Valuable contributions to the future of midwifery in Rwanda
Rwanda is taking a significant and forward-thinking step in midwifery education. With support from researchers at institutions such as the University of Gothenburg, the country has rapidly updated its curricula to meet both international standards and local needs. The result is an education programme that strengthens the role of midwives and improves the health of women and children – a model that could inspire other nations.
- Rwanda has truly shown how national leadership can transform health and medical education, says Malin Bogren, a midwife and associate professor at the Institute of Health and Care Sciences at the University of Gothenburg. Recently, the country updated its midwifery programmes at diploma, bachelor’s, and master’s levels to align with international standards set by the International Confederation of Midwives (ICM). The outcome is a competency-based curriculum that not only meets global requirements but is also tailored to Rwanda’s unique cultural context.
The Key Role of Midwives in Rural Areas
For midwives in Rwanda, working independently is a core part of their daily responsibilities, especially in rural areas where distances to hospitals are long, and resources are scarce.
- When a pregnant woman arrives at a health centre or hospital, the midwife must quickly assess her condition. This may involve identifying complications such as high blood pressure, bleeding, or other risk factors that require advanced care, explains Malin Bogren.
To provide the best possible care, midwives need confidence in their knowledge and the ability to make quick, accurate decisions about referring a woman to a higher level of care.
-This skill is absolutely critical for saving lives in areas where access to specialised care is limited, and it has been a key focus of our work, says Bogren.
Over the past two decades, Rwanda has reduced maternal mortality by over 80%, from approximately 1100 to 200 deaths per 100,000 births. However, progress has stalled in recent years, making midwifery education one of the country’s most pressing priorities. To address this, the government launched an ambitious initiative in 2024 to standardise training programmes with support from partners such as the UN Population Fund (UNFPA) and the University of Gothenburg.
Swedish Researchers Supporting Change
Malin Bogren has been a central figure in this project.
-My role has been to guide the development of education and course plans that are tailored to Rwanda’s needs. This has involved balancing international standards for midwifery competencies with the country’s specific conditions, she explains.
Ultrasound - a crucial competency
One of the challenges has been integrating ultrasound skills into the curriculum.
-In Rwanda, midwives need to use ultrasound to determine estimated delivery dates, fetal positioning, and viability. This is a crucial skill for ensuring safe care, especially in resource-limited settings where doctors may not always be available. However, safely and accurately performing ultrasounds requires extensive education and hands-on training, which is difficult to fit into an already packed curriculum, says Bogren.
Cultural factors also play a significant role in childbirth practices.
-It is uncommon for fathers in Rwanda to be present in the delivery room, Bogren explains. Instead, a female relative, such as the mother or sister, often serves as the primary support. This creates a dynamic where the father typically waits outside, which contrasts with many Western contexts where the partner is expected to be actively involved during childbirth.
-In these situations, midwives need to adapt their approach and communication to both empower the supporting relative and find ways to involve the father, such as through follow-up discussions after the birth, she says.
National Ownership – A Key to Success
What truly stands out in Rwanda’s work is the strong sense of national ownership, according to Malin Bogren.
-The entire process has been led by the country’s own authorities, universities, and professional organisations. This ensured that the education programmes were aligned with national needs, creating legitimacy and engagement among institutions and educators,” she says.
Bogren also describes how inspiring it has been to witness the government’s commitment to elevating the midwifery profession.
-Being part of such a positive transformation, where midwives receive the support and recognition they deserve, has been incredibly rewarding,” she says.
A Model for Other Countries
Rwanda’s approach of integrating international standards with national priorities could serve as a model for other low- and middle-income countries.
-With strong collaboration, cultural adaptation, and a focus on quality, Rwanda demonstrates how nationally driven initiatives can lead to sustainable change, says Bogren.
The next step will be to enhance teachers’ capacity to deliver the new curricula.
-We’ll focus on identifying what support educators need to teach the updated courses. The results of this work will inform a plan for teacher capacity building. It’s an excellent start, but there’s still room for further development, Bogren concludes.
