1. Potential roles for professional associations in South Africa – making a difference to maternal health Sharon Fonn

2. Raise the status, maintain the integrity, support and promote the interests of the midwife Develop and promote an adequate, efficient and effective midwifery service in South Africa Consider every matter in connection with or with reference to midwifery and act as an advisory body Bring about liaison and cooperation with other groups and health care providers associated with midwifery Encourage the establishment of local groups in order to promote the aims and goals of the Society Promote research in midwifery Promote liaison with midwifery groups internationally

3. National agenda - improving maternal and child health MMR is decreasing in some countries WHO - 3 common factors present 1.Policy makers and health service managers prioritize this 2.Skilled providers who operate in a professional manner 3.Access to services and related resources

4. Professional associations can and should play a role in achieving this “Because the country is in need of critical mass of leaders, the days of treating nurses as mere implementers of policy that is already exists are long gone, and it’s time for nurses to take up a leading role in solving the country’s health problems in support of existent programmes.” Thembeka Gwagwa, General Secretary of Democratic Nursing Organisation of South Africa (DENOSA),

5. Professionals have an obligation to act

6. Under what auspices do professional associations do this?

7. Human Rights framework Failure to reduce preventable maternal deaths violates women’s right to – Life – Health – Non discrimination – Equality

8. Under what auspices do professional associations do this? Human Rights instruments (CEDAW) provide mechanisms (and responsibilities) for the public to – Monitor – Scrutinize – Document progress – Report (nationally and internationally)

9. Working in alliances can make a difference – any examples?

10. Pressure from coalitions – Women’s organizations, – Health and legal professionals – Parliamentarians – Church groups

11. In South Africa and internationally saw abortion law reform In UK quality of care and patient satisfaction indicators are now standard audit tools used by health professionals

12. Did it make a difference ?

13. Reprod Health. 2011; 8: 39. Published online 2011 December 22. doi: 10.1186/1742-4755-8-39

14. Did it make a difference to maternal mortality? Choice on Termination of Pregnancy Act in 1996 Maternal mortality due to unsafe abortion down by 91% Maternal morbidity due to unsafe down by 50%, Safe TOPs increased by 67%. 26 401 to 81 900 in 1 year

15. Other examples? HIV services – a coalition of lawyers, health professionals, clinician associations, community members, NGO’s worked together to ensure that women got access to prevention of transmission to their children and then treatment for themselves and others Community – provider links (treatment literacy campaigns)

16. Other mechanisms? UK confidential enquiry published every three years since 1952 Target medical and midwifery professions who responded by improved training and M&E Consistent and sustained decrease in MMR

17. Confidential enquiry into maternal deaths in South Africa

18. Recommendations Protocols available and used Training (anaesthesia) Screening and Rx for non pregnancy related disease Referral Staffing and equipment norms Blood Contraception Abortion deaths Community involvement

19. YET 2005-2007 recommendations almost identical to 2002-2004

20. Enquiry necessary but not sufficient In South Africa and Botswana we have the reports but as yet not the required response Some don’t want to change Many are prevented from doing so – conditions prevent providing quality of care

21. Need to mobilize around maternal deaths

22. Does anyone do it? Uganda May 2011 Hundreds of health professionals and concerned citizens went to the constitutional court in Kampala to support a lawsuit which is trying to hold government responsible for the death of 2 women who bled to death By not providing essential medical commodities and health services to pregnant women their constitutional rights are being violated

23. Professional associations’ role Commitment to professional competence Providing quality care Who holds them accountable? Governments have a duty to create conducive environments to allow for providers to act in a professional way Health professionals should be accountable for the standard of care they provide Speak out about abuse

24. Why do it? Raise the status, maintain the integrity, support and promote the interests of the midwife

25. Changing policy and practice Who are the allies who can be relied on to support professionals? Learning from HIV Bring about liaison and cooperation with other groups and health care providers associated with midwifery

26. Anyone done it? SA Human Rights report Kenya a similar report – – Removal of user fees – Midwives association invited Federation of Women’s Lawyers to do training on a rights based approach – Public enquiry on sexual and reproductive health in June 2011 – Coalitions formed and partnerships developed – indication of improved quality of care

27. Challenge protectionism Nepal 1996: 3-month training for anaesthetic assistants Provided anaethesia for thousands each year including caesarean sections Physicians opposed this Nepal’s safe motherhood initiative, alliance of health professionals and NGOs ensured they were reinstated and accredited

28. If we are serious about our profession Incumbent on us to act in defense of what we do and how we do it

29. Lastly – dealing with indirect causes of Maternal Mortality Comprehensive care – Contraception – HIV – TB – Chronic diseases – Our patients are people

30. How It starts with me ….

31. Role model Explain the reasons for the baby-friendly initiative A new style of engagement: “customers”, “service” If I behave the right way and you keep on seeing me behave the right way towards the patients: being customer friendly, the patients talking to me, being happy, greeting me, I greeting them. Then you’ll also think, is this not nice?’ It won’t be everybody changing but most of the nurses will think, ‘hey, this is good’ and they’ll also change. B Harris Centre for Health Policy

32. Thank you