Male midwives unwelcome among Muslims

BUEA, CAMEROON – Lorantine Keukam, 34, is a mother of six children in Buea, the capital of the Southwest region. She serves as the chief of the Unit of Reproductive Health at the Ministry of Public Health’s regional delegation. Although some are still getting used to a rise in male midwives in Cameroon, she says enthusiastically that they are a force to reckon with.

Keukam holds a master’s degree in nursing with a specialization in reproductive health. She has also had both male and female midwives deliver her children.

A female midwife delivered her first two children. She calls the experience traumatic.

“I was traumatized,” she says. “I suffered in pain. There was nobody there to console me, nobody to share my pain.”

Keukam says the experiences made her never want to give birth again.

“After my second child, I swore never to contract another pregnancy,” she says. “But when it did come, I couldn’t stop thinking of the trauma that awaits me.”

This time, a male midwife delivered Keukam’s baby.

“I was delivered of my third baby by a male midwife,” she says. “It is an experience I will never forget.”

She says the male midwife used dialogue to help her get through her contractions. He began complimenting her hairstyle as the contractions started. He asked questions to distract her, such as who her stylist was and where the salon was located.

She says he maintained a loving smile throughout the delivery. He told her he was sorry for the pain and then soothed her lower back and abdomen as she instructed.

“We were in constant chat,” she says, remembering also how he complimented her watch. “As we talked, time was moving on. Before I knew it, my baby was crying. The male midwife encouraged me through the push process.”

Keukam says that she admires male midwives’ techniques so much that she strives to emulate them in her work.

“Male midwives are just the best,” she says. “I try to behave like them whenever I find myself delivering a woman in the labor room.”

She says that, in her experience, female midwives tend to be more abrasive in the delivery room.

“Women are violent and impatient – vraiment,” she says, using a francophone word meaning, “It is the truth.” “I am sorry to say so.”

She closes her eyes and shakes her head from side to side.

A shortage of personnel to deliver babies throughout Cameroon has been drawing more men into midwifery. While many Christian women prefer male to female midwives because they say the men are more attentive, Muslim women say it goes against their religion for men other than their husbands to see them naked.

Midwives say that the behavior of midwives depends more on the person and their training than on their sex. Last year, the government introduced the country’s first full training program exclusively for midwifery in order to ensure that birth attendants are well-trained – regardless of their sex.

There is an acute shortage of midwives in Cameroon, according to the regional delegation of the Ministry of Public Health. As a result, many nurses have had to become midwives to fill the void.

There are no exact statistics available on the ratio of male to female midwives in Cameroon, but Keukam estimates that male midwives makes up less than 10 percent, as the practice of midwifery by men is fairly recent. But their numbers are growing, she says.

The entrance of men into midwifery has created a controversy over the preference of sex when it comes to midwives in Cameroon. While many Christian women and men say they prefer male midwives to attend to their labor needs, Muslim women and men say it is taboo for men to see the private parts of other men’s wives.

Violet Yigha is a Christian mother of two pursuing her Master of Science at the University of Buea. Based on her delivery experiences, she says she prefers male midwives.

“I was delivered by a male midwife when giving birth to my second child,” she says. “It was quite a different experience from the first one, who was delivered by a female.”

She says that the male midwife was more sensitive.

“The man was very patient, sympathetic, caring and loving,” she says. “He attended to me at all times, unlike the first experience, where the female midwife just sat on her bench shouting at me as I rolled on the floor in pain.”

Yigha says that if she has a choice in the future, she will choose a male to deliver her baby every time.

Melvis Akama, 22, another Christian mother who lives in Bai Kuke, a village about 70 kilometers from Buea, says that attentiveness can be the difference between life and death. The mother of one child, she says that she lost her first baby during labor because of the inattentiveness of the older, traditional midwife delivering the baby at the village community hospital.

“Things became complicated, and I was abandoned by the midwife at the mercy of my mother, who knows nothing about delivery,” Akama says. “The midwife told my mother to look for a taxi in the middle of the night, knowing that it is difficult to get a car in that village at that hour. She then went into one of the rooms and slept. Before my mother could get a car, carry me to a nearby government hospital where trained midwives were, it was late. I lost the baby.”

Akama says a male midwife delivered her next child and that she was pleased with his service. She says he was present at all times, always there to share her pain and give her hope.

But Muslim women say that being attended to by a male midwife is against their religion.

Fatimatou Ibrahim, 24, is a Muslim woman living in Buea. She is married and a mother of one. She says a female midwife delivered her baby, as Islam requires that men attend to men while women attend to women when it comes to medical care.

“The Koran states that, ‘Male open to male, women for women,’” Ibrahim says.

Ibrahim says that the existence of male midwives in Cameroon, not a strict Muslim state, makes them go against their beliefs and practices. She says that Muslim women living here find male doctors and male midwives attending to them these days because Islam is a minority religion in Cameroon.

“We have no option,” she says. “However, most of my sisters deliver their babies at home, aided by Muslim women, just to avoid a situation where they will meet male midwives at hospitals.”

Ibrahim says that this is a worrisome issue in the Muslim community here, as well as in other nations in which they are in the minority.

Rekiatou Adamou is another Muslim woman who rejects male midwives. Adamou has one child, who was delivered at home by two Muslim women in Buea. 

