May 05 is celebrated as the International Day of the Midwives; in 2016 the theme “Women and Newborns: The Heart of Midwifery” salutes all Midwives around the globe who work hard every day to ensure quality care to the women and newborn. Midwives really are the front line in keeping women healthy — through accessible pre- and postnatal care and through comprehensive reproductive health care, including safe abortion.

According to the Midwifery Service Framework (MSF) set by International Confederation of Midwives, “The midwives should be able to provide the set of evidence-based, cost-effective and lifesaving interventions for family planning, maternal and newborn health, including safe abortion care outlined in the Essential Interventions.” In fact, the ICM has designated abortion-related care as the 7th essential competency for basic midwifery practice. Thus, while celebrating International Day of Midwives it is pertinent to address and advocate for access to safe abortion services and practices to ensure optimum maternal health. Clandestine or un-hygienic abortion is one of the five primary causes (third leading cause) of maternal mortality, causing up to 47,000 deaths and 5 million being injured or disabled annually. Midwives can reduce these consequences and improve the quality and accessibility of abortion care by performing vacuum aspiration to treat incomplete abortion or for early induced abortion; recognizing the warning signs of incomplete abortion; providing emergency stabilization and resuscitation, and offering appropriate and timely referral for uterine evacuation; and by providing family planning counseling and services, particularly to women who have experienced abortion and may be at high risk for future unintended pregnancies but are otherwise not reached by family planning programmes.

Few years back we were posted at Bhardeu for a month as a requisite of B.Sc. Nursing, 3rd year curriculum. Bhardeu is a village development committee in Lalitpur District in the Bagmati Zone of Central Nepal and is just 22 Km away from the main city of Lalitpur. Even though this place is not far from the capital city it lacks adequate health care facilities and human resources. The main purpose of our residential posting was to provide holistic care to pregnant women during her puerperium. Right there I realized the importance of midwives in rural setting. Since in such setting either Staff Nurse or Auxiliary Nurse Midwives are the one responsible to provide Maternal and Child Health care services including safe abortion services. At Bhardeu Sub – Health post-Auxiliary Nurse Midwives was the incharge of MCH department and was running birthing centers successfully in the absence of medical officer. She was referring the women seeking abortion to the appropriate centers and providing post abortion services and counseling to the couple on post abortion contraception to prevent unintended pregnancies.

This is an example of only one VDC. In Nepal, there are about 3,276 other VDCs where midwifes either with formal higher education as defined by ICM or informal education and training as ANMs and Female Community Health Volunteers are working hard to provide maternal and neonatal health care services and making a significant contribution to increase access to safe abortion services. Nepal’s maternal mortality ratio has declined by nearly half—from 415 to 229 per 100,000 live births between 2000 and 2010 and to 170 per 100,00 (MDGs, 2015) by 2014. Now, comprehensive abortion care is available in all 75 districts. Various frontline volunteers are used in informing communities about making timely referrals to safe abortion care. Over 500,000 Nepali women had received safe, legal abortion and contraceptives services through the listed facilities since 2004 and this was possible with the help of Midwives contributing to increased access to safe abortion services and thus reducing country’s maternal mortality rate. I strongly believe that strengthening midwifery services ultimately increases women’s bodily autonomy and accessibility to safe and desirable abortion services.

To celebrate International Midwifes day, 2016, Midwifery Society of Nepal (Midson) the national professional organization representing midwives and the profession of midwifery in Nepal has organized the Second National Midwifery Conference on 4th -5th May, 2016, with the theme ” Reaching to unreached women: Strengthening midwifery services post-earthquake in line with policy decision 2006 in Nepal”. Midson with the help of its young, energetic and dynamic midwives is advocating women’s rights to safe abortion services as well. We appreciate their work and wish for grand success.