Making evidence a reality

02 May 2023

From my PhD study I hope to provide evidence that can become a reality for midwives working in rural and remote communities in resource-limited settings.

Kristen Graham is a midwife, nurse, educator and researcher.   

A PhD candidate at the ANU National Centre for Epidemiology and National Health, Kristen's doctoral work explores the preparedness and readiness of primary care midwives for emergency maternal and neonatal care in rural and remote resource-limited settings. 

The theme for this year's International Day of the Midwife on 5 May is Together Again: From Evidence to Reality - a theme that couldn't be more relevant to Kristen's PhD.  
"From my PhD study I hope to provide evidence that can become a reality for midwives working in rural and remote communities in resource-limited settings." 

Beginning her career as a nurse and midwife, Kristen has worked with midwives in refugee and rural communities on the Thai Burmese border, Sierra Leone and Timor Leste and has experienced and observed the many challenges midwives face working in this context.   

"I have seen the impact of poor quality maternal and neonatal care which comes from a lack of adequate preparation and support to ensure midwives are ready to provide timely quality care," Kristen says.  

"I want to find ways to further strengthen and support this essential workforce." 

Despite significant progress towards improving global maternal and newborn health outcomes, an estimated 810 women still die each day from pregnancy and childbirth-related causes around the world. This is the equivalent of two Boeing 777-200 planes crashing each day.   

Additionally, each year 2.4 million newborn babies die,and 2 million babies are stillborn.  

"Most of these deaths occur in low and lower-middle-income countries (LMIC) and almost all are preventable." 

"Many deaths result from delays in accessing health care, however up to 62% of deaths are attributed to poor quality health care." 

Kristen believes that trained midwives are the answer to this global problem.  

"When trained to international standards and working in a supportive environment, midwives can provide 90% of essential sexual, reproductive, maternal, newborn and adolescent health services." 

However, midwives working in LMIC are often ill prepared and not well supported for the unique challenges of the rural and remote primary health care context.   

New graduate midwives are often deployed to rural and remote communities with very limited professional experience, which can be challenging for them and the communities they serve.  

From her own experiences working with midwives, Kristen has seen an urgent need for finding ways to better prepare and support primary care midwives to provide quality emergency maternal and neonatal care in rural and remote communities in LMIC.  

After her PhD, Kristen plans to work in a development or academic role to action recommendations from her doctoral work and to contribute to strengthening workforce capacity to improve maternal and newborn health outcomes. 

This month, Kristen will travel to Cape Town this month for the inaugural 2023 International Maternal Newborn Health Conference, and in June will present her PhD study at the 33rd International Confederation of Midwives Triennial Congress  in Bali.