Midwives on the Edge—Providing Essential Care in Crisis Settings

Across many settings, midwives are key players in the maternal health workforce. The Maternal Health Task Force’s Kayla McGowan recently had the pleasure of interviewing Sera Bonds, Founder/CEO of Circle of Health International, for her insight into successes, challenges and the role of midwifery in crisis settings.

KM: Please describe your background and work in maternal health.

SB: I have an undergraduate degree in women’s studies. I went to midwifery school, direct entry—I’m not a licensed or practicing midwife, but I have training in midwifery. I have a Masters in Public Health; I went to Boston University where I focused my studies on complex humanitarian emergencies and reproductive health. I founded Circle of Health International in 2004 in response to a gap that we saw in the sector of disaster management and complex humanitarian emergencies—that midwives were not included and prioritized in those responses. That did not make a lot of sense given that outside of the United States, midwives deliver most of the world’s babies. And if you are introduced to communities through the midwives in that community, that introduction is embedded with a level of trust that really can’t be replicated for someone from the outside coming in. Midwives are privy to a lot of information outside of things like the number of pregnancies, how breastfeeding went, that sort of thing. They know [about intimate partner violence], who lives in poverty, whose kids go to bed hungry, they know family histories. When you know those people in a community, you know immediately so much more about their needs than you would if you just came in from the outside or went to the ministry or different folks in the community. We really prioritize midwives—that’s where we started in 2004.

KM: Could you talk specifically about your work related to midwifery in crisis settings?

SB: Over the last 14 years, the organization has worked in 22 different countries, and the crisis settings have ranged from acute conflicts—we’ve been working in Syria for seven years—to rural Tanzania where they have high rates of teen pregnancy and HIV as well as poverty. We have been working in south Texas on the Mexico border for the last four years supporting a refugee clinic, though most of the folks that come to the clinic are asylees or migrants. The clinic sees people immediately upon their release from border patrol, so we are their first stop.

We’ve also been doing a lot of disaster work in America as hurricane seasons pick up and up and up. Our primary responses last year were Hurricane Harvey in Texas and Hurricane Maria in Puerto Rico. Because of the populations that we work with, we also do some work related to human trafficking.

We have been engaged in human trafficking advocacy and training for different social service agencies, medical schools, and clinics to help those who are working in clinical settings in places where there are high instances of human trafficking support survivors. The more you can know about a person—not just their clinical history—the better the care.

KM: Can you describe the impact so far?

SB: Over the last 14 years, we have reached over three million women and children with services or support either directly or through our local community-based partners. We have trained over 7,000 health care providers—including medical students—and we have provided well over one million dollars in supplies and equipment.

We really try to have all of the work we do be informed and led by the people who are directly impacted. As part of our response in Texas after Hurricane Harvey, for example, we hired a local evacuee woman who had been relocated to Austin. She led our evacuee efforts on a short contract and has now become a staff member. We try to pull locally when we can. We try, when possible, to purchase everything locally, too.

KM: What are some key takeaways regarding the role of midwifery in these settings?

SB: So many of the world’s displaced people are women and children—with the majority of them experiencing some interaction with family planning, menstrual health and hygiene, domestic violence, sexual assault, pregnancy, breastfeeding or raising children, etc. Midwives are uniquely positioned to address and support most of those needs, and they’re cost-effective. A midwife’s scope of work could meet the needs of most women in these displaced settings.

We are continually surprised with how little women in any place know about their own bodies. As we’ve grown as an organization, we have learned about all of the intersections we need to be educating about as well, such as sexual consent, menstrual health and hygiene, domestic violence, sexual assault, gender issues in conflict settings and others, so our work has taken on a nuanced hue. Midwives in humanitarian emergencies are unique and significant players that should be supported.

KM: Could you talk a bit about the impact of your work on a global scale?

SB: The biggest impact we have made on a global scale is the midwifery training work we have done in various settings, from Syria to Nigeria.

Within the profession of midwifery globally, we have tried to identify and support local leaders who are trying to grow the profession. For example, we founded a program called Midwives for Peace that was a co-existence project between Israeli and Palestinian midwives, and it has been completely locally driven and locally run. We just helped to get it started. The goal of the project is to help each community support each other and fortify their profession in the context in which they work.

KM: If you had an unlimited budget, how would you invest in midwifery?

SB: We would double down on education. We have an online training portal, and we would make that available for free, provide scholarships for people to go to midwifery school. We have our first cohort of Nepali midwives graduating, and they’ll be the first professionally trained midwives to go back to their villages. We need more midwives trained, and then we need to support their inclusion in the health care system and work with ministries of health and governments to understand their strength, utility and impact. More local investment in local women.

Learn more about Circle of Health International.

Watch a brief documentary about the work of two midwives, one Palestinian and one Israeli, whose project to raise awareness about the importance of skin-to-skin contact between mothers and newborns is an inspiring story of coexistence.

This blog was first published on the Maternal Health Task Force blog.

About the Author

Kayla McGowan is a Project Coordinator with the Women and Health Initiative at the Harvard T.H. Chan School of Public Health.

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