Woman holding a baby

On March 27, 2017, at a general meeting of l’Union Nationale des Accoucheurs et Accoucheuses du Congo (UNAAC), the DRC’s midwifery association, the members adopted not only new statutes but, also, a new title for the organization. It is now known as the Société Congolaise de la pratique Sage-Femme (SCOSAF), (the Congolese Society of Midwives).

It is worth taking a look at the organization’s historical development as a means of understanding the importance of this milestone. It is a story whose roots go back to colonial times when professional maternity care, under the Belgian influence, began to take shape. At this time, Belgian midwives working in DRC were supported by Congolese midwife-assistants—a cadre of health worker who had received nine-months training. In 1960, when DRC gained independence, the Instituts Techniques Médicaux (Institutes of Medical Technology) was created and launched a two-year training program for auxiliary midwives at that time. The prerequisite for this training was completion of primary school plus two years of secondary education. Ten years later, in 1970, the Ministère de l’Enseignement Supérieur et Universitaire (Ministry of Higher and University Education) created the midwifery education program within Kinshasa’s Institut Supérieur des Techniques Médicales. This program was an extension of the nursing program and required that students have a high school diploma and Bachelor’s degree. The combining of midwifery training to the Nursing Sciences program resulted in blurring the lines of the two professions falling under the same umbrella association. The profession of midwifery was not distinct. This situation lasted until 2000 when a group of male and female midwives, led by Samukungu Mawanga Samy, decided it would be beneficial to create an autonomous and independent midwives’ association. The result was the birth of UNAAC. A year later, in 2001, the organization acquired national legal status with the formal recognition of the category of midwives.

Over this time, from 2001 to 2011, UNAAC faced many challenges and difficulties as it strove to further its development as a professional organizational: low membership numbers; competition for potential members under the powerful influence of the nurses’ association; the management team’s lack of experience; and the lack of technical and financial partners. All these combined explain the trial-and-error missteps and difficulties of these ten years. It was determination and perseverance of a strong leadership that brought the organization through this difficult and uncertain phase.

Simultaneously, global attention towards the improvement of maternal health gained momentum. From Safe Motherhood in the early 1990s to Making Pregnancy Safer in the new millennium, recognition of the contribution of midwives to improving maternal health outcomes became formally recognized in 2011 through the UNFPA-led publication “State of the World’s Midwifery”. At the heart of the strategy, adopted by UNFPA in the wake of the report, lies the conviction that reducing the deaths of women due to pregnancy complications can only succeed if one strengthens the practice of midwifery throughout the world. That same year, UNFPA in the DRC decided to technically and financially support an evaluation of midwifery training in the Congo. The evaluation found several gaps in the training of midwives—it was highly theoretical and lacking hands-on training, there were insufficient qualified midwifery teachers in the country and that the training itself met neither the international norms and standards nor the needs of the population. In response to this, the Ministère de l’Enseignement Supérieur et Universitaire (Ministry of Higher and University Education) took the decision to reform the midwifery education program, adopt the international designation of Midwife and recognize the midwifery profession as its own entity. This reform led to the establishment in 2013 of a direct-entry midwifery education program accompanied by a curriculum that met the norms and standards of the International Confederation of Midwives (ICM).
This change motivated UNAAC’s management team, under the leadership of Ambrocckha Kabeya its President, to revise the organization’s status and, also, adopt the designation of Midwife. The coming together of UNAAC and Cuso International was timely: in the spring of 2015 the two organizations formalized their desire to work together within the context of Cuso International’s VOICE project—strengthening partners’ capacities through the involvement of professional Canadian volunteers. Didier Muamba Kabeya, a Canadian lawyer originally from the Congo and was the first volunteer sent by Cuso International to support UNAAC initiate these reforms. During his stay in Kinshasa, Didier worked with UNAAC’s management to perform an organizational evaluation that, in turn, prompted the association to create their strategic plan. One of the plan’s main objectives was to overhaul the organization’s statutes, policies and bi-laws and change its name to Société Congolaise de la pratique Sage-Femme (the Congolese Society of Midwives) SCOSAF. A second Cuso International volunteer, Claudine Muaka, continued this work by contributing to the association’s drafting of the different documents required to make UNAAC’s transformation a reality.

In 2016, UNAAC became a partner in a new project called Midwives Save Lives (MSL). MSL is a collaborative Midwifery-focused initiative between Cuso International, the Canadian Association of Midwives (CAM), local Midwifery Association partners and other health stakeholders in Tanzania, Benin, Ethiopia, and DRC. It if funded by the Government of Canada through Global Affairs Canada. The timely three-way partnership facilitated UNAAC to start a decisive phase of the process with the validation of new by-laws and policies as well as the development of a draft legislation to create a College of Midwives, which would become the regulating body for midwives. Thanks to MSL whose objective is to strengthen midwifery associations in four nations so that they can contribute to the drive to reduce the deaths of women occurring during pregnancy and  childbirth in their countries—UNAAC receives support from Cuso International volunteers and CAM consultants in organisational development and strengthening. Through ad hoc committee made up of UNAAC members, face-to-face meetings in Kinshasa to long distance communications via the Internet, CAM’s experts are supporting UNAAC through a transition to being a strong, vibrant professional organisation and leaders in maternity care in the country.

Results of this work are already being realised. On March 29 2017, the final legal documents were submitted and adopted at UNAAC’s General Assembly and UNAAC officially became SCOSAF.

The story doesn’t end there—another landmark meeting will take place the week of May 8. At this time the legal process of the creation and operation of the College of Midwives will be discussed and initiated. During this process, CAM’s expert consultants will continue to support SCOSAF’s advocacy efforts at the government level.

On the eve of the triennial Congress of the International Confederation of Midwives, which will be held from June 18–22 in Toronto, CAM and Cuso International wishes to jointly celebrate  this important milestone for SCOSAF and reassert their commitment to continue this highly rewarding collaboration!