Access to sexual and reproductive health care is a fundamental human-right. Moreover, not having access is correlated with women’s economic disempowerment and gender-based violence (1, 2). The current COVID-19 pandemic has magnified the human-rights deprivations experienced by marginalised groups and communities. Subsequently, women and girls are experiencing increased difficulty accessing sexual and reproductive healthcare (3).
According to a United Nations Report, midwives are equipped to provide up to 90% of sexual and reproductive health care and therefore play an essential public health role in its provision (4). Indeed, the relational philosophy underpinning midwifery prioritises sensitive, individualised care from puberty to menopause (4). Recent research conducted in a tertiary hospital in Western Australia found that midwives regularly provide education on sexual activity, sexual health, and contraception as part of their work (5). However, their ability to provide individualised quality care was undermined by busy clinical workloads and other systemic barriers. Furthermore, the research identified the need for further continuing professional education related to sexual and reproductive health (5).
A study conducted in New South Wales, Australia, examined a practice innovation where midwives have been credentialed to insert long acting reversible contraceptives. Findings of the study showed widespread support for the program which enhanced midwives’ ability to provide point of service education and provision of contraceptive choice for women in their care. Barriers to further roll out and expansion of the program were identified as the already demanding clinical workloads, waiting for medical charting of the contraceptives and the availability of staff to supervise and credential insertion (6).
There is an evident gap between midwives’ wish to work with women concerning their sexual and reproductive health needs; and their capacity to provide it. The main barrier is hospital management systems. In addition, some midwives need to upskill in reproductive health care. Importantly, there are no regulatory barriers to midwives providing primary sexual and reproductive health care. Guidance from the national regulator for midwifery – Nursing and Midwifery Board of Australia (NMBA) (7) indicates that scope and evolution of professional practice should be guided by
- The needs of and feedback from, those receiving care
- The evolution of new practice areas/ capabilities
- Negotiation between health workers and
- Evolving health service needs
In conclusion, social justice and equality through the provision of global sexual and reproductive health care, needs to be met by an agile, equipped, and prepared workforce. Midwives are in a respected and trusted position as sexual and reproductive health experts. Likewise, the principles of advocacy, agency, and justice are inherent in midwifery practice. Therefore, the situation demands rapid action to remove unnecessary barriers to midwifery provision of sexual and reproductive healthcare. Importantly, this action requires a multi-level approach that includes preparing midwives to prescribe within scope on graduation from entry to registration courses. Furthermore, midwives need enhanced opportunities to work in primary care settings and continuity models.
Bradfield Z, Officer K, Barnes C, Mignacca E, Butt J, Hauck Y. Sexual and reproductive health education: Midwives’ confidence and practices. Women and Birth. 2021.
Blog written by
Dr Zoe Bradfield
- World Health Organization. Sexual and reproductive health and rights: a global development, health and human rights priority [press release]. Geneva: World Health Organization. 2014.
- United Nations Population Fund. Working Paper Linking women’s economic empowerment, eliminating gender-based violence and enabling sexual and reproductive health and rights. Canberra: UNFPA; 2020.
- Hall KS, Samari G, Garbers S, Casey SE, Diallo DD, Orcutt M, et al. Centring sexual and reproductive health and justice in the global COVID-19 response. The Lancet. 2020;395(10231):1175-7.
- United Nations Population Fund. State of the World’s Midwifery 2021. Geneva: United Nations Population Fund; 2021.
- Bradfield Z, Officer K, Barnes C, Mignacca E, Butt J, Hauck Y. Sexual and reproductive health education: Midwives’ confidence and practices. Women and Birth. 2021.
- Botfield JR, Tulloch M, Contziu H, Wright SM, Phipps H, McGeechan K, et al. Feasibility, acceptability, and sustainability of postpartum contraceptive implant provision by midwives in NSW public hospitals. Women and Birth. 2021.
- Nursing and Midwifery Board of Australia. Decision-making framework for nursing and midwifery. Canberra: Nursing and Midwifery Board; 2020. p. 14.