WONDER Foundation is a charity dedicated to empowering women and girls across the globe through quality education and access to good work, so they can exit poverty for good. Since 2015, the charity has been working with the Institut Supérieur en Sciences Infirmières, a leading institution for training nurses, and now midwives, in the Democratic Republic of Congo, equipping students with the much-needed skills to respond to the national health crisis.
WONDER Foundation has made significant healthcare achievements in collaboration with Institut Supérieur en Sciences Infirmières, transforming healthcare in the region by providing high-quality midwifery education and training to women, enabling them to become skilled healthcare professionals.
The charity celebrated the graduation of the first 13 midwives in the Democratic Republic of Congo trained to international standards, a groundbreaking achievement in the region. The midwives, all established leaders or experienced nursing teachers in the Democratic Republic of Congo, have highlighted that this training has empowered them to provide better care and become agents of change (WONDER Foundation, 2024). They learnt about patient-centred care and consent, in some cases for the first time. All 13 are already training others in clinical or classroom settings, using competence-based training, a learning style that is new in Democratic Republic of Congo.
Better outcomes for mothers and babies reduce the stress that death and injury cause to midwives, most of whom are dedicated to their profession. Education, combined with effective training, holds the potential to end poverty and address the health crisis in Democratic Republic of Congo.
Training midwives is crucial for the country's wellbeing. Each year, thousands of women and babies die from preventable causes, not only because of a lack of equipment but also a lack of skills. While well-trained nurses are scarce, well-trained midwives are even rarer, making their development essential for improving maternal and infant health outcomes in the Democratic Republic of Congo.
The insufficient number of skilled midwives in the Democratic Republic of Congo can be attributed to several systemic problems. Midwifery is unclearly defined and often looked down upon by both doctors and nurses (Bogren et al, 2021). The role of the midwife is often not well understood by midwives themselves because of inadequate training. Additionally, there have only been two levels of formal midwifery education in the Democratic Republic of Congo since 2013, neither of which meet international criteria. The training offered in the state-run tertiary level institutions for medical training also does not meet international standards.
The role of a midwife also lacked any legal recognition or meaning, until December 2023. At this time, the government established the Order of Midwives, legally recognising the profession for the first time, following advocacy from the Institut Supérieur en Sciences Infirmières and others (Guka, 2023). However, for a long time, there was no guarantee that those who completed training would receive ministry recognition for their studies.
Midwives were not fully protected, facing low or irregular job security, unsafe working conditions and a lack of resources and equipment, leading to a scarce number of trained midwives (Bogren et al, 2020). There is only one midwife per 20 000 people in Democratic Republic of Congo (Bogren et al, 2020).
Highlighting the ongoing neglect of midwifery in the Democratic Republic of Congo, WONDER Foundation found that midwives lacked adequate training, and midwife educators were themselves insufficiently educated. Instructors should typically possess training at a level higher than what they are teaching. However, some midwives training new students had only completed secondary education while 68% of midwives offering technical education had a Bachelor's degree (Bogren et al, 2021). Only one in five of the midwives supervising clinical training had a Bachelor's degree, and some students were offered clinical supervision by a nurse without any midwifery training at all (Bogren et al, 2021).
As part of the Democratic Republic of Congo midwifery curriculum (agreed upon following the 2013 education reforms), simulation-based learning was included as a requirement. Many educators had not received education on how to lead this type of training and continuous practice is needed to maintain this skill, leading to a significant gap in student's learning.
Maintaining up-to-date knowledge has been almost impossible for midwives. This is because some midwives did not understand the latest evidence related to the subjects they were teaching, and much of the research is published in English, a language that they do not speak. Personal study is difficult because of a lack of library resources.
There are devastating consequences to the insufficient number of skilled midwives. Only 19% of women who gave birth in the Democratic Republic of Congo were seen by a midwife (Bogren et al, 2021). One study reported that 90% of birth attendants had never received specific training on preventing maternal and newborn mortality (Brenner et al, 2022). Another study showed that basic hygiene in childbirth was low, even when there were functional handwashing facilities and sterile gloves available (Brenner et al, 2022).
Perineal tears and fistulae are common complications experienced by women in the Democratic Republic of Congo because of a lack of training on obstetric emergencies and poor preventative care (Paluku et al, 2021). One study reported that continuity of competent care during the immediate postpartum period was ‘nearly absent’ and observed in only 4% of cases (Brenner et al, 2022).
Through the charity's work, WONDER Foundation has empowered mothers and significantly improved maternal and neonatal outcomes by training midwives on the importance of informed consent during childbirth. Previously, women were typically directed on what to do without their input. For many midwives, informed consent was a new concept introduced during the training. This highlighted that medics often assumed they knew the best course of action for a woman's care, leading to frequent use of invasive procedures, including surgeries, without informing or obtaining consent from women or their families.
‘My dreams have changed – I am no longer just “doing my job”. I see the importance of giving the mother information so that she can understand the care we are offering and truly consent. This is part of the higher quality of care that we are offering. A good professional does everything for the benefit of the patient’.
As a result of the charity's collaboration with Institut Supérieur en Sciences Infirmières, women have gained further knowledge allowing midwives to offer higher quality, timelier and preventative, person-centred care.
One of the midwives who completed the training, Cecile, spoke about how it equipped her with the knowledge and skills to advise women to prevent problems caused by cultural practices and superstitions, such as women who consume clay during pregnancy.
‘[I met an] anaemic woman who was consuming clay without taking into account food hygiene, which could have caused her baby to have stunted growth. With training, we learnt how to advise women to prevent problems. I used these techniques to advise her, and everything went well’.
Sylvie reflected on how the programme taught her how to deliver antenatal care and treat postpartum haemorrhage, as well as new techniques for delivering babies.
‘I am particularly proud to have learned how to conduct the antenatal consultation and to detect complicated cases. This approach means that from this early stage, we can offer quality and comprehensive care to combat maternal and infant mortality. And now, when I examine a woman during labour, I am more knowledgeable and better able to identify what stage of labour she is in and to ensure that she gets the right support’.
Students also learnt new techniques to help women during labour, and to manage pain, as well as to give them options during labour.
‘In the labour room, there are mums who can't stand the pain of uterine contractions. We have developed attitudes to apply, positions to give to women in labour to enable them to face these pains and it works and they are grateful’.
The charity looks forward to continuing their partnership with the Institut Supérieur en Sciences Infirmières, sharing learnings broadly, enhancing outcomes for mothers and babies, and further developing the isntitute's efforts to build midwifery capacity in the Democratic Republic of Congo.