Feature: Communities in Aweil reject male midwives
The women in Northern Bahr-el-Ghazal State, supported by elders, have complained about the introduction of male midwives in government hospitals and those run by Non-Governmental Organizations (NGOs), saying it goes against their cultural norms.
Several women Radio Tamazuj interviewed confessed that they delivered children at home due to the fear of being attended to by male midwives at hospitals.
“You see, I have seven children and I delivered all of them at home, there was no child I delivered at the hospital. I fear seeing male medical workers at the hospital and I prefer to deliver at home,” Bakheita Anyang said.
Many women prefer to deliver at home, avoiding being attended to by male midwives at hospitals despite the poor health conditions in the state.
Community members vehemently expressed their rejection of male midwives and said it breaches cultural norms and ethics.
Northern Bahr-el-Ghazal State is populated by Dinka Malual and Luo communities and their cultural practices dictate how people interact with adults, women, and chiefs among others.
Teresa Achol Bilwan, a young woman in Aweil, strongly condemned the introduction of male midwives and said the ‘small boys’, referring to male midwives, cannot deal with pregnant mothers in good faith. She said that the few female midwives have not been given a chance to work in the maternity wards yet they can do the job.
Despite the existence of male medical personnel who specialize in gynaecology and obstetrics, Achol recommends female staff to deal with women because according to her there are many challenges facing women that cannot be understood by men.
She tasked the government to handle the matter seriously and reverse the introduction of male midwives, “otherwise peaceful protests must be carried out for more attention on the matter.”
Akuei Deng, an eminent elder with knowledge of the old Sudan culture, said it is a shame for South Sudan to introduce male midwives and that it contradicts local customs. He blamed South Sudan for borrowing blindly from East Africa after independence.
According to Akuei, there were women trained in the past as midwives, but they are now neglected and not participating actively in maternity facilities in the state.
He said that some of the ‘boys’ who have embarked on becoming midwives may lose sexual appetite in the future.
“In our previous community, especially the old Sudanese community, for a man to become a midwife was not good but in South Sudan, we are working in so-called East Africa, the East Africa system allows men to become midwives,” Akuei lamented.
“Actually, for us in our old Sudanese system, it was not possible for a boy to become a midwife to attend to the woman, clean her, and to know more and do many things on a woman delivering. It is not supposed for boys to do that,” Akuei added. “The best thing is that people should train women and return to the old system. There are old women Sudan trained as midwives, they are neglected and the organizations brought this new concept and marginalized them.”
A young lady, Alia Dut, said men can become physicians but she warned men against exercising the duties of midwives, “because midwifery is simply meant for female members.”
She agrees that male doctors can help women and small children in general health conditions except for issues of direct birth-giving.
“My opinion is that a doctor is a doctor, the doctor gives advice and treatment to the patient. Regarding midwives, they are supposed to be women because they know things affecting fellow women. It is supposed to be women in the maternity department.” Alia emphasized.
Another Aweil resident, Kajok Majok, slammed health institutions for hiring male midwives because, according to him, South Sudan has not reached the level at which males can be midwives.
“We still don’t have experience for a man to become a midwife at a hospital because you cannot tell what you have seen there. It is a secret between you and our Lord, but some people talk about it on the street, that the wife of Mr. X has something like this and something like that,’’ Kajok qualified. “My opinion is that women should be the only midwives. It is fine for a male graduate doctor from medical college to carry out fistula operations. The male doctor has the right to operate because he was trained and has experience.”
Male midwives who talked to Radio Tamazuj are proud of their career choice and said that there are a lot of chances to extend the career as the best experts in the field of midwifery. They also said there are some problems which their female colleagues can’t cope with and said the criticism against them by the community is ill-founded.
Deng Long, who is currently serving as a midwife at Aweil Civil Hospital in Northern Bahr el Ghazal State said, “Of course, based on this career choice, I am proud because there are a lot of chances to be an expert. So, now as a midwife, I interact with female midwives and we work together and there are a lot of things that can defeat female midwives which I manage and other colleagues manage as male midwives.”
“Whenever the female midwives see too much blood they panic. Other people don’t turn up to help the mother when she is in labour; they cannot manage but male midwives can stand firm and help the mother,’’ Deng said. “Yes, of course, there are a lot of challenges that I face as a male midwife because some people provoke me by repeatedly asking me how I can be a midwife.”
Akot Ngor, a male midwife in training at the Aweil Health Science Institute, said he decided to help the vulnerable mothers.
“What made me become a midwife is that I want to help pregnant mothers because many women deliver outside health facilities and others suffer during delivery, bleed to death or lose their children,” Akot said. “There are challenges I saw untrained people helping women deliver at the hospitals but they don’t have enough experience. Someone may be negligent and the baby dies in his hands immediately.”
An official at the Aweil Health Science Institute said about 50 male midwives will graduate by 2021 after completing a three-year course in midwifery and that they will be deployed in health facilities across Northern Bahr el Ghazal after graduating.
He also disclosed that some undergraduate male midwives are assigned to the hospitals but some fail to perform professionally and that babies have died in the past due to the inexperience of the trainees.
Abuk Akol, an experienced old woman in the field and a long-term serving midwife at Aweil Civil hospital blames the government for offering a chance to allow males to grab their duties and said they are ignored simply because they aren’t educated according to the government.
