Friday, April 18, 2008

Midwifery education in Pakistan

Today I briefly met Rafat Jan Rukanuddin via web conference using Elluminate. Rafat is developing a midwifery education program at the Aga Khan University School of Nursing, Karachi, Pakistan and she is very interested in how we have developed our program in New Zealand.

Rafat has been following my blog and is interested in the online seminar project.

The frustrations of technology
Unfortunately, within 10 minutes of our meeting, my Internet connection crashed so we didn't get to finish our discussions. I was cross about this because I never usually have problems with my connection and I had been really looking forward to talking to Rafat.

From the short time we managed to talk I got a sense that midwives in Pakistan are faced with a number of complex problems that I can only imagine. Maternal and neonatal mortality rates remain high. Mothers die because of a lack of resources and skilled health care providers.

Midwifery in Pakistan
My understanding is that maternity care is provided by nurses and midwives who have basic obstetric education, but they are not skilled midwifery practitioners. Maternity services are dominated by male medical doctors who have made little difference to poor maternity outcomes, and cannot deal effectively with underlying problems that face women in Pakistani society such as family violence. Midwives support the doctors as opposed to being autonomous midwifery practitioners.

Looking at midwifery education
Rafat is convinced that midwifery education is the key to improving maternity outcomes in Pakistan. Midwives need to be educated to be autonomous practitioners practicing across the full midwifery scope of practice including complete mother and baby assessment and 'catching' of babies. At the moment Rafat is looking at models of midwifery education all over the world, so I am keen to support her as much as possible.

If you are interested to knowing more about midwifery and midwifery education in Pakistan, Rafat recently had a paper published:
  • Midwifery education and maternal and neonatal health issues: challenges in Pakistan. Rafat Jan Rukanuddin, Tazeen Saeed Ali, Beth McManis. J Midwifery Womens Health (Vol. 52, Issue 4, Pages 398-405)
This scenario supports the argument for open access midwifery education.

Image: 'Northern Pakistan'


Anonymous said...

wgat is rafats role in the health system in Pakistan?

Anonymous said...

hmm - an autonomous midwifery profession is one thing - but to make this feasible you really need a women centred context - in NZ our autonomous profession is very constrained by the dominant medical model - in Pakistan the climate is even less favourable. Open access education won't fix those social / man made problems - but perhaps it will lend a vision.

Sarah Stewart said...

What I meant by the argument for open access education is if our (as in the global midwifery profession) education programs were open access, then people like Rafat could see what people were doing and get ideas relatively easily.

Anonymous said...

yeah - all for that

Anonymous said...

I live in pakistan. There is a complete dearth of trained and experiennced midwifes here. I want to homebirth my next child but that seems impossible since there are no midwifes out there! In the end , we just have to resort to the hospitals which strap you down and make childbirth oh so ugly!

Sarah Stewart said...

I can give you the contact details of midwives in Pakistan if that would help. Sarah

Anonymous said...

Hello there again,

just read your reply! Could you please provide contacts for the midwives in pakistan. It would be of great help!

Thanks! My email is

amber said...

Can u also give me some contact names as well?

Thanks in advance!!