Midwifery in Jordan

Abstract

Jordanian midwives, particularly those working in the public sector, are the major health care providers for mothers and their young children. Many women, however, do not receive early prenatal care, and some receive no prenatal care at all. Because of persistent high rates of maternal and early childhood morbidity and mortality, the Minister of Health has identified advanced preparation in primary health care nursing as a priority for some midwives, who will then be expected to function as leaders in the movement toward universal primary health care.

PIP: The Jordan Ministry of Health supports midwifery training and practice because of high maternal and child mortality in Jordan. A national priority in primary health care is the development of midwifery leaders; quality assurance evaluations are considered necessary for attaining optimum health outcomes for all mothers and children. In 1991 about 90% of Sunni Muslims in Jordan have available health services comprised of 6365 physicians, 2426 professional nurses, 4183 practical nurses, and 725 midwives. About 45% of citizens receive health care from public services, 40% from the military sector, and 15% private care. The roles of women have expanded since the 1950s due to increased educational and work opportunities. Woman's role in the family is affected by socioeconomic status. The birth rate in 1992 was 39.5/1000, and infant mortality was 44/1000 live births. Population growth was 3.4%. Marriage and first births occur at young ages and birth intervals are short. 45% are married by the age of 17 years and 50% had 6 or more children. 25% of women gave birth within 18 months of the preceding birth, and 50% gave birth within 2 years. 44% of the population is aged 0-14 years. Major health problems are maternal mortality, premature birth, low birth weight, and infant mortality. Due to government investment in health infrastructure, by 1986 80% of the population was within 10 km of a health center. Services are free of charge to government employees and the poor. In 1983, the most recent year when data was available, about 42% of women did not receive prenatal care and 30% of those with care had only 4 or less visits. Modesty, modesty toward male physicians, and religious belief in God as the best source of good health are obstacles to acceptance of health care. Midwife education is available from the Ministry of Health in a 27 month diploma program; a 6 month training programs is available to "dayas" and a 9 month post-basic training course is available to nurses. Licensing is performed by a professional organization. Program evaluation recommends more and better training of midwives and development of standards of training.