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Midwives – Gate keepers or game changers for youth-friendly reproductive healthcare?

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2 May 2024 Tags: Ado Avance Ensemble, DKT International, Meaningful and inclusive youth participation, midwives, Safe abortion, SRHR, youth-friendly

Midwives are at the frontline when it comes to preventing maternal deaths and providing childbirth and family planning services. This holds especially true in countries where sexual and reproductive rights and choices are questioned or under threat. Midwives are responsible for ensuring the provision of quality care to adolescents and youth, but they can also act as a barrier to young people’s access to these services, even in the absence of legal or administrative prohibitions.

They are the ones who sound the alarm on gender-based violence and harmful practices like female genital mutilation and child marriage. They have the ability to bring sexual and reproductive products and services closer to those who need them most.  But this doesn’t always happen.

 “Midwives are socialised by the societies in which they live, where sexuality is still taboo. The provision of SRHR services and products for adolescents and young people can be seen as going against prevailing moral and religious ethics. Lack of training among health workers is another barrier,”

Mounaya,  midwife working in Abomey Calavi, south Benin.

Midwives training as part of the Ado Avance Ensemble programme

Midwives training

This is why the Ado Avance Ensemble programme strengthens the capacity of professionals in the healthcare sector to provide services adapted to the needs of adolescents and young people. Rutgers supported DKT in training midwives between March and June 2023. These midwives are then able to train other midwives (more than 12,000 trainings were conducted to date) and other health professionals in the DKT network in Benin, Burkina Faso, Cameroon, Côte d’Ivoire and Togo. The midwives were trained on the reproductive rights of adolescents and young people in each context, counselling techniques including for family planning, the use of new contraceptives and, where appropriate, protocols for safe abortion.

Youth-friendly services
During the training, specific attention was given to providing information and services to adolescents and young people, free from judgement and stigma. To that end, Rutgers facilitated an online course offering participants awareness of their personal, professional and societal values around SRHR. The online training consisted of three sessions: on provider attitudes towards young people accessing services, on adolescents and young people’s ability to choose for themselves and one on communication techniques and practice for youth-friendly counselling.

Esther Solange Ewolo, a midwife in Yaoundé, Cameroon, was one of the first midwives who was trained. “In the training, I noticed that many midwives are reluctant to prescribe contraception to young people. We learnt in the training that this is not compulsory by law. Of course they can consult their parents should they wish to, but there is no obligation to do so. We as midwives are there to respond to the needs of young people themselves, so they can make their own informed choices,” Esther Solange recalls.

“The training revealed that midwives are not necessarily aware of the legislation governing adolescents and young people’s access to SRH services in their countries,”  , one of the training facilitators for Rutgers. “Their way of working sometimes is stricter than the actual legislation,” she adds.

When asked whether the training changed the perspective of midwives on young people, Esther says: “Yes indeed. They listen more carefully to their needs.”

Midwife Mounaya in Benin offering a consultation on SRHR products.

Safe abortion

Access to safe abortion is limited. As a consequence, many young people seek out for unsafe options, leading to complications and sometimes death. According to a 2016 report published by IPAS, the region has the highest death rate from abortions in the world, estimated to be 540 in 100,000 abortions.
Young people need to be aware of the risks related to unsafe abortions, and midwives need to be prepared on how to talk with them.

Mounaya: “I still remember a young girl who came to my health clinic. I took my time to lecture her and I sent her away. I gave her a few days to reflect, but she never came back. I heard that she had undergone an unsafe abortion. It broke my heart I had treated her this way. When I took the training, I learned useful tools on changing my behaviour towards young people and to treat them more friendly. Friends are there to help each other and to listen to each other. I will never send someone away again.”


What’s next
Although Esther and Mounaya are seeing positive changes in their communities, they both agree there is still a long way to go. Esther: “We tend to put the focus on the abstinence message. There is still the wrong perception that when we talk about sexuality with young people, it will only encourage them to have sexual intercourse. And so, health professionals tend to avoid the subject altogether, or they focus on the negative aspects of sexuality. We need to explain that when you offer reliable information about contraceptive methods, it will allow young people to make their own decisions.”

Mounaya adds: “Young people in Benin, especially in the northern region, where I am from, still have difficulties finding their way to SRH services and information, especially when it comes to accessing safe abortion care. We need to create an environment that allows them to find their way to reliable information and products, without adding unnecessary barriers for them.” Mounaya is full of ideas on how to do this. “For example, I have seen that creating an anonymous hotline staffed by midwives is a great way to do this. Midwives are trusted professionals in our region, and having them staff call centers can help us reach adolescents and youth with reliable information, in an anonymous and easily accessible way. I hope we can grow these call centers in the future, so that young people in all parts of the country know about these services.”

Lydia Conseil hotline for adolescents and youth in West Africa

Offering SRHR advice over the phone

Through our partners, Ado Avance Ensemble offers the following hotlines in West Africa:

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