One year after the onset of the Ebola outbreak, the most affected countries, Guinea, Liberia and Sierra Leone, are still struggling to fight the virus. As in many humanitarian settings, the Ebola outbreak had a devastating impact on women, girls and newborns: Weak health systems even before the outbreak, could not address their sexual and reproductive health needs. The number of pregnancies affected by Ebola was estimated to be around 1.1 million in 2015 (UNFPA 2015).
Not only the deaths of health workers, including midwives had a severe impact on the provision of services for women, girls and newborns, but also the fear of the population to access the facilities as they were associated with the transmission of the Ebola Virus Disease (EVD). Health workers in return, abandoned their post out of fear to get infected caring for their clients.
In all three countries, midwifery services and education was interrupted, but continued in April 2015. Once graduated, many of the new midwives will be deployed in midwife-led units in health centers and hospitals, together with other midwives, including retired midwives and internationally recruited senior midwives, to provide quality services in the most affected populations with the support of UNFPA, the United Nations Population Fund, and the overall coordination of the respective Governments.
All three countries have identified human resources for health as major focus in their recovery plans. Midwife-led care will be at the centre of the programme Mano River Midwifery Response to ensure that services will not only be re-established, but hugely improved. These midwife-led units will be staffed adequately with at least three midwives, supported with appropriate housing and well-introduced to the communities. To improve the working conditions, UNFPA country offices have started to procure equipment and supplies. Quality of midwifery care will be a major focus of the intervention and therefore a strong supportive supervision system and monitoring and evaluation mechanisms are currently under development.
Lessons-learned from the Ebola outbreak to be applied for current and future disasters are the early integration of midwifery services in the disaster response. This is important as midwives can provide most of the essential services such as family planning, care in pregnancy, during and after birth and can also provide support for women facing gender-based violence.
Michaela Michel-Schuldt, Technical Officer Midwifery, UNFPA
Luc de Bernis, Senior Maternal Health Adviser, UNFPA