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Midwives Struggle to Get Maternal Care to Most Needy Syrian Refugees

Among female Syrian refugees and women displaced within Syria, almost 450,000 are pregnant, many as a result of sexual assault. As midwives try to give these women consistent maternal healthcare, they face limited resources, lack of education and cultural taboos.

Written by Felicity Simpson Morfey Published on Read time Approx. 5 minutes
A combination of limited resources and the transient nature of refugee communities makes it difficult for midwives working in refugee camps to give pregnant women the consistent care they need. AFP/Dimitar Dilkoff

In September this year, Baby Newman became famous when he was born aboard the MSF/SOS Méditerranée rescue boat Aquarius, just hours after his Nigerian mother and her family were rescued from a packed dinghy. Baby Newman’s birth made headlines due to the rarity of babies being born aboard rescue boats. But midwives who work among refugees say they often find themselves rescuing heavily pregnant women, and don’t have the resources to give them the care they need.

The United Nations Population Fund (UNFPA) reports that, among female Syrian refugees and women displaced inside Syria, nearly 430,000 are pregnant. Only a small number of midwives work in refugee camps, but together they have to treat and support these huge numbers of women who are pregnant or require postpartum care. And their job isn’t just about delivering babies. They also have to help a growing number of refugee women cope with unwanted pregnancies that are the result of lack of contraception, poor education and gender-based violence. Finding the balance can be difficult.

According to Laureli Morrow, midwife and founder of the U.S.-based NGO Midwife Pilgrim, getting access to the most vulnerable people is the primary issue for midwives in the Greek and Turkish camps where the organization works. “People who need the most help don’t seek out the help,” she says.

Morrow set up Midwife Pilgrim a year ago in response to the need for midwives to treat Ebola victims in Africa. Her husband, who is a registered nurse and was working out there, noticed that patients were not getting the appropriate care, and Morrow was invited out to help train health workers during the Ebola crisis. She founded the organization with the aim of going where it was needed, responding to natural disasters like the earthquake in Nepal and the October hurricane in Haiti. A large focus of Midwife Pilgrim’s work continues to be on the refugee camps in Europe, and soon Lebanon, where, unlike the other several other NGOs providing medical care in those locations, it concentrates solely on midwifery care.

While the authorities struggle to accommodate the continuing flow of arrivals, organizations such as MSF have set up clinics, but they are in high demand and wait times are long. The ill, weak or heavily pregnant often can’t stand in line waiting to be seen. Taya Mohler from California spent around a month in spring 2016 working as a volunteer midwife for Midwife Pilgrim at camp EKO on the Northern Greek border. She noticed a disconnect between the needy and their ability to access care, so instead of assisting at one of the mobile units, she decided to go from tent to tent in the camp with a translator to help women who needed care but couldn’t visit the clinic. During that month, she counted 80 pregnant women.

“I am sure there were more because there were just so many people, there were around 15,000 people in that area,” she says. “There were just so many babies.”

In the few weeks that Mohler was on the Greek border, there were between 30 and 50 births that she knew about. Refugee populations tend to have much higher pregnancy rates than the general population, according to the UNFPA, and midwives working with these women say many of those pregnancies are unplanned.

British MSF midwife Jonquil Nicholl, who works aboard the MV Aquarius and helped deliver Baby Newman, says there have been 80 pregnant women and two births on the ship this year alone. One of Nicholl’s tasks aboard the Aquarius is to provide counseling to women with unwanted pregnancies as a result of rape. “We are seeing a significant number of women who have been abused while travelling,” she says.

Research by Amnesty International shows that refugee women are highly vulnerable to sexual and gender-based violence – especially in what Nicholls calls “collecting centers,” where they wait to board the boats. Amnesty says refugee women are at risk at every stage of their journey, even after they arrive in Europe. Smugglers often force women to sleep in confined spaces shared with men. Aboard the Aquarius, men and women are kept separate, but for some women it’s already too late.

Both Nicholls and Mohler say they have also encountered many young refugee women who reported being married off early or even trafficked by their parents because they could not afford to keep them. This too would often result in unwanted pregnancies.

Another key factor driving the large number of pregnancies among refugees is a desperate lack of education and adequate contraception. Aid workers need bulk supplies of contraceptives that are hard to come by, especially for the Turkish camps where access for aid agencies is limited. When the volunteers for Midwife Pilgrim do manage to provide some contraceptives, they, like many healthcare workers at the camps, find follow-up almost impossible. They can periodically give out long-term contraceptives but might not manage to get back to the same women in time for repeat prescriptions.

Volunteers working with Midwife Pilgrim want to see a team of midwives dedicated to educating and informing refugees about issues like contraception, nutrition and breastfeeding. (Luc Scheffers)
Volunteers working with Midwife Pilgrim want to see a team of midwives dedicated to educating and informing refugees about issues like contraception, nutrition and breastfeeding. (Luc Scheffers)

There are additional challenges when it comes to women who want to terminate their pregnancies. “One of the biggest challenges is in terms of termination of pregnancy,” says Lia Motska, a midwife activity manager for MSF who covers two large refugee camps in Greece. “We have to ensure 100 percent confidentiality. We have to do our best to be on time according to national protocols, which is first trimester, 12 weeks.”

But the hardest struggle for these women is often cultural. “Women are coming from contexts where termination of pregnancy is illegal,” Motska says.

For Midwife Pilgrim’s Mohler, one big step toward a solution would be the creation of a team of healthcare providers dedicated to maternal healthcare for refugees. She says displaced women need education and information about contraception, both natural and medical, as well as nutrition, breastfeeding and pregnancy.

Midwives and organizations like Midwife Pilgrim can do their best to ensure safe deliveries and postpartum care for refugee mothers and babies, but once the volunteers leave, women and their babies are once again at risk of health problems, sexual assault and gender-based violence and a lack of education and safe housing.

“Helping women give birth is absolutely what I do,” says Nicholls. “But Baby Newman … I don’t know what the future holds for him. What are they going to do? How are they going to be treated when they get there?

“[His birth] was a great and uplifting ray of hope, but we always have to remember that this isn’t the end, and there is a lot more in front of us.”

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