She, however, believes that they have enough experience in midwifery because they went through training by qualified tutors at well-renowned institutions.
“It is the government who refuses and says we women are not going to deliver women and they allowed the men to deliver the women and we were told that we are not educated. And if we are not educated we are not allowed to enter into the wards. Some of us are educated and some are not educated, but the educated ones are also removed,’’ Abuk bemoaned.
For his part, the Aweil Civil Hospital Director, Dr. Wol Wol Akeen, said men were not allowed to exercise the duties of midwives in the past, saying that things had changed since South Sudan joined the East African Community and other donor countries support males in the field of midwifery.
He urges the communities to accept the change since the male midwives are meant to provide the much-needed health services to the poor pregnant mothers despite communal barriers on the matter.
Dr. Wol has concluded that the issue will be addressed if the number of female students who pursue midwifery is high at state and national health institutes.
“Concerning the men’s work as midwives at the hospitals, of course, this system was not available in old Sudan. The women were midwives, but when we came to South Sudan it happened that men became midwives and this became a permanent system and there are some countries in East Africa and the world where men are working as midwives. So, the community has to accept the current situation because the purpose in these people is the provision of the services to people,’’ Dr. Wol advised.
The greater Ajak Wek Ateny community paramount chief, Ayom Wek Akol, criticized the new system which allows men to deliver women at hospitals, saying that it is alien to Dinka culture. He called for more training of female midwives to replace their male counterparts.
“Yes, in Dinka culture it is bad and we don’t like it. No one will accept it if they are originally Dinka. It is bad in our culture for a man to be involved in midwifery, it is not accepted, and it will not work at all. Another thing we are saying is that little by little we need girls to be educated, to do training so that they will be the midwives,’’ Paramount chief Ayom said.
In the old Sudan, it was illegal for males to attend to and deliver pregnant women. Respect to these cultural values has been observed in the region until South Sudan gained its independence from Sudan on 9th July 2011.
Rumbek embraces male midwives
Peter Dor Meen, a male midwife in Rumbek State Hospital’s maternity ward says male midwives take better care of pregnant women than their female counterparts because the latter abuse and beat up mothers during childbirth.
Speaking to Radio Tamazuj, Dor Meen, said some female midwives abuse and beat mothers who are delivering in the maternity ward, a practice the male midwives do not do. He said in Rumbek women prefer male midwives.
Dor Meen who has worked for the UNFPA in Rumbek Civil Hospital for several years said, “The midwifery profession started a long time ago and was pioneered by women but they discovered that women cannot work alone and men started getting involved. The midwifery profession is very vast and women cannot manage alone.”
“If other doctors like gynaecologists and obstetricians can treat women, then they decided that male midwives can also help in delivering women, so the profession was introduced,” Dor Meen said. “In South Sudan, the sensitization and awareness about male midwives are very low so some communities do not know that men can deliver women. That is why some women in South Sudan are saying they should not be delivered by men.”
“In my hospital, I have not come across that challenge because we male midwives are the majority. We also have other male students who are pursuing studies in midwifery and they have joined us in helping women deliver,” Dor Meen added. “The only challenge I have seen is that women are not happy with male midwives in training or with little experience in delivery and prefer professionals and those with a long experience.”
Asked about the situation in Aweil, Northern Bahr-el-Ghazal State, where women shunned and or rejected male midwives, Dor Meen said, “If a male midwife forces himself or imposes on a mother, she will not respect you, but you have to appeal to her and tell her all the steps and everything you will do. In our profession, you have to tell a mother everything and every step that you will take before, during, and after delivery. If you do not counsel the mother psychologically and don’t brief her well, then this will automatically lead to her refusing a male midwife. This is common with trainee male midwives.”
According to Dor Meen, women in Rumbek prefer male to female midwives. “Women here tell me that male midwives care more than their female counterparts. That female midwives abuse and beat and tell them things like “when I delivered I did not shout like you” and that male midwives care because they don’t deliver. So in that sense, we care more than the female midwives and we are preferred in the station where I am currently working.”
He said the problem in Aweil might be due to the big number of mothers delivering, cultural beliefs, no psychological counselling, and no control that has brought about that complaint and fear of male midwives.
“I have worked in Rumbek with UNFPA for six years, I also worked in Maridi and Juba Teaching Hospital. I have over thirteen years’ experience in this midwifery profession.
The biggest challenge we face here is the lack of qualified midwives because the few we have are Traditional Birth Attendants and they have little experience as midwives,” Dor Meen said. “A midwife is someone who is trained for three to four years and when they graduate they have a lot of knowledge to give mothers and possess techniques in delivery. So we have a shortage of trained midwives.”
He said as midwives they are understaffed and overwhelmed because three trained midwives work through the different shifts of the day and night.
“You find one midwife delivering up to twelve mothers in the night. Our data here shows that we average 250 to 300 deliveries in a month. And for the antenatal clinic, those pregnant mothers who come for follow up, range from 1000 to 1200 per month,” Dor Meen said. “So you find one midwife seeing up to 1000 expectant mothers each month. This translates into a lot of work.”
According to Dor Meen, this is further complicated by lack of and or delayed government salaries for government health staff who then do not come to work at times and this leads to medical personnel paid by the NGOs being overworked.