Mongu — "Growing up in a remote village, I witnessed my grandmother, a traditional birth attendant, assisting women and girls to deliver babies. She would perform these deliveries at home, using local herbs to try and address complications," said Michelle Simukayi, a student at Lewanika College of Nursing and Midwifery in Western Province.

"Many mothers and their newborns lost their lives during pregnancy and delivery. This made me sad," she said.

She observed how the lives of pregnant women in her village in in Shibuyunji District of Central Province were at risk due to limited access to information and long distances to health facilities, and decided to do something about it. After completing high school, she began researching the topic of maternal deaths and came across a book, Sellers' Midwifery by Pauline McCall Sellers. It changed the course of her life.

"I was determined to become a midwife to save the lives of women and girls in remote rural areas," said Michelle, now a third year student pursuing a Diploma in Nursing and Midwifery.

While studying full time, she also provides information and services to women, young people, and newborn babies at Lewanika General Hospital. Here, her experience has made her aware of the diverse challenges faced by nurses and midwives in the call of duty, especially in remote rural facilities. She remains optimistic about her chosen career and looks forward to completing her studies so that she can begin saving lives in earnest.

Reducing Zambia's maternal and newborn deaths

Zambia has made significant strides in the past two decades to improve maternal and newborn health outcomes. The maternal mortality rate dropped nearly 300 per cent in 16 years - from 729 deaths for every 100,000 live births in 2002, to 278 deaths per 100,000 in 2018.

What has been critical in this achievement is greater availability of skilled midwifery personnel. The number of births assisted by a skilled attendant more than doubled over the same period, from 42 per cent in 2002 to 80 per cent in 2018.

When midwives are well trained, adequate in number, and appropriately supported to provide better quality of care, they can avert about two thirds of preventable maternal and newborn deaths. Unfortunately, in many underserved communities with high maternal and neonatal deaths, significant gaps remain in availability of these essential health workers. The World Health Organization (WHO) recommends at least 4.2 midwives per 1,000 population.

Enhancing the standards of nursing and midwifery

Opened in 1970, Lewanika College of Nursing and Midwifery offered the Enrolled Nursing/Midwifery Programme, which was upgraded in 2016 to the Registered Nursing/Midwifery Programme, with support from UNFPA. The aim was to enhance knowledge and skills in the management of maternal and neonatal health. In 2018, the college 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 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.

Since 2018, 215 midwives supported by UNFPA have graduated from the school, and are currently serving in Western Province, including in hard-to-reach communities.

"Our learning at Lewanika College of Nursing and Midwifery has been fascinating from the start," says Gift Chimovu, a fellow third year student. "We have 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."

Looking forward to graduating this year, he makes 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."

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