Higher Education in Midwifery in Pakistan: A Proposed Framework

Access to a skilled professional midwife is the right of each woman. Research evidence shows that midwives prepared to international standards decrease rates of morbidity and mortality and promote health of both mothers and infants. At present, in Pakistan, there are several midwifery cadres, with different formal education levels, who provide maternal and child health services. There are currently three types of diploma programs each serving a different cadre. Until 2012, there was no opportunity to obtain higher education in midwifery in the country. This absence contributed to non-acceptance and invisibility of midwifery as a profession. As a result, midwives were not adequately prepared or permitted to provide full scope of care to women. Making higher education available in programs based on the International Confederation of Midwives’ Global Standards for Midwifery Education and its Essential Competencies for Midwifery Practice will enable midwives to provide improved health care services and increase opportunities for them to be advocates, leaders, and teachers who will continue to strengthen the profession. This paper proposes a framework for higher education in midwifery in Pakistan

Birth Centre Management and Business Skill Training for Community Midwives of Pakistan

The Community Midwifery program was introduced in 2007 across Pakistan with the idea that the trained Community Midwives (CMWs) will be deployed back to their ‘native’ rural communities. Hence, they are not employed by government rather they must earn their income by charging fees for their services. It is expected from them to attract clients, establish birth clinics and operate as a small business to support and sustain them financially. However, the CMW training program only teaches students about antenatal, intranatal, postnatal and newborn care, family planning services and awareness of community dynamics and does not include content about setting up a ‘birth station’ and how to market and sustain a small business. We encountered comments from CMWs in a variety of forums that many of them were unable to sustain a birthing station and financially support themselves. Hence a research intervention was designed for them known as ‘Business Skills Training (BST)’ with the objective of enhancing the business skills of CMWs to increase their likelihood of establishing financially sustainable birthing clinics. This article is the description of BST intervention and the process of this training

Implementation of a Bachelor’s in midwifery programme in Pakistan: Reflections of Midwifery Faculty

Introduction/Objective: There is an international consensus on the significant role of competent midwives in improving maternal and newborn health indicators. Midwives and midwifery education in the developing world including Pakistan have lagged behind in being part of higher education. To enhance the quality of maternal and newborn services through competency based higher education in midwifery, the first Bachelors of Science in Midwifery (BScM) programme was introduced in Pakistan. As part of a larger study about establishing this programme, this paper focuses on the reflective logs of midwifery faculty members who initiated this new programme in Pakistan. Method: The team of faculty members involved in the planning and execution of the programme were asked to record their reflections throughout the process of planning the programme to facilitating students in the first cohort. These reflections were collected at the time of the graduation of first cohort in 2014 and content analysis was applied to identify major themes emerging from the reflections. Findings: Major themes which emerged were: a) Scaling up of faculty competence, b) Utilizing student diversity as strength, c) Supporting students’ transition and adjustments in the programme d) Scaffolding students’ learning e) Helping students acquire clinical competencies. Overall, the team regarded the experience as unique and enriching for both students and faculty. The first Bachelors in Midwifery demanded a great deal of theoretical and clinical proficiency from faculty. Rigorous planning, networking with international midwifery experts, continuous faculty development, facilitating student learning through scaffolding, and incorporating periodic feedback from students were found to be the major strengths of the programme. Conclusion: The Bachelor of Midwifery programme in Pakistan has given new hope to the profession. The lessons learned and some of the practical recommendations may prove useful to other institutions and South Asian countries intending to initiate similar programmes

Whose voice counts?:Achieving better outcomes in global sexual and reproductive health and rights research

Many indicators related to sexual and reproductive health and rights have worsened, with COVID-19, war and powerful conservative political movements around the world reversing decades of improvements.Improving sexual and reproductive health and rights generates a cascade effect that contributes to gender equality and power and improves overall health and well-being.Any solutions to address the problems in global sexual and reproductive health and rights research first require recognition of a fundamental disconnect between who is leading the research and the actual needs of the users of care.We encourage pursuit of transdisciplinary solution-focused questions and research designs that address the needs of local communities by drawing on the knowledge of diverse interprofessional groups, across geographic regions, who have access to the resources and space that amplify their voices and ways of working

