Best Investment for a Healthier World


A Malawian frontline midwife speaks

By Mtondera Munthali for White Ribbon Alliance 

I am Mtondera Munthali, a midwife from Mzuzu city in the north of Malawi. My job is a very busy one. I’m in charge of the labor ward where 15 to 20 babies are born every day. I’m responsible for making sure there are enough midwives with enough resources to keep those women safe. I also coordinate safe motherhood services for the district and head up nursing and midwifery services for Mzuzu health center.

We have daily prenatal clinics with 200 women and family planning clinics daily with more than 100 women. When I left Mzuzu to attend the 31st ICM Triennial Congress in Toronto this past week, a bedside midwife had to be called away to cover for me.

We face many challenges. We are short of staff and overwhelmed with work. We often don’t have sterile gloves and medicines. We only have 12 beds, and yet, there are often 40 women in postnatal so they have to share those beds – sometimes two or three women and their babies on each bed.

Midwives in Malawi get paid only $160 a month, and out of that we have to pay our rent, food, children’s school fees, and transport to work. Some midwives walk long distances to save money on fuel. It’s a hand to mouth existence. Many of my colleagues work extra jobs such as selling potatoes, or second hand clothes, just to survive.

Despite this, we do love our work as midwives. We have many successes in saving the lives of women and resuscitating newborns who would otherwise have died.

In Mzuzu we had a big problem of women giving birth at home because of travel distance and the fear of midwives being rude. This means they lack quality care at birth. There is no equity or dignity.

To change this, I called on Mzuzu city councillors and together we organized a meeting for the community leaders. The leaders are very powerful in their communities and they decided to regularly sensitize the people on safe birth. They also followed up with all the pregnant women to make sure they attended antenatal clinics, and that they gave birth in the health facility.

I also did trainings on respectful maternity care in Mzuzu Health Center for all midwives. Many of the midwives had not realized they were disrespecting and abusing women; they thought abuse was only physical. So, they committed to being polite and kind to women and their families. It was a quick result and they did change their behavior. I even heard midwives reminding each other; they would call out and ask. “Have you forgotten? Be polite to women!”

The impact on the community was also big. The number of women giving birth at home without midwifery care went down by half across Mzuzu, and in two communities it went right down to zero.

So, I am proud to be a midwife, proud to bring lives into this world, and to save women and their babies.