Between 2004 and 2012 Children in Crisis, working with local NGO Jinpa, trained community midwives in the Yushu Tibetan Autonomous Prefecture (Yushu TAP) in Western China. In such a remote, isolated environment the network of trained midwives will be of enormous benefit and support to their communities.

Sadly, increasing unpredictability and political and social tensions in the region following the devastating earthquake in Yushu in April 2010 led to unacceptable restrictions on our ability to plan, deliver, and assess the programme and to work effectively in partnership. As such, our involvement with Jinpa and the midwife training programme came to an end in early 2012. 

Why midwife training?

During our time working in Yushu TAP the problem we aimed to address was the lack of access to basic essential healthcare for the nomadic and semi-nomadic communities. The nearest hospital is often a long journey and high fees are charged if people do manage to get to a hospital, making it very prohibitive as many cannot afford it. Rates of maternal and infant mortality are high, which is why the trained midwives who know the communities well, build trusting relationships with them (especially with the women) and can provide basic but essential information and support are crucial.

How did Children in Crisis help?

Midwife Training

We supported our local partner Jinpa to train young Tibetan women to become midwives and basic healthcare providers for their communities. Those selected would attend 8 months of residential training which would start by improving literacy skills and go on to equip the young women with the skills needed to:

• Attend births to help women in their communities
• Give support, education & advice to women before and after childbirth
• Administer basic healthcare within their community
• Provide their communities with essential information on basic hygiene, health & sex education (particularly raising awareness of HIV and other sexually transmitted diseases)

Following the residential training, the trainee midwives would spend time back within their communities, honing the vital skills they’d learned and building relationships with their communities in their new roles. They would then receive follow-up training and supervision to give them a forum in which to exchange experiences and any problems that may have arisen and continue their learning.

Health Education

Children in Crisis and Jinpa also ran a Health Education Programme to promote health and hygiene in these remote communities. The workshops, aimed at raising awareness, increasing knowledge and fostering the development of positive behaviours among school children, teenagers and adults and run during the summer months, helped to address one of the biggest problems in the region –the lack of even basic knowledge about health and hygiene, which too often leads to poor quality of life and needless deaths.

Midwives, trained by Children in Crisis & Jinpa, would work alongside Jinpa to facilitate these workshops.

The results

‘Now I can read and write Tibetan and I have studies about midwifery . . . and I am now more courageous and have more hope in myself and my ability to help others’ (Midwife Graduate, Nangchen County).

‘In remote nomadic areas there are very few doctors and even if there is one it would be a male doctor so women face difficulties to be open with them, so midwifery is very important to deal with women’s issues and to understand women better and to get better help’ (Midwife Graduate, Nangchen County)

Between 2004 and 2009 we trained 150 community midwives across three of the six counties in Yushu TAP. The training provided these young semi-nomadic and nomadic Tibetan women with opportunities to learn and to develop skills and knowledge that they would not otherwise have. Importantly, it also enabled them to increase their self-confidence and sense of self-worth. 

For women in their communities the benefits of the programme have also been important. They reported greater awareness about basic health and hygiene, positive change in healthy behaviour among villagers, the presence of midwives at births, and increases in women’s status. 

Our Learning

A number of important learning points have come from the programme that will be useful to consider in future planning of other programmes:

1) Given the remoteness of the villages that the midwives live and work in, some of the women reported finding themselves professionally isolated and identified the need for opportunities to exchange experiences and ideas with other midwives. One suggestion from the graduates themselves to address this was refresher/intensive training annually for shorter periods of time, such as two to three month periods so that women are not away from their families for too long,

2)Some of the midwives faced challenges, particularly upon first returning to their villages, in raising issues around sexual health with the men. However, most gained more respect and found this easier over time and many felt that their participation in the health education programme (above) played an important part in this as the communities could see them working alongside the Jinpa team who assigned them responsibilities.

Why our midwife training ended

In March 2010 we had started to train an additional 22 midwives. Their training had to stop due to a devastating earthquake that hit Yushu in April of that year. We were eventually able to re-start the training of the 22 midwives in July 2011 using tented accommodation set up by Jinpa due the level of destruction to buildings in Yushu town (the location of the residential training, the medical school was completely destroyed along with approximately 85% of the town’s buildings).

Following the earthquake we were faced with an increasingly unpredictable operating context and an uncertain and sensitive political environment, which posed significant challenges to our ability to run the programme.

Children in Crisis require that all of our programmes are monitored and evaluated on a regular basis. We cannot commit our donor’s funds and organisational resources unless we can deliver transparency and due diligence to our work. We felt that this was not possible under the growing constraints we were facing in our partnership and our work. As such, the programme was put under review towards the end of the year and after careful consideration and discussion with Jinpa, we decided to bring the work to a close.

The decision to end the Midwife Training programme was in no way a reflection on the value of the work carried out in Yushu TAP training young Tibetan women as midwives. We admire the tenacity and commitment of Jinpa and of the midwives trained over the years who are, and will continue to be, of enormous benefit to the communities. We wish Jinpa every success for the future.