The Stories

Photo Credit: Seed Global Health

Harriet Nayiga | Bringing Midwifery Services to the Community

Story By: Seed Global Health   |   August 21, 2020     |    Uganda,

Harriet Nayiga | Bringing Midwifery Services to the Community

Harriet Nayiga

Please tell us about yourself.

I am a midwife with six years’ experience in both clinical and community practice. After completing a diploma in midwifery from Mulago School of Nursing and Midwifery, I worked at Wakisa Ministries, a nonprofit organization that cares for teenage girls with crisis pregnancies. In 2018, I graduated from Aga Khan University School of Nursing and Midwifery with a Bachelor of Science in Midwifery. I currently intern at Masaka Regional Referral Hospital. I am also a team leader at Midwife-Led Community Transformation (MILCOT), a young midwife leader with the International Confederation of Midwives, and a young midwife innovator with Nursing Now.

My hobbies include watching and reading motivational stories and sharing information. 

What inspired you to become a midwife?

Growing up, I did not know much about midwifery. However, I heard good stories about nurses and also admired their nice uniforms. I wanted to be like them when I grew up. Later on, I had a deep desire to one day help pregnant women give birth. 

As a young girl, I saw women in my village deliver with the assistance of traditional birth attendants (TBAs) because hospitals were very far. Unfortunately, I also heard stories of women, or their babies, who died after childbirth. This was because the TBAs lacked the knowledge and skills to deal with childbirth related complications like, postpartum hemorrhage, vaginal tears, and yellowing of the newborn, known locally as “Kamuli.” The TBAs often attributed these complications to women failing to take enough herbs during pregnancy. 

On the other hand, there was a particular TBA who was well recognized in our village for delivering babies safely. She was loving and welcoming towards expectant women. They felt very comfortable with her. My mother delivered some of my siblings at this woman’s home. 

I reflected on this reality and knew I wanted to be a midwife. I have helped many women deliver and it is such a humbling experience. It is so fulfilling to give mothers and their newborn babies care that goes beyond physical healing to soothing them emotionally and bringing happiness to their souls.

Could you please talk to us about the work you do to improve adolescent health in Uganda?

I work with MILCOT, a grassroots organization that bridges the gap that exists between the midwife and local communities through provision of sexual and reproductive health services and information. We mainly target marginalized adolescents and young adults. Our goal is to prevent teenage and unplanned pregnancies. 

Our team of midwives, counseling psychologists, programming officers, and social workers provide sexual and reproductive health and rights (SRHR) information, counseling, psychotherapy, and vocational skills. We hope that the support we give can help individuals make informed health decisions and thrive on safe sources of livelihood. 

I personally feel burdened by Uganda’s maternal mortality that stands at 336 deaths per 100,000 live births. Mothers die of complications that can be prevented. Our rate of teenage pregnancy is about 25 percent. Adolescents lack adequate information about SRHR. They internalize myths and misconceptions from peers and herbalists. Midwives are more concentrated in hospitals and often don’t work at the grassroots level to provide youth friendly information and services. MILCOT addresses this by bringing midwifery services out of health facilities to the community to reach people for prevention rather than response.

What are some of the challenges that midwives in Uganda face?

Midwives are challenged by a limited scope of practice. This denies them the opportunity to practice at the top of their license. In Uganda, midwives are fully trained and qualified to deliver babies safely. However, they do not have enough resources to effectively utilize their skills. Unfortunately, there are people who do not believe in midwives’ competencies. For example, midwives are trained and are capable of performing breech deliveries but are not always given the opportunity to do so which has led to a lack of confidence and resilience in their practice as they work alongside doctors. They are trained to care for women right from pregnancy until after delivery. Midwives should also be recognized as scientists.

It is a global challenge and happens in both private and public hospitals. To address it, midwives must be empowered so that they can advocate for themselves. We are capable and are ready to provide quality care to the scope of our work. There needs to be open dialogue among doctors, nurses, midwives, and other health professionals to create a mutually beneficial working relationship that will boost midwives’ confidence to fully exercise their competencies within multidisciplinary teams.

COVID-19 has transformed our world. How has it impacted how you provide care?

MILCOT’s community work was suspended. We currently only implement programs that can be done online and over the phone. We also support the young people we serve through our Covid-19 Emergency Relief Project. So far, we have reached out to 75 vulnerable adolescents and young mothers to provide them with food and reliable Covid-19 information, guidelines, and updates from the government and Ministry of Health. We still share sexual and reproductive health information with them as they are likely to continue facing SRHR related challenges.

What do you want people to know about the role midwives play in responding to health crises?

Midwives are truly part of the healthcare chain and on the front lines working hard amidst challenges.We deliver women and provide postnatal care, following up with the mother and baby to ensure they are healthy. We provide family planning services and immunize babies. Midwives are determined to see that mothers and their babies are alive and happy.

We need to support midwives in their practice by providing ongoing capacity building training and mentorship, ensuring health facilities are well resourced, and paying them well.