As humanitarian crises unfold, the sexual and reproductive health needs of women and girls intensify. Increased risks during pregnancy, unsafe births, exposure to sexual violence, and a significant reduction in access to healthcare services put them in immediate danger. In these desperate circumstances, midwives are often the only trained professionals available to deliver essential services in sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH).
At the Rugombo and Gihungwe sites in Burundi, midwives from The Midwife in Action’s Association (MAA Burundi) stepped up, providing life-saving care in collaboration with WHO Burundi, the Ministry of Health, and UNHCR. Their work included antenatal and postnatal care, safe deliveries, contraceptives, gender-based violence treatment, and health education.
In just two weeks, the team completed over 400 antenatal consultations, supported high-risk pregnancies, and reached more than 16,000 people with vital health information. Despite working in tents lacking privacy, essential equipment, and basic medicines, midwives persevered. Some walked long distances daily to reach the site, while others managed complicated deliveries without access to diagnostic tools like ultrasounds.
“We do our best to provide quality care, but the lack of medications and tests is a major obstacle,” said Fabrice, a midwife.
“Every consultation is a victory. Today, I saw a woman in her eighth month who had never had a medical check-up,” said Parfait, another midwife.
Global Crisis: A Pattern of Neglect
Burundi’s situation is not isolated. The world is grappling with overlapping crises, from the refugee and hunger emergency in Sudan to ongoing violence in Haiti, the Middle East, and Myanmar.
According to the UN, countries affected by conflict or instability account for 61% of global maternal deaths, despite representing only 25% of the world’s live births. In 2023, nearly 260,000 women died from pregnancy and childbirth-related complications. Four countries—Democratic Republic of Congo (DRC), India, Nigeria, and Pakistan—are responsible for nearly half of all maternal deaths, facing challenges that increase maternal risks.
This crisis is not due to a lack of knowledge or resources, but a failure to prioritize the needs of women and gender-diverse people during emergencies. It is also a failure to include the health workers best equipped to address these needs.
Midwives: A Lifeline in Emergencies
Midwives trained to global standards can provide up to 90% of essential SRMNAH services, particularly in emergency situations. Their roles include:
- Delivering antenatal and postnatal care
- Ensuring safe births and managing complications
- Supporting breastfeeding
- Providing care during pregnancy loss
- Offering contraceptives and safe abortion services
- Responding to gender-based violence
- Offering mental health and psychosocial support
- Raising awareness about disease prevention and reproductive rights
Midwives are uniquely positioned to address health needs in emergencies due to their deep community ties and knowledge of local contexts. Even when resources are limited, they can provide high-quality care using minimal supplies. When supply chains break down or international aid is delayed, midwives are already there, ready to act and save lives.
Amina, a Congolese refugee, shared, “I had never had a pregnancy check-up before. The midwives gave me medicine and explained how to care for my baby. This gives me hope.”
“We provided a concrete response to the needs of refugee women. Our goal remains clear: zero preventable maternal or neonatal deaths. And we move forward with conviction,” said Emelyne, a midwife.
Midwives: Indispensable Yet Often Forgotten
Despite their critical role, sexual and reproductive health and rights (SRHR) are often neglected in crisis situations. Midwives are frequently left out of emergency preparedness and response plans, resulting in delayed or overlooked essential services.
“Many women arrive in labor without any prior follow-up. We have managed several complicated deliveries under these very challenging conditions,” said Evelyn, a midwife.
Even when midwives are deployed, they often work in unsafe environments, with insufficient pay, inadequate protection, and limited resources. Many also lack proper referral systems, making it harder to provide timely, appropriate care for women with complications. In many cases, midwives are expected to deliver exceptional care under impossible circumstances, often working voluntarily or with little support.
Yvette, a midwife, described the situation: “From the moment we arrived, we were struck by the distress of pregnant women. Some had never had access to prenatal care. Despite the lack of equipment, we do our best to ensure follow-up. But proper equipment would help us detect complications more effectively.”
The crisis continues to highlight the importance of prioritizing sexual and reproductive health services and ensuring that midwives have the support, equipment, and resources they need to save lives.
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