“I will prefer my children to be delivered at home [rather] than to expose my nakedness to another man who is not my husband in the name of a midwife,” Adamou says.

She says her husband is also bitter about the existence of male midwives because it goes against their religion.

Although the preference for the sex of midwives seems to fall along religious lines, there are some Christian women who say they prefer female midwives. For example, many young Christian women giving birth for the first time say they feel uncomfortable with male midwives. 

Elisabeth Mosele is a young mother who just gave birth to her first child.  She shivers at the thought of having a male midwife.

“Eesh, no no no no, I don’t like male midwives,” she says as if she were cold. “I will not stand and see male midwives fondling with my vagina for the mere fact of checking the position of my baby. No, no, no, no, I don’t want male midwives.”

But for the most part, preference for the sex of midwives seems to divide along religious lines when it comes to men as well. While many Christian men say they have no problem with male midwives attending to their wives, many Muslim men say this is wrong.

Polycarp Obi is a Christian trader from Nigeria living in Buea. He says that any competent person should do the job, be it a male or a female midwife.

“I don’t care about who does the delivery,” he says. “All I am concerned about is that the baby be born safe and healthy. After all, there are male doctors.”

Mohammad Awal is a Muslim man who has been living in Buea for more than 15 years. He says that he doesn’t feel his religion is respected here.

“Pure Muslim states respect the laws of Islam,” Awal says. “In Cameroon, we are in a state of confusion.”

He says that male midwives represent a violation of privacy.

“The privacy of our women is being violated by other men,” he says. “This is not fine. We are not supposed to accept this, but there is nothing we can do about it.”

Still, he says they are trying. The Muslim community in Buea has acquired a vast tract land of land on which they plan to build a Muslim complex.

“The Muslim complex is going to comprise of Muslim hospital, Muslim schools,” he says. “These are going to meet the needs of the Muslim community in and around Buea, and it will solve our worries of not having our women’s privacy violated.”

Male and female midwives both voice their competency.

Vivian Wirba, a midwife at St. Veronica Medical Center in Buea, offers an explanation for why some mothers may say that female midwives are insensitive. She says that older midwives sometimes feel that they need to shout or beat women who are uncooperative during labor in order to safely deliver their babies.

“Midwives need to be strict or else the mother will lose the baby,” she says.

She says that older midwives can’t be blamed for this harsher treatment because their practices are rooted in a more traditional knowledge of midwifery.

“Old midwives shout and frighten women,” she says. “I don’t blame them. They do this because they lack refresher courses to update their knowledge on modern techniques.”
Caroline Mutchacho is a midwife at Bai Estate Hospital in the Southwest region. In her 50s, she has been practicing for about 22 years. She says that midwives’ behavior depends on the person, not on their sex. She condemns the generalizations made about female midwives.

“I treat my women with utmost respect in the labor room,” she says. “Many women even call me to come attend to them even when I am not on duty because of the way I have been attending to women. I am proud to say that I am not associated with all the negativity attached to female midwives.”

Victor Mahop, 36, is a professional nurse who began practicing midwifery because of the shortage of midwives in the hospital in which he works, St. Veronica Medical Center, as well as throughout the country.

Mahop says most women are unfazed when they find him in the labor room attending to them. He admits that some women, especially young girls who are having their first babies, are uncomfortable with male midwives.

But Mahop says that, in all, most women prefer male midwives, with some even calling him on the phone when they are in labor to come and deliver their children. He says there should be more male midwives.

“Generally, women will prefer male midwives, even in other hospitals,” he says. “But the problem is that there are very few male midwives in Cameroon. Women want male midwives because of that cordial relationship that exists between men and women. There is that natural flow or soft link between the man and the woman, so a man will always want to care for the woman.”

Mahop says that some women are noncompliant during labor, but he tries to instruct them in a more mature way rather than shouting at them. He says that shouting is the wrong approach to correct a person in pain.

“Male midwives are bringing a change in the practice,” he says. “My wife was delivered by a male midwife, and she admits it was good experience. Our impact is being felt positively.”

Atenoh Aloysius is a male midwife at Pamol Lobe Estate Hospital who has been practicing for about 13 years. He says that it’s natural for women to prefer male midwives.

“Women needs to be pampered at all times,” he says. “When this is coming from the men at a time when they need it most, it becomes wonderful. It plays the magic at that magic moment – trust me.”

As the debate between male versus female midwives continues, government officials say the solution is formalizing midwife training so that they do their jobs in a safe and professional manner – regardless of their sex.

In the past, Cameroon has never offered exclusive training for midwives, according to the Ministry of Health’s delegation in the Southwest region. Keukam says that midwifery education has instead been available as a post-nursing program, and prerequisites included at least two years of experience as a nurse.

But last year, the government introduced a full training program exclusively for people who aspire to become midwives. Students who enrolled in the program are currently in their first year of the three-year program.

“Government policy to introduce midwifery education is timely,” Keukam says. “It will go a long way to change perceptions on some important nursing practices. Nurse/patient relationship will improve drastically.”

She says that the ministry also offers refresher courses for older midwives who have been trained in more traditional practices as well as nurses who have responded to the shortage of staff in the delivery room.

“These days we organize refresher courses for midwives and nurses in order to improve on the treatment of patients and women in labor,” she says.

These programs aim to prepare all midwives for their duties and remove the preference based on sex.

“The situation will change with time,” Keukam says.