Should more men train to be midwives?

Summary

Africa Daily — "Should more men train to be midwives?"

Host: Alan Kasuja (BBC World Service)
Guest: Robert Aule, male midwife in Baringo County, Kenya
Episode Date: February 19, 2025

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Episode Overview

This episode tackles the underrepresentation of men in midwifery across Africa—a profession overwhelmingly dominated by women, with less than 1% male participation. Alan Kasuja interviews Robert Aule, a pioneering male midwife who has helped deliver over 500 babies in remote, underserved regions of Kenya. The conversation explores Robert’s career journey, the cultural stigma faced by male midwives, the technical and emotional aspects of assisting childbirth, and whether more men should enter this vital field.

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Key Discussion Points & Insights

The State of Midwifery in Africa

• Severe Midwife Shortage: Africa suffers from a dire lack of midwives. According to the UN Population Fund, there are only 2 midwives per 10,000 people in Eastern and Southern Africa.
  • [02:15] B (Alan Kasuja): “...midwifery is seen as a female profession. Could encouraging more men to become midwives help bridge this gap in healthcare?”

Robert Aule’s Path to Midwifery

• Early Motivation and Training: Started as patient attendant/nursing aide at Capedo Mission, trained by Finnish missionaries from 1980, and delivered his first baby in 1982.
  • [04:10] C (Robert): “...started this job from Capedo Mission I as a patient attendant...in 1980 up to 91 March, the government of Kenya employers as a senior first aid.”
• Transition through Insecurity: Missionaries left due to security issues, Robert remained as local staff hero.
• Dedication to the Profession: Robert views his work as a calling, shaped by his own experience with disability and early medical care after birth.
  • [06:08] A (Robert): “After helping this mother deliver her baby, from that moment onwards I felt that my passion is helping mothers to deliver and I believe that is my calling.”

Cultural Perceptions and Stigma

• Male Midwives Rare and Stereotyped: Traditionally, childbirth is viewed as “work for women,” creating cultural hurdles for men entering the field.
  • [07:54] A (Robert): “Culturally, the people here do fear. But for me, because I had joined the work through church, I did not have reasons to fear, as I was only offering help. But you see, this is a practice that is not wholly embraced here culturally.”
• Local Acceptance: Despite initial skepticism, Robert is accepted and trusted by his community.
  • [08:15] A (Robert): “The people saw me as a professional carrying out my duties. They have accepted me. Even the men, when they see their wives start labor pains, they are quick to reach out to me. Men here are okay with me, and the patients too, are very comfortable with me.”

The Practice and Art of Delivering Babies

• Approach to Childbirth: Robert emphasizes kindness, patience, and support.
  • [09:24] A (Robert): “You must not be harsh with a woman. Treat her with dignity, be gentle with her...I dedicate myself. I sit next to her and I treat her gently.”
  • [10:05] A (Robert): “As a midwife, there will be a point at which you can see the baby isn't very far. It will be out soon. And that is the moment to say to the mother, look, the baby is almost yours. Now you just need to make the final push.”
• Handling Complications: Robert assesses each case and refers complicated ones to the district hospital, recognizing his limits and prioritizing safety.

Impact and Legacy

• Over 500 Deliveries: By his count, Robert has helped deliver over 544 children, some even named after him.
  • [13:05] A (Robert): “Oh, many, many...There are so many of them in Nyang area, and it's even a bigger number in the nearby villages. My names are Robert Aule, and many have been given both names, while others have been given my surname, Aule.”
• Personal Fulfillment: Robert’s motivation is rooted in gratitude and service, not profit.
  • [15:31] A (Robert): “Nah, they don't pay me any money. I only do this as a way of giving back because I myself received help when I was born.”
  • [16:41] A (Robert): “I'm not in this for any benefit. My fulfillment comes from committing myself to helping these people, my community. This is because I was born with a physical deformity, like I said earlier, but I was treated at birth by the missionaries.”

Should More Men Train as Midwives?

• Advocacy for Male Inclusion: Robert encourages men to join the profession, while noting cultural barriers remain.
  • [16:08] A (Robert): “I certainly encourage you to join.”
  • [16:16] A (Robert): “Oh, yes. But, you know, culture remains an issue here. It is definitely a matter you'd come face to face with if you offer to help as a male midwife...if they want to become midwives, I'm here to welcome them.”

Challenges and Barriers

• Infrastructure and Resources: He highlights the lack of ambulances, doctors, and basic dispensaries in remote communities—sometimes resulting in tragic maternal deaths on the way to care (14:30).

