The training and activity of village midwives in the Sudan.

Abstract

In 1921 in the Sudan a small-scale pioneering program to train illiterate midwives in delivery procedures was initiated. Since 1921 the program was gradually expanded. Reports of the Sudan Medical Service were used to assess the program. In 1921 the Omdurman Midwifery School was established. At the school midwives from surrounding rural villages were trained for 4 months under the supervision of a British nurse Miss M. Wolff. Training was gradually extended to 6 and then 9 months. Miss Wolff also recruited the trainees and supervised them when they returned to their communities. Between 1921-1949 544 midwives were graduated from the school. After 1949 midwife training schools were gradually established throughout the country and by 1974 there were 16 schools. From 1950-1975 annual enrollment in these schools increased from 30 to 523 and during this period a total of 3889 village midwives were trained. The midwife to population ratio increased from 4.8/100000 in 1945 to 13.6/100000 in 1970. The current program provides 9 months of both practical and theorectical training. Trainees must be between the ages of 18-25 years and acceptable to their communities. Recruitment preference is given to women who are married divorced or widowed. Graduates are licensed and supervised by the Provincial Medical Officer. The midwives receive a small salary from the local government council but most of their income is derived from client fees. Midwives duties include: 1) performing at-home deliveries; 2) providing maternal and child care at the local dispensary; 3) registering births; 4) dispensing some drugs; and 5) making referrals. An examination of declining maternal mortality rates indicated that the midwives have an impact on the health status of rural women. Suggestions for further improving the program were: 1) to provide graduates with in-service training; 2) to provide new trainees with more comprehensive training in maternal and child health and in community health; 3) to equalize the distribution of trainees throughout the country; and 4) to put greater emphasis on training professional midwives. Tables provide information on the distribution of village midwives in the country.