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In Zambia, Midwifery Schools Set the Stage for Improved Maternal and Newborn Health Outcomes

In the last two decades, Zambia has made significant strides towards improving maternal and newborn health outcomes. Maternal mortality rate has dropped nearly 300 per cent, from 729 deaths for every 100,000 live births in 2002 to 278 deaths for every 100,000 live births in 2018.

Ensuring the availability of skilled midwifery personnel has been critical in securing this achievement, with the number of births assisted by a skilled attendant increasing from 42 per cent in 2002 to 80 per cent in 2018. This underscores available evidence that when well-trained, deployed in adequate numbers, and appropriately supported to provide better quality of care, midwives can avert approximately two thirds of preventable maternal and newborn deaths.

In my village, many mothers and newborns lost their lives, and this made me sad. Determined to make a difference once I completed my high-school, I began researching about maternal mortality and was fortunate to come across the book “Sellers' Midwifery” by Pauline McCall Sellers. After reading the book with keen interest, I was determined to become a midwife, in order to save the lives of women and girls in remote rural areas” – Michelle, a 3rd year student at Lewanika College of Nursing and Midwifery in Western Province

Unfortunately, in many underserved communities with high maternal and neonatal deaths, significant gaps in availability of these essential health workers remains, including towards meeting the World Health Organization (WHO) recommended threshold of 4.2 midwives per 1,000 population.

Gift Chimovu and Michelle Simukayi, both 3rd year students pursuing a Diploma in Nursing and Midwifery at Lewanika College of Nursing and Midwifery in Western Province of Zambia, share their experiences of learning and obtaining clinical skills at the School.

“Growing up in a remote village in Shibuyunji District of Central Province, I witnessed my grandmother who was a traditional birth attendant, assisting women and girls to deliver babies. She and many other traditional birth attendants would perform these deliveries at home, using local herbs to try and address complications during delivery. Many mothers and newborns lost their lives, and this made me sad. Determined to make a difference once I completed my high-school, I began researching about maternal mortality and was fortunate to come across the book “Sellers' Midwifery” by Pauline McCall Sellers. After reading the book with keen interest, I was determined to become a midwife, in order to save the lives of women and girls in remote rural areas” – says Michelle. 

Alongside their full-time studies, Gift and Michelle provide life-saving information and deliver services to women, young people, and newborn babies at Lewanika General Hospital. They are aware of the diverse challenges faced by many nurses and midwives in the call of duty, especially those in remote rural facilities. Yet, they remain optimistic and look forward to completing their studies and be posted in facilities where they can continue to save the lives of women, girls and newborns.

Enhancing the Standards of Nursing and Midwifery Profession

Lewanika College of Nursing and Midwifery was opened in 1970, offering enrolled nursing programme. In 2016, with support from UNFPA, the Enrolled Nursing/Midwifery Programme was upgraded to Registered Nursing/Midwifery Programme, with the aim of enhancing knowledge and skills in the management of maternal and neonatal health. In 2018, the College further introduced the Direct Entry Midwifery Programme, to increase the number of trained midwives across the country.

With financial support from the Maternal Health Trust Fund (MHTF), UNFPA procured and delivered various training models for use in the skills lab, as well as textbooks and other ICT equipment for use by students at the school. UNFPA is also providing scholarships for in-service student midwives who are specifically serving within Western Province. Since 2018, a total of 215 midwives supported by UNFPA have graduated from the school, and are currently serving within the Province, including in hard to reach communities.

“Our learning at Lewanika College of Nursing and Midwifery has been fascinating from the start. We have well-learned tutors who guide us through the theoretical aspects of nursing and midwifery; while our clinical instructors equip us with practical clinical experience in a well-equipped and conducive skills lab. I am able to diagnose a complication and make a decision on time, to save a life” says Gift.

Whilst noting the valuable skills and enriching learning experiences, Gift and Michelle share some of the challenges faced by many students pursuing a nursing and midwifery qualification.

“Availability of student accommodation, as well as financial support for student midwives is limited. This becomes very challenging for many students who hail from under-privileged families as well as those from out of town” says Michelle.

Looking forward to their graduation in 2022, Gift and Michelle also share a call to action for decision makers – “we need to train more pre-service midwives to increase the number of births assisted by a skilled provider, especially in remote facilities. Of equal importance is to ensure adequate availability of equipment and medical supplies in all facilities, coupled with continuous mentorship of midwives, so that they are able to diagnose a complication and make a decision” - says Gift and Michelle.