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Notable Quotes & Memorable Moments

• On Stigma:
  • “[07:54] C (Robert): Culturally, the people here do fear. But for me, because I had joined the work through church, I did not have reasons to fear, as I was only offering help.”
• Empathy in Practice:
  • “[09:24] A (Robert): You must not be harsh with a woman. Treat her with dignity, be gentle with her.”
• Personal Motivation:
  • “[16:41] A (Robert): My greatest fulfillment for me is in helping this community.”
• On Acceptance:
  • “[08:15] A (Robert): Even the men, when they see their wives start labor pains, they are quick to reach out to me. Men here are okay with me, and the patients too, are very comfortable with me.”
• Encouraging Men:
  • “[16:08] A (Robert): I certainly encourage you to join.”
• Legacy:
  • “[13:05] A (Robert): Many...have been given both names, while others have been given my surname, Aule. Some have become teachers, others...doctors, others are nutritionists, and there are technicians. So many.”

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Important Segment Timestamps

• [00:00-02:15] — Opening, context on midwifery shortage and gender imbalance
• [03:41-05:03] — Robert Aule’s career beginnings and training
• [06:59-08:41] — Cultural barriers and personal experiences with community acceptance
• [08:42-10:35] — Robert’s approach and philosophy in childbirth
• [12:06-13:31] — Impact of Robert’s work on community and namesakes
• [14:30-15:15] — Logistical and infrastructure challenges in rural healthcare
• [16:00-16:34] — Robert’s advocacy and advice for aspiring male midwives

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Summary

This episode uses Robert Aule’s remarkable career to illuminate both the challenges and opportunities for men in midwifery across Africa. His story illustrates how, despite cultural stigma and resource constraints, a devoted professional can earn trust and make a life-changing impact. Robert advocates for greater male participation to fill crucial workforce gaps, but stresses the need to gently challenge and reshape societal attitudes. Ultimately, his testimony reframes midwifery not only as a medical skill, but as a courageous form of community service—open to anyone with compassion and dedication.

Transcript

[A]

As a midwife, there will be a point at which you can see the baby isn't very far. It will be out soon. And that is the moment to say to the mother, look, the baby is almost yours. Now you just need to make the final push.

[B]

Now this might surprise you, but when I was five years old, I helped a woman deliver a baby. First responder, first man on the scene. Hey. Now before you overthink it, this is what happened. I was just taking a stroll from home, walking around not too far from the hospital where my mother worked in Western Kenya. A nice afternoon stroll. Now, about a kilometer away from the hospital, I noticed a woman lying on the grass and writhing in pain. Ay. Now my little curious mind told me to move closer to find out what was wrong so I could help her. Now not too far away was a priest's house. And she asked me to go there and ask them for help and tell them she was having a baby. Now, five year old me knew nothing about babies and how they're delivered and where they come from and things like that. I don't know. I don't know if I was ready for that lesson about life. But it taught me that women give birth to babies, number one, and they can only be helped by fellow women. But that is also a fact these many years later. Because midwifery is a female dominated profession, research indicates less than 1% of midwives are men. To be more specific, the number given is zero.

[C]

Or.

[B]

This does not make a lot of sense to me because I've also read reports which show shortage of midwives, especially in Africa, is a major cause of high rates of maternal mortality. And so today I'm asking, should more men become midwives? I'm Alan Kasuja and this is Africa Daily. The World Health Organization says There are between 500 and 999 deaths per every 10,000 live births in Africa. And apart from a myriad of other challenges, that's also down to a shortage of midwives. For example, according to the United Nations Population Fund, eastern southern regions of Africa have only 2 midwives per 10,000 population. Yet midwifery is seen as a female profession. Could encouraging more men to become midwives help bridge this gap in healthcare? My guest today is a man who has helped deliver more than 500 babies over the last three decades. He has not only had to put up with stigma and cultural perception, but he's also been working in one of Kenya's most remote region, Baringo county in the Rift Valley. The region is also known for conflict as communities fight for resources occasionally Due to drought, 63 year old Robert Awule has become a lifeline for many women who find themselves in such circumstances. I started our conversation by asking him if he calls himself a midwife or a mid husband.

[C]

I'm a midwife person. I'm a midwife. Yeah.

[B]

So you call yourself a midwife?

[A]

Yes.

[B]

Not a mid husband?

[C]

Not a mid husband.

[B]

So you are a man who does the work of a midwife?

[C]

Yes, yes, you are right.

[B]

Is that a better description?

[C]

Yeah, it is a better.

[B]

And from what I've read, You've helped deliver 320 babies.

[C]

Yes. First of all, starting this job from Capedo Mission I as a patient attendant or nurse aid because mission from Finland they trained us as a first aid or patient attendant. From 1980 up to 91 March, the government of Kenya employers as a senior first aid.

[B]

So you went in to support in first aid. So how did you end up delivering babies?

[C]

Beginning, beginning of the employment of missionaries. First 1980. From 1980 we trained as a mission midwife from Capedo Mission Full Gospel Church. From that stage, due to security, missionaries disappear to go.

