A project on maternal and neonatal care in the African Nations has identified the issues midwives face in providing optimal care.
The research, conducted by Dr Yakubu Ismaila, was born from a separate study, Evidence for Action Project, which he was involved in.
The Evidence for Action Project implemented a digital assessment tool in Ghana to measure how the healthcare environments enabled emergency maternal and neonatal care in six different countries – Ghana, Ethiopia, Kenya, Malawi, Nigeria, and Sierra Leone.
Dr Ismaila said once those reports were completed, stakeholders were invited to offer their insights, however, he was struck by the inadequate engagement with the workforce responsible for providing a large portion of the care.
“There was not a lot of effort that focused on the midwife,” Dr Ismaila said of the work being done in his phase of the program, which was funded by the United Kingdom’s Department for International Development from 2011 to 2016.
“In maternal and neonatal health, the outcomes are very good when we have a continuum of care: From pre-pregnancy, during pregnancy, at birth and the period immediately after birth.
“The midwife is very important because they are the key providers of healthcare within this continuum.”
Dr Ismaila’s realisation led him to complete a further body of research that centred on the concerns of midwives on the ground, the fruits of which are now being seen in an Australian and global academic context.
Dr Ismaila is the lead author of ‘Doing Magic With Very Little’: Barriers to Ghanaian Midwives’ Ability to Provide Quality Maternal and Neonatal Care, which appeared in last year’s International Journal of Childbirth, and is one publication outcome of his PhD research, conducted at Western Australia’s Edith Cowan University through a scholarship grant by the university’s School of Nursing and Midwifery.
The article, which is co-authored by Dr Ismaila’s supervisors, Professor Sara Bayes and Associate Professor Sadie Geraghty, found that local midwives are “committed” to the provision of sound healthcare but were inhibited by factors such as “inadequate resources of care, unsupportive facility management and client-related barriers.”
Despite this, the research also noted that midwives on the ground were highly resilient, with Dr Ismaila’s findings identifying that the midwives could still complete their tasks despite the barriers they faced.
The research concludes that funding must improve for Ghanaian midwives at both a “national” and “facility” level, with more supportive management practices and “action” to improve engagement with women and communities also recommended.
While the findings were not surprising, given the research was conceived from his experiences while working in an aid project designed to help nations struggling to meet the UN’s Millennium Development Goals relating to maternal and child health; to hear Dr Ismaila articulate their experiences was nevertheless empowering for the midwives working on the ground.
“Most of them [the midwives interviewed] told me, ‘nobody has asked us,’” he revealed to the ANMJ. “They were really happy when I told them that we want to hear from their point of view what the barriers are.”
“They were always looking forward to seeing the results published… they believe that the findings of the research could be used to advocate [on their behalf].”
When Dr Ismaila commenced his research, he consciously sought out supervisors that had experience in midwifery, recognising that while he had a background in medical sociology and anthropology, he needed the support of someone with an applied understanding of midwifery to enable him to explore the subject thoroughly.
His work with Evidence for Action also proved foundational, with one of his eventual supervisors doing work that he felt matched the methodologies he wanted to embrace.
“When I searched for universities because I did something on Evidence for Action, I got interested in ECU when I found a project here on the implementation of evidence-based practices which was led by my principal supervisor, Professor Sara Bayes, so I sent her an email,” he explained.
“She was also excited and agreed to supervise me.”
Splitting his time between Australia and Ghana for the project, Dr Ismaila’s methodology (Grounded Theory) required him to conduct his interviews and analyse the content while working in the field.
As a result, he discovered a theory that identified midwives’ barriers to quality maternal and neonatal care in Ghana and its consequences, as witnessed by midwives on the ground but the coping mechanisms that allowed them to perform their duties despite the barriers that they faced.
“I was surprised to see that they were still able to do their work in the conditions that they found themselves,” he noted.
“Because of this, I wanted to learn more about how they were able to do it.”
While the resulting work formed a “middle-range Grounded Theory” that takes a qualitative approach to understanding the myriad workplace barriers that midwives face on the ground, Dr Ismaila added he is keen to continue exploring this area of research further.
Dr Ismaila said he was especially interested in cross-country studies and piloting and implementation strategies. He also stressed that while the midwives on the ground in Ghana were performing above and beyond despite the challenges of their environment, he would like the relevant stakeholders to consider their obstacles.
“They are not supposed to do magic; they need to have all the inputs and the support that is required for them to get the results or the outcomes that everybody wants,” he says.
“Because they are still getting the results… we don’t actually appreciate what they are doing, but I think we should reflect and really consider what they go through to be able to deliver the kind of outcomes that we get.”
Dr Ismaila’s work with Professor Bayes and Associate Professor Sadie Geraghty is available to be accessed here.
