Katja Iversen is the CEO of Women Deliver, a global advocacy organization that brings together diverse voices and interests to share solutions and drive progress in maternal and sexual and reproductive health and rights. Women Deliver builds capacity and forges partnerships – together creating networks, messages and action that spark political commitment and investment in the health, rights, and well-being of girls and women.
Victoria Melhado is a Jamaican advocate, midwife, and one of Women Deliver’s Young Leaders. Victoria is an active member of several committees, including the Nurses Association of Jamaica, and is the youngest winner of the prestigious National Nurse of the Year award. Ms. Melhado is also a member of the National Youth Month Planning Committee and is the author of ‘Be Inspired!’, a book of inspirational poems.
Katja: We know that there is a global shortage of health workers. The WHO estimates that by 2035, the world will be short 12.9 million health workers. What made you first become interested in being a midwife?
Victoria: The thought of being able to facilitate another human being coming into the world has always been fascinating. I am by nature a very caring individual, so nursing was a natural career choice, although journalism and law were my first interests. I believe I was intrigued by crying babies and screaming women, from an early age. I enjoyed hearing stories of the village midwife, planting the baby’s ‘navel string’ (umbilical cord) at the root of a tree that would grow as the child grew, and helping people in need of help.
Right after completing nursing school, I was given the opportunity to choose between working at Kingston’s largest general or maternity hospital. I quickly seized the opportunity to work at the maternity hospital because I was born there and I thought it was a welcomed coincidence to be able to give service to the institution that had facilitated my existence. Secondly, it was mandatory to pursue midwifery training at this hospital given its specialty and this was not an opportunity at many other institutions.
Katja: Is there anything in your career development training that you would change to make it easier for midwives, nurses, and other health workers to join the workforce?
Victoria: Yes! I would definitely change the cost or affordability of health care related courses because so many individuals genuinely want to pursue a career in nursing and midwifery, but are unable to do so due to insufficient funding. I would also re-implement the system where individuals are granted scholarships to pursue training and are then committed to the workforce for a couple years after.
Katja: What can policy makers do to help facilitate a career path for midwives and other health workers?
Victoria: Well, I certainly believe that midwifery is a basic lifesaving skill and just like learning first aid; it should be mandated that every health care worker pursue midwifery training. Individuals could also be targeted at the high school or secondary level to consider becoming a midwife post-graduation.
Katja: We know that health workers provide a variety of lifesaving services and information – from vaccines to information about contraception. We also know that health workers and midwifes can have the greatest impact when they can treat patients before and after pregnancy – not just during childbirth. For example, although postpartum family planning is a key lifesaving intervention, women who have just given birth are among those with the greatest unmet need for family planning. What do you think explains this gap?
Victoria: Working in the largest maternity/obstetric health care institution gives me first-hand experience with several of these women, many of whom are teenagers. I believe one of the greatest contributing factors to the unmet need for family planning is the lack of choices and diversity of family planning methods. For example, most women are offered hormonal methods (pills or injectables), but some have undesirable side effects, such as ‘break-through’ bleeding. Only a few females, based on select criteria, can access implants, due to an island-wide shortage of the method. It is also an extremely costly method to access privately. Some females resist an intra-uterine contraceptive device (IUCD) because it can predispose them to frequent and severe pelvic infections and barrier methods, such as condoms or diaphragms, are rather expensive.
Teenagers still experience stigma at some institutions when they try to access family planning; therefore, the attitude of the health care provider may be a deterrent to those seeking contraception.
Katja: But we can overcome these gaps if we work together. What are you doing in your home country of Jamaica to make sure that girls and women have access to the information and services they need throughout the course of their life?
Victoria: Increasing access is an individual as well as collective health team and institution-based effort. On a personal level, I provide and advocate for more diverse family planning methods to be provided. I also offer family planning services in a respectful, non-judgmental, and non-discriminatory manner to the women and teenagers I encounter and I advocate for all health care providers to do the same.
I am also always trying to spearhead or be a part of national advocacy campaigns that empower females and challenge our government to respect and protect women’s reproductive rights. Some issues are ‘rocky’ territory, or rather controversial, so progress has to be pursued progressively, instead of trying to change people’s perceptions, cultural and religious beliefs, and the health care system overnight. Change and advocacy has to be done in a prudent and culturally sensitive way to maintain individual equilibrium and prevent system anarchy.
Learn more about Women Deliver’s investment in midwifery, including our 2010 Midwifery Symposium, which convened over 200 midwives and others with midwifery skills, leading UN agencies, civil society, policymakers, and donors. The symposium focused on strengthening midwifery education and quality of midwifery services globally, while building a consensus to make a fundamental push for investments in midwifery services, as a way to reach MDGs 4, 5, and 6.
- The State of the World’s Midwifery 2014: A Universal Pathway – A Woman’s Right to Health, published by the United Nations Population Fund (UNFPA) together with the International Confederation of Midwives (ICM), the World Health Organization (WHO) and other partners.
- The Lancet series on Midwifery; the most critical, wide-reaching examination of midwifery ever conducted.