The World Health Organization (2018) defines health inequality as the ‘systematic differences in the health status of different population groups. These inequities have significant social and economic costs both to individuals and societies’. The National Institute of Health and Care Excellence (2024) further expands on the definition and states that ‘health inequalities are differences in health across the population, and between different groups in society, that are systematic, unfair and avoidable. They are caused by the conditions in which we are born, live, work and grow. These conditions influence how we think, feel and act and can affect both our physical and mental health and wellbeing’. Midwifery, at the intersection of women's health and childbearing, provides a powerful lens from which to consider these issues, both in relation to the health and care of women and in the profession of midwifery itself.
On 11 September 2024, the Science Museum in South Kensington, London held a ‘Late’ event entitled, ‘Journey of Life’. Late events are special evening events open to the public that aim to showcase sciences differently and invite a wider adult public to engage with the museum in a fun, social and creative format. The theme of the event was related to global health inequalities, which provided the opportunity to explore issues and provoke public dialogue. The event was supported by the Bill & Melinda Gates Foundation and brought together global health researchers and community members to showcase and inspire conversations with the wider public around equity in health. Participating organisations at the event included clinicians, researchers and scientists with involvement/projects in global health, including non-governmental organisations and research teams from local universities with global health departments, including King's College London, London School of Hygiene and Tropical Medicine and Imperial College London, in addition to non-governmental organisations/charities dedicated to improvements in global health.
In the sub-theme of women's health, Alison Perry, a midwife and Parasol Foundation doctoral research fellow at The George Institute for Global Health at Imperial College London, was invited to propose a public engagement concept. Contextually, Imperial College London is a neighbouring institution of the Science Museum and conducts much women's health-related research. The recently formed Women's Health Network of Excellence across the wider college aims to promote interdisciplinary research and innovation in women's health and gender-based health equity and this event provided an opportunity to consider these topics.
Leading up to the event, a global twinning project had enabled colleagues in Imperial College London and Makerere University in Kampala to become a small interdisciplinary network and apply for additional project funding. This was funded by the Tropical Health Education Trust, now known as Global Health Partnerships. The over-arching aims of the twinning project included developing research capacity among midwives in Uganda through good clinical practice skills-training, conducting a qualitative research project related to the vaginal microbiome and supporting the ongoing provision of midwifery workshops and online Women's Health Journal Club.
Embracing the theme of the event at the Science Museum, the team proposed to create a virtual ‘radio’ show in which issues around health inequalities in maternal health and midwifery could be explored live. A large retro-style radio, a DJ table and guest table with two handheld phones for members of the public to join the show helped to set the scene and create the small radio ‘studio’.
The radio show was entitled HER Radio (Health Equality Radio) 5XX. The acronym ‘HER’ reinforced the main theme of the event and ‘5XX’ referred not only to female chromosomes, but also to a statistic in the UK that exposed the stark racial inequality that Black women were at one point five times more likely to die in childbirth than White women. This figure has now reduced to around 2.9 times more likely, which is positive, but serves as a stark and ongoing reminder of health inequalities around childbirth in the UK (Fivexmore, 2024). The fact that 5X is also the radio call sign for Uganda contributed to the concept.
As ‘guests’ on the talk show, several Ugandan midwifery colleagues were invited to take part. Humphrey Beja, Immaculate Ndyamuhakyi and Betty Najjuuku played central roles as radio show guests and shared valuable insights and experiences from different practice areas of midwifery in the Ugandan setting. Additional public participants then joined by Zoom from the Science Museum and all were visible on a large screen to attendees of the event in London.
The talk show host facilitated questions. One such question asked was ‘what does health equality mean to you in midwifery?’. Discussion topics centred around the consideration of what health inequality means to midwives. Ugandan midwifery colleagues emphasised the importance of equal access to healthcare resources, respectful maternal care and their commitment to promote equality in health care, while reflecting on the challenges of this in practice.
Another topic of discussion was exploring how health inequality displays itself in Uganda. Specific examples of inequality were discussed, such as limited access to quality care for rural women, inadequate healthcare facilities and insufficient staffing in maternal health units. Midwives spoke about the systemic barriers that prevent them from providing optimal care, including unequal access to resources, disparities in job opportunities and challenges and barriers related to career advancement. Additional themes explored included power and authority in maternity care and unequal access to jobs and promotions. This segment also explored how gender roles and workplace dynamics influence women's decision-making around personal health.
Each midwife also shared personal stories related to career motivation for becoming midwives, including deep commitment to improving maternal and newborn health, the desire to be a voice for vulnerable women and the fulfillment that comes from seeing lives transformed and created through midwifery care.
