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Call for more research on role of midwives in humanitarian crises

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More must be done to enable midwives to deliver sexual and reproductive healthcare “to their full potential” to vulnerable women and girls caught up in humanitarian disasters, according to new research.

A study, published in the journal Human Resources for Health, found “considerable gaps” in the information available to define the midwifery scope of practice in such crises.

“This lack of guidance for important aspects of the emergency cycle is significant”

Alison McFadden, Angela Dawson and Kristen Beek

The report identified three phases of disaster management: mitigation and preparedness, response and recovery. It found that there was a particular lack of guidance in the public domain for the role of midwives in the first and last phases.

The report authors said: “We found a paucity of evidence from the research literature that examines the activities and roles undertaken by midwives across the disaster management cycle.

“This lack of evidence was more apparent during the mitigation and preparedness, and recovery phases than the response phase of the disaster management cycle,” they added.

The report noted that 75% of those in need of humanitarian assistance were women and girls, aged 15 to 49. It added that a lack of access to sexual and reproductive health services and information was a leading cause of morbidity and mortality among displaced women and girls of reproductive age.

In addition, 60% of preventable maternal deaths and 45% of neonatal deaths took place in displacement settings, and more than one in five displaced women in humanitarian settings experienced sexual violence, placing them at risk of unplanned pregnancies and sexually transmitted infections.

“Without such guidance, midwives are unlikely to deliver care to their full potential”

Alison McFadden, Angela Dawson and Kristen Beek

For their investigation, the researchers searched for international studies that pertained to the role of midwives in delivering and performing sexual and reproductive health services in humanitarian settings.

They found just 14 that met their criteria – 12 were undertaken in conflict settings, and two were conducted in the context of the aftermath of natural disasters. Five studies were from the Eastern Mediterranean region, four each were from Africa and Southeast Asia, and one was from the Americas. 

Of those studies included, eight reported findings from the response phase of the disaster, seven from the recovery phase and just two for the preparation stage.

In addition, only one discussed interventions to address sexual violence and provide emergency contraception. The researchers added that there was “even less information on actual practice in the field”.

“Given that the [World Health Organization] recommends that nurses and midwives are supported to operate with a greater scope of practice in emergencies, this lack of guidance for important aspects of the emergency cycle is significant,” they said.

“Without such guidance, midwives are unlikely to deliver care to their full potential across all phases of the disaster management cycle,” the researchers added.

The report also highlighted gaps in guidance in how midwives should work in partnership with other health professionals during crises.

It noted that collaboration between midwives and nurses had resulted in midwives “assuming care that is beyond the scope of midwifery practice”.

In contrast, the study found that “tensions” between midwives and medics had resulted in midwives being limited in their work.

“We did not find any research that focussed directly on describing the role of midwives in relation to other cadres,” the report said. “Such research could inform future guidance for midwives operating in these contexts and seeking to contribute to building the resilience of their communities.”

“We did not find any research that focussed directly on describing the role of midwives in relation to other cadres”

Alison McFadden, Angela Dawson and Kristen Beek

In addition, the review raised concerns about the impact of worldwide midwife shortages and a lack of training for midwives on how to work in humanitarian settings.

The report said: “There is an urgent need to scale-up all midwifery training to address shortages and to ensure that midwives have the necessary knowledge and skills to function to their full potential in non-emergency contexts as well as across all phases of emergency management.”

The researchers stated that lessons from successful midwifery training in emergencies must be shared and scaled up.

They concluded that research-informed guidelines and strategies to better define the role of midwives in humanitarian emergencies were needed to “ensure that the potential of midwives can be acknowledged and optimised across the disaster management cycle”.

The review was led by Alison McFadden, from the School of Nursing and Health Sciences at the University of Dundee, alongside Angela Dawson and Kristen Beek, both from The Australian Centre for Public and Population Health Research in Sydney.

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Readers' comments (2)

  • Such an interesting area of research. From my own personal experience this is absolutely true. I worked in a refugee camp in Greece and there was such a gap in relation to sexual and reproductive health provision, and certainly a lack of communication between providers of emergency health care.

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  • Would love to know if the researchers are planning to commission some research in this field, thank you.

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