. Like the extreme Malthusians known to advocate for cuts in famine relief to poor and overpopulated nations (Hartmann, 1995), this document called for drastic and ethnocentric population control measures, including falsifying food shortages to Southern countries and advocating the use of birth control drugs that would lead to sterility without knowledge or consent (Kissinger, 1974).

Thus, the importance of traditional midwives educated in modern contraception methods is paramount. In this arena is where first world professional midwives play a crucial role. "It was Western civilization that ripped off the indigenous birth practices of the world. It is now up to the midwives of the West to promote the healing of birth globally," said Cuban midwife Marina Alzugaray (Lim & Zenack, 2000, 1). Through outreach programs to reach midwives in rural Asia and elsewhere, these midwives of the West offer thorough education and training to TBAs about the birth control offered by their governments. They also provide training in non-artificial methods of contraception, which are not always available or affordable to women in rural Asia (Lim & Zenack, 2000). Viable methods of fertility control, such as the Ovulation Method, are necessary to the health of women everywhere.

The influx of Western medicine has greatly complicated the role of traditional midwives. Third world governments increasingly recognize only new biomedical practices as formal healthcare. As Western biomedical techniques are dependent upon diagnostic tests and expensive machinery, it is not realistic in rural areas. Here again, the structural violence of government systems orchestrated by structural adjustment programs and international policies takes its toll. Clinics are shut down as financial aid is cut (Loder, 2003), and hospitals are inaccessible from communities with no means of transportation. Professional and community midwives are divided by a hierarchical, colonialist system in which development planners try to exterminate TBAs as the unskilled bottom level of the biomedical pyramid (Davis-Floyd, 2000). Traditional midwives are scapegoats for maternal mortality rates, as Western medicine sees their "unskilled" practice as the cause of fatal complications during birth Ð'- the leading cause of premature death among women in developing nations (Maine et. al., 1996).

Impact on Maternal Mortality and Women's Health

Indeed, research has shown that midwives greatly impact rates of maternal mortality in developing nations. Where traditional midwives are available, maternal mortality is decreased. This is proven, in one instance, by a study done in Bangladesh. Prior to intervention, which entailed posting TBAs with training by government health