Event reflection: a midwife's account by Humphrey Beja
Since the event, we have reflected on it and one midwife used a reflective cycle to gain further insight from a personal and professional perspective (Gibbs, 1988).
The reflection
When I was invited to participate on the radio talk show, I accepted. I felt honored to have the opportunity to discuss equality in women's health on an international platform. We joined the session in the evening from our homes in Kampala, and thankfully, the internet was stable, allowing us to connect smoothly with our UK colleagues. Members of the public could stop by and one listener even shared insights about midwifery in the UK, which added an interesting perspective.
Feelings
As we discussed inequality in midwifery, I considered that these issues are deeply rooted in traditional gender roles, norms and customs, where men were historically more valued than women and women assumed the caring role. Despite global advocacy for gender equality, traces of these inequalities persist unspoken.
Approximately 99% of midwives are women, and I believe this gender imbalance could contribute to some of the longstanding inequalities in the field. In many societies, traditional gender roles still influence women's lives profoundly; they often bear the primary caregiving responsibilities at home, while men remain uninvolved. Women, even when feeling overwhelmed, accept these responsibilities as their duty, and I worry that this mindset can sometimes carry over into the profession. From my experience, I have seen midwives work demanding day-and-night shifts for an entire month without complaint, a level of endurance that I doubt most men could match quietly. Society seems to take women's efforts for granted in subtle ways; for instance, women dying of preventable causes, with insufficient action to address it.
Since many women see caregiving as inherently female, they often believe midwifery should be a female profession. This perception can leave male midwives feeling out of place and, at times, subjected to complex emotional experiences, including gaslighting. I have personally encountered midwives who are not supportive of gender diversity in our field. However, those who are well-educated and empowered often hold positive views about gender diversity. Still, I am hesitant to openly discuss gender in midwifery as it is a sensitive topic. Midwifery is perceived as a female profession and focusing on gender issues could inadvertently raise concerns about male dominance. Some may feel that men wish to ‘take over’ midwifery, so I continue to approach this topic with sensitivity and discretion.
Evaluation
The low level of education among midwives in Uganda and other sub-Saharan African countries further limits their empowerment and makes them more vulnerable to inequalities. Personally, I have found tremendous value in networking with a diverse range of professionals. Interacting with UK midwives and members of the public gave me a global perspective on midwifery and related inequalities. I realise that although there are cross-cutting and global themes, inequalities vary greatly across the world and addressing them requires context-specific solutions. Nevertheless, I remain committed to open discussion of inequalities across midwifery and aim for a future where midwives can work to their full potential in an environment that fully supports them.
Analysis
The inequalities facing midwives mirror those faced by women more broadly, as many women struggle to access essential medical care for themselves and their children. To truly prioritise women's health, these disparities must be addressed.
Conclusion
Reflecting on this experience, I see that traditional gender roles and limited empowerment significantly contribute to inequalities in midwifery and women's health. This discussion reinforced for me the importance of advocating for the rights of midwives, along with broader societal changes toward equity for all health workers, particularly in fields dominated by a single gender.
Action plan
This experience has provided the opportunity for me to reflect on midwifery and my relationship with midwifery. In the future, I will continue to advocate for equal treatment for midwives, mothers, newborns, adolescents and children. I am committed to raising awareness about these inequalities and to championing changes that create supportive, enabling environments for midwives, allowing them to fully exercise their roles and deliver high-quality care.
Conclusions
The radio talk show event provided an excellent opportunity for midwives across settings to raise awareness about ongoing health inequalities affecting midwifery practice and maternity care in Uganda. It also fostered collaboration and learning among midwives across both settings. Through this platform, we shared insights into the challenges that midwives face as a result of health inequities and inequalities and discussed strategies to promote more equitable healthcare systems.
The conversation was engaging and informative, with both the Ugandan and UK teams sharing examples of health inequalities in their respective countries. The opportunity to speak directly with members of the public was novel and interactive. Ugandan midwives particularly focused on the rural-urban divide and the ongoing challenges of maternal health in under-resourced areas. Discussions reinforced the need for continued advocacy for health equity, better resource allocation and systemic reforms in maternal health.
We welcome future public engagement opportunities like this to raise further awareness, provoke conversation and inspire action to improve maternal health outcomes, which includes the promoting the role of midwives in more equitable healthcare systems. Since this event, the World Health Organization (2024) launched, ‘transitioning to midwifery models of care: global position paper’, which positions midwifery itself to address the challenges of inequality for both midwives and mothers. We, too, are committed to this global goal.