[B]

So the missionaries left because of insecurity?

[C]

Yes. And we remaining there. 1991, Serekhale took the hospital as a government hospital.

[B]

So 1991 the government takes over the hospital as a government makes it a government hospital. And at this time you have been working there for 11 years.

[C]

You are right, yes.

[B]

Which year was it that you delivered your first baby?

[C]

1982.

[B]

That's when you delivered your first baby?

[C]

Yeah, yeah. 82.

[B]

At this point Robert preferred to express himself in Swahili with a voiceover. I asked him what he remembers about the first time he helped a woman deliver a baby.

[A]

Yes, that night I helped a woman deliver at 2am this woman had been brought from the neighboring Pocott county while I was still serving at Kappedo Mission. After helping this mother deliver her baby, from that moment onwards I felt that my passion is helping mothers to deliver and I believe that is my calling. Serving with the mission hospital in Kapado, we had opportunity to deliver more babies than I have had while working with government hospital here in Gorong Barengo County.

[B]

Had you been trained?

[A]

Yes, I had been trained by missionaries from Finland. We had been exposed to sufficient practical lessons going out with the missionary nurses to help deliver babies.

[B]

You helped this woman give birth at 2am in the morning. Do you remember how you were called to go and help? Was it an emergency?

[A]

No, it wasn't an emergency.

[B]

It wasn't an emergency.

[C]

It was a normal delivery.

[A]

It was a normal delivery. We were under the mission organization. So the first woman I helped deliver, I remember very well. Her name was Sarah Paulo from Turgan. She had been brought to Capedo to deliver. I was on duty for the first time since completing phase one of training as a nursing aide. And that responsibility was handed to me.

[B]

Right. First opportunity as a nursing aide and you had a chance to help her delivered. She'd been admitted into the hospital. Was it difficult because you're a man? Was it difficult for you to help mothers deliver?

[A]

I did not find it difficult at all because the missionaries had trained us, we had done practicals, and they were right there with me. So I didn't find it challenging, to be honest. Two nurse sisters had been assigned to supervise me. I was confident. I wasn't shy about it because I was passionate about what I was doing.

[B]

You were not shy about it?

[A]

Not at all. And I guess that is why they still come to my home, even at night.

[B]

But I'm sure some men would have hesitated to allow their wives to get help from male midwives because of cultural reasons.

[A]

Culturally, the people here do fear. But for me, because I had joined the work through church, I did not have reasons to fear, as I was only offering help. But you see, this is a practice that is not wholly embraced here culturally.

[B]

Right. Do you remember an incident where you were confronted by another man because you are helping his wife deliver?

[A]

Not at all. Not at all. You know, for me, it is work. When I was transferred here in Ngorong, Baringo county, the people saw me as a professional carrying out my duties. They have accepted me. Even the men, when they see their wives start labor pains, they are quick to reach out to me. Men here are okay with me, and the patients too, are very comfortable with me.

[B]

So even the patients who are comfortable with you assisting them?

[C]

Yes.

[B]

I wonder, what is the process of delivering a child? Right from when the woman begins to feel the birth pangs to the moment where you put the child in her hands.

[A]

You know, the labor process involves several stages. When birth pangs begin, you make the mother lie down. You assess how the baby is coming out and whether it is in a good position. Now, there are quite a number of things you can assess and determine if she will have a normal sieve delivery. Then the second stage follows, and then the third stage, which is really about the baby coming out.

[B]

Lots of pushing.

[A]

Oh, yes. But during the process, you must not be harsh with a woman. Treat her with dignity, be gentle with her. You know, there Are some hospitals where nurses are not polite and are always in a rush, making the woman fearful. But for me, I dedicate myself. I sit next to her and I treat her gently. If she wants water or milk, I get it for her that there might be complications, she might even vomit. But you need to persevere and treat her gently until the stage where the baby starts to come out as she pushes. As a midwife, there will be a point at which you can see the baby isn't very far. It will be out soon. And that is the moment to say to the mother, look, the baby is almost yours. Now you just need to make the final push that makes her feel like she already has the baby. Then when the baby comes out, you quickly cut the umbilical cord, you wipe the baby and quickly hand it over to the mother to feel the smell. You very quickly place it on her chest, near the breasts. And while she is mesmerized at seeing her bundle of joy, that is when you complete the rest of the process.

[B]

Have you ever seen a complication happen during delivery?

[A]

There are complications, but not often. Because when the woman is brought to me, even at night, I have the necessary tools for assessing whether it is going to be a normal delivery or not. Then I make a decision as to whether I should refer her to the main hospital. I have referred so many of them to Kapenguria and to Cabrarnet hospitals. When I have observed the baby's position wasn't going to allow for normal delivery. When they get to the hospitals I referred them to, an operation is performed on them to remove the baby. And I have referred so many of them.

