Celebrating a ‘Brilliant Visionary’: Malian Midwife Makes a Difference

Fatoumata Maïga Dicko is a proud Malian midwife who has never regretted her career choice. “I was actually inspired by another midwife,” she shares. ”She had a great reputation, and everyone spoke highly of her. When I saw how good she was to other women, she made me want to become a midwife. I also feel great empathy for people, so this job is a good fit for me.”

Fatoumata started working as a midwife in 1978. She remembers that on her first day on the job, her very first assignment—in Menaka, Mali—was to assist a woman with difficult labor who had been referred from a remote village. “When I examined her, I realized that the labor had been slowed down because she had started pushing before reaching complete dilatation. I helped her and took care of her so that she could finally give birth to her child.” Fatoumata adds, “And her child survived. It’s an unforgettable experience, and it created a strong bond between me and the family—they actually named the child after me. I may not be part of the family, but it’s a great sign of recognition.”

Supporting midwives to meet challenges
Starting in 1982, in addition to working as a midwife, Fatoumata became a trainer at a midwifery training institute. She still trains and supervises midwifery students in the field, but she also co-founded and is now president of Mali’s National Midwives’ Association. Midwives are a lynchpin in Mali’s health system because they provide a range of needed services—from family planning to malaria treatment. Midwives also train and supervise obstetric nurses and other health workers at community health centers.

Fatoumata speaks about the need for well-trained and supported midwives, especially in rural areas. “When midwives are sent to difficult areas, they should be motivated to go there,” she adds, proposing special training sessions, supportive supervision and, if necessary, financial incentives.

When midwives do accept positions in remote areas, they face additional challenges. “There are myths surrounding pregnancy… women don’t want other people to know that they are expecting. And by hiding their pregnancy, they may not notice the various risks they are running.” She further explains that, in the socio-cultural context of Mali, “strangers should not be aware of someone’s pregnancy. Pregnancy is something sacred. Therefore, if a woman is not educated enough, if she can’t identify risks, if she can’t go to a facility on her own without asking for permission, she’s bound to develop complications. And when she finally makes it to the hospital, it might be too late for us to save her.”

Fatoumata describes the decision-making process for a woman to get that “permission” to go to a facility, which, she says, “is at the heart of the problem” and can involve not only the husband but sometimes the mother-in-law and father-in-law and even the father-in-law’s eldest brother.

Another obstacle, she explains, is that “once the decision has been made to go to the health center, delays can occur due to the road’s poor state of repair, accessibility issues, the inadequacy of transportation, or a lack of money.” She adds that “any of these delays can be detrimental to the woman and her child.”

Advocating for midwives and matrones
In her role as president of Mali’s National Midwives’ Association, Fatoumata advocates for all midwives, and she has partnered with Mali’s Ministry of Health for the equitable distribution of midwives in the country. Fatoumata organized a national human resources forum focused on improving the deployment of midwives—and she has seen results. “This year, 60 midwives have been recruited, and they’ve all been deployed to remote areas,” she explains.

Fatoumata leads an annual national congress for nurses and midwives in Mali—over 1,000 of them—to spend three days discussing and finding solutions to health issues at the local level. As part of the event, IntraHealth International organizes a mini-university—a refresher training that gives midwives the chance to update their maternal and child health skills, including such topics as malaria treatment during pregnancy, fistula prevention, and IUD insertion and removal. During the most recent mini-university, IntraHealth trained 192 midwives trained in active management of the third stage of labor (AMTSL), infection prevention, and birth planning.

Fatoumata also led the National Midwives’ Association’s work with IntraHealth to pioneer allowing matrones, or auxiliary midwives, to perform AMTSL in Mali. IntraHealth and the association were the first ones to train matrones in AMTSL. The technique reduces postpartum hemorrhage—the leading cause of maternal mortality—and helps decrease other major complications that can occur during delivery.

IntraHealth’s efforts to promote AMTSL in Mali began in 2000 during the USAID-funded PRIME II Project. The work continues through other USAID-funded projects, including CapacityPlus, ATN Plus, and Fistula Care.

Honored as a ‘brilliant visionary’
IntraHealth chose Fatoumata Maïga Dicko as one of its five 2010 Health Champions for her work to ensure an equitable distribution of midwives across the country. In her honor, Mali’s First Lady Touré Lobbo Traoré, who is also a midwife herself, donated a new office to the National Midwives’ Association and provided 21 million francs CFA, or about $46,000, for furnishings and equipment.

“Madam Dicko is a brilliant visionary and incredibly talented at bringing teams together so that everyone’s strengths are maximized, and their weaknesses limited,” says Cheick Toure, IntraHealth’s country director in Mali. “She is a great example for the next generation of midwives.”

IntraHealth leads CapacityPlus and is a supporting partner on ATN Plus, led by Abt Associates, and on Fistula Care, led by EngenderHealth. These projects are funded by USAID.