Stance Control Orthotics

Lower limb orthosis design has been advanced by the introduction of knee mechanisms that provide stance phase control and swing phase freedom, referred to as a stance control orthosis (SCO). The intent is to allow a more normal, energy efficient gait. This technology is relatively new and many practitioners have only limited experience. This instructional course will make it possible for more practitioners to gain the knowledge needed to introduce this technology into their clinical practice. Attendees will gain knowledge about the technical features of SCO designs along with an understanding of the biomechanical deficits that can be replaced. Clinical examples will be provided to document patient selection and treatment criteria. The effective use of various types of SCOs will be presented. The course will also provide a summary of current research on SCOs and areas that require future development efforts

Instructional Course : Stance Control Orthotics

Lower limb orthosis design has been advanced by the introduction of knee mechanisms that provide stance phase control and swing phase freedom, referred to as a stance control orthosis (SCO). The intent is to allow a more normal, energy efficient gait. This technology is relatively new and many practitioners have only limited experience. This instructional course will make it possible for more practitioners to gain the knowledge needed to introduce this technology into their clinical practice. Attendees will gain knowledge about the technical features of SCO designs along with an understanding of the biomechanical deficits that can be replaced. Clinical examples will be provided to document patient selection and treatment criteria. The effective use of various types of SCOs will be presented. The course will also provide a summary of current research on SCOs and areas that require future development efforts

The first competency-based higher education programme for midwives in the South Asian region – Pakistan

Midwives in Pakistan and the South Asian region who complete a diploma program face many challenges for career growth and development. The absence of higher education in professional midwifery in the region has contributed to general non-acceptance and invisibility of midwifery. In response to the interest, Aga Khan University (AKU) developed bachelors program in midwifery based on the Global Standards for Midwifery Education developed by the International Confederation of Midwives (ICM) with the vision to equip midwives to provide full-scope practice, develop confidence to practice midwifery independently, become clinical leaders and contribute to the future of midwifery. The final curriculum had a balance of theory and clinical practice in order to develop a high level of clinical competence that would meet the ICM standards and guidelines. The two year bachelors program is currently in progress. The first cohort of 21 midwives graduated in 2014 and a second cohort was enrolled in 2015. There is a planning for a future graduate program in midwifery to prepare individuals for leadership roles in practice, teaching, maternal-child health provision and policy making through a master\u27s degree in midwifery

Experiences of the graduates of the first baccalaureate midwifery programme in Pakistan: A descriptive exploratory study.

BACKGROUND: in 2012 the Aga Khan University in Karachi, Pakistan opened the country\u27s first bachelor\u27s degree program in midwifery for women who held diplomas in nursing and midwifery. The principal aims were to prepare midwives who would be competent to provide full-scope practice. For quality assurance, the programme was continuously monitored and assessed. As part of this ongoing evaluation process we sought in-depth feedback from the first graduates about their student experiences. OBJECTIVE: this study aimed to explore the experiences of the first graduates of a Bachelor of Science in Midwifery (BScM) program to deepen our understanding of their views of the program\u27s strengths and difficulties and to obtain their suggestions for change. DESIGN AND METHODS: This qualitative descriptive exploratory study used universal sampling to collect data from all 21 of the firstgraduates of the BScM Program. Data collection involved focus group discussions using a semi structured interview guide and content analysis. The study was approved by Institutional Ethics Review Committee. FINDINGS: three main themes emerged from the data: (1) Competence acquisition, (2) Attitude transformation, and (3) Strengths and limitations of the program. CONCLUSIONS: the study findings highlighted that the degree program in midwifery had a positive impact on graduates\u27 perceptions of their knowledge, skills, attitudes and ability to implement evidence-based midwifery practice. The graduates regarded the university\u27s environment, teaching-learning strategies, preceptorship model, self-directed learning and exposure to diverse clinical settings as major facilitators in achieving competence