[B]

So you don't do any surgeries yourself?

[A]

No, I don't perform surgeries. My work is to assess if it is going to be a normal delivery or not. Once I determine that, I make her lie down. You know, sometimes a woman can be in labor for up to six hours or even 10. But if it goes to two or three days, then I obviously know there is a challenge and I have to refer her to hospital for safer delivery. Sometimes I can observe and see the head of the baby is not well positioned. Other times I can tell the woman is carrying twins. And that is when I refer her to the main district hospital and the medics there find it is exactly as I had observed.

[B]

What has your work taught you about life? When you see all these children being born, what does it teach you about life?

[A]

You know, as I said earlier, this is a calling for me. It is my passion. I took it up because I myself, I was born with a physical deformity right from birth. When I was born, my left leg was operated on by the Africa Inland Church flying doctors because I was sure I wanted to help others in the same way as I was helped. After the second year of my secondary school education, I went to the missionaries and told them I wanted to help others too. I had a physical deformity from the womb caused by polio, but they were able to straighten my affected left leg. So if you look at me, you can see I have a slight disability. But I can tell you this left leg was only straightened through operation. After I was born, I offered myself to be of help to children the same way I received help at a time no one was sure that I would live.

[B]

So, have any of the children been given your name? Are there children who have been named after you?

[A]

Oh, many, many. So many of them, my friend. There are so many of them in Nyang area, and it's even a bigger number in the nearby villages. My names are Robert Aule, and many have been given both names, while others have been given my surname, Aule. Some have become teachers, others have become doctors, others are nutritionists, and there are technicians. So many. Wow.

[B]

You consider all of them your children, right?

[A]

Totally, yes. Some even do remember me every once in a while and send me some money. It could be 3,000 Kenya shillings or 2,000, they say have that for groceries. They do invite me to their weddings and to their children's weddings. They are also growing old, if you consider I am now 63. These people, they must not be in their 40s or older.

[B]

You're listening to the BBC's Africa Daily podcast with me, Alan Kasuja. And today I'm discussing why there are so few male midwives. My guest, Robert Aule, has made her name by helping deliver hundreds of of babies in the remotest villages of Kenya's Rift Valley, where having male midwives is not a very welcome idea culturally. I asked Robert what challenges he has faced in his work.

[A]

This place where we are is near the border between Turkana and Pokot counties, two very remote areas. Most of the patients I attend to come from the Pokot community. There are no dispensaries in this area and no nurses. So they have to come here to Ngorong, where I observe whether it is likely to be a difficult birth. If necessary, I refer them to the main hospital. We don't have an ambulance here and there are no doctors in Koret, Kapow and Kambi villages. We only have a dispensary here in Ngorong. Sometimes women have lost their lives on their way here. We have had cases where a mother bleeds to death, but the baby survived. It's a difficult situation without an ambulance. There are only three dispensaries in the Wada area and that is a challenge.

[B]

Yeah. So are you still actively. When was the last time you helped a mother deliver?

[A]

Or even yesterday? In the month of January. I helped deliver four babies in February. It's been two so far.

[B]

Do they pay you for your services?

[A]

Nah, they don't pay me any money. I only do this as a way of giving back because I myself received help when I was born.

[B]

How many kids have you delivered so far?

[A]

In total, I think it is 544.

[B]

Probably about 544 children.

[A]

Yes, because the total number in ngorong area is 320. There are those I help deliver in Kappedo. And remember, I haven't counted those. I have referred.

[B]

Would you encourage more men to become midwives? If I came to you and asked you if I should be a male midwife, what would you say to me?

[A]

I certainly encourage you to join.

[B]

You think it's good for men to be midwives? To participate in childbirth?

[A]

Oh, yes. But, you know, culture remains an issue here. It is definitely a matter you'd come face to face with if you offer to help as a male midwife. There are some men who have been joining the church and from there I'm sure two or three may want to join. And if they want to become midwives, I'm here to welcome them.

[B]

What has been the greatest benefit for you in as far as your work is concerned?

[A]

I'll tell you the truth. I'm not in this for any benefit. My fulfillment comes from committing myself to helping these people, my community. This is because I was born with a physical deformity, like I said earlier, but I was treated at birth by the missionaries. So, yes, I appreciate the little I get from the government as a support staff. But my greatest fulfillment for me is in helping this community.

[B]

Many thanks to Robert Aule for taking time to talk to me. Africa Daily is a BBC World Service production. This episode was produced by Peter Msembi. Our editors are Mailenda Zochiori and Simon Peeks. Remember to listen now to our sister podcast, Focus on Africa. Three stories every afternoon from the continent. And if you have thoughts on today's podcast, you can email us africadailybc.co.uk or just find me on X, formerly known as Twitter, My handleasuja and that's with two Js. Thank you for listening.

[A]

Sam.