Thursday, August 26, 2010

Midwifery education in Pakistan

One of the main reasons I am at the Aga Khan University in Karachi is to help Ass. Prof Rafat Jan look at the current midwifery curriculum and think about where to take it in the future.

Diploma to Degree
At the moment there is direct entry into a midwifery diploma course which takes 15 months. The aim of the midwifery educators here is to take education to degree level over three years so that it becomes more consistent with other countries, and to raise standards overall.

Too young?
One of the problems they face is that they have the exact opposite age proportion to us in New Zealand - our average age is 45...the midwives here are very young...many start their education at 16 years. Doctors find it very difficult to trust and work with midwives who are so young.

The other problem the midwives have is that the maternity system is very 'hospital' focused which means experience is fragmented - midwives do not carry caseloads, and it is difficult to teach full scope of midwifery practice. Doctors make a lot of the decisions and catch the babies...a similar situation to Australia in the private sector. So education programs needs to provide full theory and clinical experience which is woman-focused, rather than systems-focused.

Small businesses
The interesting thing is that midwives are being funded to set up small maternity units as a self-employed business. So I think there is a real opportunity to get women on board. If students follow women through the pregnancy and birth, similiar to the New Zealand model, I think it will not take long for women to see the advantages of continuity...just as they have in other countries. Midwives still have to face the perception that the 'doctor knows best', but as women start to experience midwifery care, I am sure midwives will come into their own.

What can we do to support Pakistani midwifery educators?
The main thing we can do is to share our ideas and experiences, curriculum and teaching resources so that educators in developing countries are not wasting valuable time re-inventing the wheel. I know that they will have to turn things into their own context, but basic midwifery principles are the same the world over.

If you are a midwifery educator and you will like to know more about how you can support midwifery education in Pakistan, please let me know and I will forward your details to Rafat and her team.


Tatiana said...

These posts about Pakistan are fascinating! I admit I might be uneasy with a 16 year old midwife, myself, though intellectually I can say that's partially ageism. It's also placing value on experience. Interesting to notice that internal discomfort.

Sarah Stewart said...

The midwifery educators recognise this as a major problem which is one of the reasons they want to raise the entry age, entry requirements and start a 3 year undergrad degree

Meg Wirth said...

You and I were last in touch for the Virtual Day of the Midwife when Maternova held a photo contest as part of that day!

As you know we track and follow innovations in maternal health. We also have developed a next generation obstetric kit, focused on preventing PPH, but designed for midwives working in very rough conditions. We would like to explore with your contacts in Pakistan and at Aga Khan, the relevance of this kit (solar headlamp + rotary mobile phone charger + AMSTL reminder + silicone cup to measure blood loss).

Sarah Stewart said...

Hi Meg, the person to talk to is Dr Rafat Jan rafat.jan(at)