Emily Denness, International Midwifery Specialist for UNFPA Somalia, member of the Royal College of Midwives (UK) and Honorary member of the Somali Midwives Association
Brief introduction to yourself, including member association, area of interest and expertise and why you decided to become a midwife:
I am a midwife who was trained in the UK, but I have become global through my career, working in developing countries. I now work with the United Nations Population Fund (UNFPA), which is the UN organisation for reproductive health and rights in Somalia. I have seen countries around the world without strong midwifery, and I see the huge potential we as midwives could bring. This potential is what I am looking to bring to places like Somalia.
I have maintained my membership with my UK midwifery association, the Royal College of Midwives, but through my international work I have worked with more associations, particularly – at the moment – the Somali Midwives Association, the Somaliland Nurses and Midwives’ Association, and the Puntland Association of Midwives.
My decision to become a midwife was more than a decision. I think it was a realisation of who I was meant to be. I very much see my profession as part of my identity. Before I trained, I visited a birth centre in Hampshire in the UK which had a birthing pool and was very pro-normality. It was like a switch flicked in my head: I knew I had to become a midwife. I trained at Oxford Brookes University in Oxford, and was particularly motivated by one of my teachers, Mary Hopper, who was from Zimbabwe and gave me yet more insights and inspiration as to what was ahead of me.
What issues do you think impact the life of women and their newborns the most in your country?
Somalia has some of the worst maternal and newborn health indicators in the world, with significant cultural and security issues having held back development for many years. Some of these issues include the severe shortages of midwives, high – but reducing – incidence of Type III Female Genital Mutilation (FGM involving full infibulation), the complex cultural decision-making mechanisms around consent for life-saving procedures, and the poor distribution of services that leave many families to needlessly suffer at a time that should be one of joy.
What programmes currently exist in your country to support women and newborns, and do you think they are working? Why or why not?
There are programmes run by various agencies, local and international, trying to make a difference to Somali mothers and newborns. These range from training midwives and capacity building to bringing services to communities. My organization, UNFPA, is also supporting infrastructural coordination, including regulatory and association development, to ensure that the future of midwifery is led by midwives. This has been a gap for some time, leading to ineffective development, but recently our support to the development of a Somali Midwifery strategy has helped government to recognise the expertise and potential not only of midwifery as a profession, but also as a service.
What could be improved by Governments and the public to save more lives of women and newborns?
This varies greatly by country, according to the context. But a commitment to implementing the evidence-based best-practice of quality midwifery care, referral mechanisms, country development in prevention and response mechanisms, and bringing services close to where they are most needed would be truly life-saving.
What could be improved by Governments and the public to support midwives in delivering high-quality, respectful maternity care?
The recognition of midwifery along with midwifery leadership is key in all countries. This is not always easy, particularly in typically patriarchal societies, given that midwifery is a female-dominated profession. This will take a change in some cultures to enable women to advance in their education, work outside the home, and make key crucial decisions in order to save lives and create the quality, respectful care we know that we can deliver as midwives.
What do you love most about being a midwife?
The connection that midwives have, all around the world, is unique in our profession. We have all had the privilege and honour of supporting families welcoming new life into this world. We know what makes a difference to families, we are their advocates, we have stepped in when help is needed, and made a difference to families and communities. It is always a privilege to meet others who have also experienced this.
What progress is happening in your country, region, community or even just in your own professional life that excites you about the future of midwifery?
In many countries, including Somalia, midwifery is gaining in strength and recognition. The direction of Somali midwifery development through a five-year midwifery strategy has laid out the spectrum of development that is needed, enabling appropriate investment by stakeholders to best impact midwifery and the families that midwives serve. This will enable the development of the health system to be midwifery focused, starting right from the beginning.
ICM is increasing its advocacy capacity for midwives at country, regional and global levels. As a member, what would you like to see ICM do to support advocacy efforts in your Association, community or country?
Somalia, along with other insecure countries, is often overlooked by global interventions due to decision-makers thinking that complexity and security of the country is too much of a challenge to be able to deliver. Accordingly, some key interventions that we know work remain unimplemented.
The International Confederation of Midwives (ICM) engaging with countries that are classed as ‘conflict’ or ‘insecure’ countries would have such great impact. There is a huge opportunity to influence the systems both through the insecurity and when recovering, enabling midwifery to be a key focus of healthcare development. This is what has been so rewarding in Somalia: Seeing the associations develop with our support through UNFPA, with the government recognising and prioritising midwifery, and knowing that midwifery leadership is strengthening day by day.