The outstanding work of MAP's community midwives

The health of women and children is a major cause for concern for Palestinian refugees in Lebanon.

The country’s refugee camps and Palestinian gatherings are beset by overcrowding, poverty, and a chronic lack of opportunities. These conditions are set to deteriorate further following the US administration’s decision to cut all funding to UNRWA, the UN agency responsible for humanitarian support to Palestinian refugees. The cuts represent a dangerous politicisation of aid. They amount to a reduction of nearly a third of UNRWA’s operating budget, jeopardising vital services, including health clinics, social services and education and undermining the protected status of Palestinian refugees.

The impact of US cuts is felt particularly keenly in Lebanon where the poverty rate is 60% among Palestinian refugees and 90% among those double-displaced from the war in Syria. Amid this context, rates of maternal and child mortality and morbidity remain high.

Determined to help support the latest generation of Palestinians being born into exile, MAP provides an essential community midwifery and perinatal outreach service. It is the only homevisiting midwifery service in Palestinian refugee camps in Lebanon. Working in Nahr el Bared, Beddawi, Mieh Mieh, and Ein el Helweh refugee camps and surrounding gatherings, the community midwives complement the clinic-based services provided by UNRWA.

For the past ten years, MAP’s midwives have helped to enhance the care offered to pregnant women and their new-born babies. They visit mothers who are most in need, including those not registered with UNRWA; with a mental illness or disability; young or pregnant for the first time; double-displaced from the war in Syria; and suffering domestic violence.

During their visits, the midwives measure their weight, blood pressure and urine for protein, and listen to the babies’ heart rate with the mother. They also offer advice about serious signs and symptoms to look out for during pregnancy as well on diet, sleep and physical activity.

Once the baby arrives, a mother is visited, on average, once a month for up to a year. The health of the baby and the mother are carefully monitored, and the midwife also provides contraception, breast feeding and well-being advice.

Both before and after giving birth, mothers can contact the midwives with any queries they have. One mother reflected, “[the midwife] would answer me whenever I called. If she couldn’t, she would call back. She never neglected me”.

MAP’s community midwives have had remarkable success in extremely challenging circumstances. In 2018, the American University of Beirut (AUB) assessed the impact and added benefit of MAP’s maternal and child health programme to the existing UNRWA services and found “MAP has significantly contributed towards a positive shift in its impact on maternal and neonatal health outcomes.”

The community midwives have helped to increase breast-feeding rates, significantly reduce anaemia among pregnant women and newborns, reduce high-risk pregnancies, pre-term births, and the rates of caesarean section deliveries among Palestinian refugees.

The midwives are highly trusted amongst the women they support. Descriptions such as “compassionate”, “supportive”, “comforting”, “knowledgeable” and “patient” were used by the mothers to describe the midwives.

Zeina’s story

Zeina is a 37-year-old and lives in Ein el Helweh camp, the largest Palestinian refugee camp in Lebanon. She has five children.

Zeina learned about MAP’s Maternal and Child Health (MCH) project six years ago when she was pregnant with her daughter Lina. Abila, a MAP midwife, visited her and supported her during the pregnancy and after childbirth. According to Zeina, the midwife’s help was vital at that time, as Lina suffered from a congenital heart defect.

In the last three years, Zeina had four miscarriages which caused her great distress. Then, nine months ago, when Zeina discovered that she was pregnant again, she contacted Abila and sought her support. She received regular home visits throughout her pregnancy, with Abila helping her through multiple pregnancy complications, listening to her concerns and reassuring her.

Last month Zeina gave birth to a healthy baby boy, Mohammed, and waited eagerly for the midwife’s visit. As Abila entered her house, Zeina handed over her baby Mohammed and asked her if he was doing well.

Zeina was particularly concerned about baby Mohammed’s umbilical cord stump and skin colour. Abila explained umbilical stump care to Zeina and showed her the steps for cleaning the area. She also examined baby Mohammed carefully and recorded his weight and measurements.

Abila gave Zeina breastfeeding and baby care advice. Zeina said that the doctor at the hospital had prescribed baby formula milk and encouraged her to use it instead of breastfeeding. She proudly told Abila that she refused to use the formula milk and insisted on breastfeeding her baby exclusively. “There is no milk better than the breast milk for the baby,” Abila added in agreement with her.

Zeina asked Abila’s advice about suitable family planning methods and about food to help maintain a good breastmilk supply. At the end of the visit, Zeina expressed her gratitude to Abila for helping her and her children.

This article originally appeared in the Winter 2018 edition of our supporter magazine, Witness.

Names changes to protect identity