May 5th is the International day of the Midwife. The theme for this year is Midwives: Critical in every Crisis, focussing on the important role midwives have during global and local emergencies. Midwives work in many challenging situations. Ahmed Abdi Abdulahi, New Ways Communications Officer, celebrates here the work of Maryan Hajji, midwife in Somalia, and the legacy of her long career.
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Sixty-two-year-old Maryan Hajji has embarked on a remarkable career that began in 1987 when she enrolled in her first Civil Service Nursing School in Mogadishu at the age of 22. A mother of seven, Maryan was born in the rural town of Walanwayn in the Lower Shabelle region of Somalia in 1963. She never imagined that she would have the opportunity to attend school; however, that dream became a reality when her father took her to Mogadishu to start a new life. Maryan recalls her excitement upon learning of her acceptance into the nursing school in 1987. As her nursing journey began, her path in midwifery transformed her career and life for decades to come. She graduated with a diploma in midwifery in 1999, fulfilling a dream she had long awaited. However, as Maryan entered the workforce in late 1990, Somalia’s civil war erupted. “I was thrilled to start a new job and career that I had worked so hard for,” Maryan recalls, but “everything changed overnight,” she remembers. As the fighting intensified in the capital, Mogadishu, Maryan had no choice but to flee the city.
For years, Maryan had lived in peace, and fleeing a country she called home was “unfortunate and untimely.” She reflected on her departure from Mogadishu as war raged in the capital. “Somalia’s golden era of peace and stability was coming to an end, but I was grateful to have graduated just before the onset of the war,” she said. As uncertainty regarding Somalia’s impending conflict grew, Maryan decided to board a boat bound for Marka, a small and historic coastal town about a two-hour sail from Mogadishu. Gradually, Maryan began to rebuild her life and continue her midwifery career in her new home of Marka.
Maryan began her first midwifery job in Marka and had a stable life there since 1990; however, the new environment was not ‘conducive to her growth and family.’ During her time in Marka, she safely and successfully delivered countless babies. In 1991, Maryan joined UNICEF’s neonatal centre in Wardhiigley, where she worked as a registered midwife. For her, working with UNICEF Somalia was a stepping stone toward her aspirations for a career with the United Nations and non-governmental organizations (NGOs). She later joined Concern Worldwide, an Irish organization that has been ‘present in Somalia since 1986.’ Maryan pursued a career in NGOs, and throughout her time as a midwife, she has worked for several organizations, including the New Ways Organization, where she currently serves as a registered midwife at the Malable Health Centre in Walanweyn, Lower Shabelle. During her tenure at Banadir Health Centre, UNICEF, Concern Worldwide, and now the New Ways Organization, she has saved countless pregnant mothers and infants through her maternity expertise and counselling in some of the most challenging health environments for women.
One of the most complicated and memorable cases that Maryan recalls from her 34 years as a midwife occurred in 1991 when she was brought to a heavily expectant mother who was in labour. According to Maryan, the woman was in labour for five days, which she found ‘strange and unique.’ When she had realized that the woman was in a critical labour condition and help was not available at her centre, she decided to speak with the locals about raising money for her so that she could be referred to a hospital in Mogadishu, which was a three-hour drive away from her health centre. After two days, the struggling pregnant woman was taken to Mogadishu, but she couldn’t give birth, and she was still in a complicated labour condition, which posed a challenge for the doctors and midwives. Unable to grasp the full extent of her prolonged labour and pain, the woman was returned to her town, where Maryan was working, while she was still in labour and experiencing the pain of childbirth.
When Maryan discovered that the woman had come back without delivering, she had to make a critical decision to save the mother and baby in time. As stated by Maryan, the process required slicing a portion of her uterus and the anterior section of her vagina to facilitate the baby’s delivery. The woman had no choice but to accept Maryan’s proposal. To some extent, the woman knew that Maryan’s decade-long midwifery experience meant that anything she recommended was worth trying. “In firm conviction and trust in God,” Maryan decided to consider any alternative to save the pregnant woman and baby. And after intense hours in the delivery room, Maryan emerged holding a healthy baby. The news that the woman had given birth successfully relieved everyone, including Maryan herself. “Everyone was happy that day, and I was extremely happy too,” Maryan said, reflecting on the tense situation in the delivery room. “This is just the tip of the iceberg given the prevalence of maternal deaths in the country,” she added, acknowledging the maternal and neonatal care challenges in Somalia. “There are hundreds of cases like that woman, who knows,” she said, “but we are doing everything we can to save as many lives as possible,” Maryan said in an assuring and confident voice.
One of the four biggest challenges to maternity care and the safe delivery of babies in her 34 years of experience as a senior midwife is FGM, also known as Female Genital Mutilation. For years, Maryan has vividly spoken about the short- and long-term consequences of Female Genital Mutilation on women’s reproductive, obstetric, and psychological health. In her 34 years of service as a midwife, trainer, and FGM advocate, Maryan has come across hundreds of cases of FGM-related birth complications. She believes that if enough action is not taken to eradicate the harmful practice, it will lead to many maternal deaths in areas that lack access to neonatal and birth services. Despite recent successes in reducing the practice, Maryan thinks it’s not easy to eliminate FGM entirely. Despite her full-time job at Malable Health Centre, Maryan’s responsibilities extend beyond delivering babies; she occasionally conducts community awareness sessions to educate others about the harmful practices that hinder women’s reproductive and sexual health. For years, New Ways Organization has worked to address FGM through its women’s empowerment programs in Marka. New Ways provides training and community awareness-related programs in areas where the practice is prevalent. We work closely with survivors and victims of FGM in their journey to recovery and support their efforts to build a dignified livelihood that is free from fear and stigma.
Impact of conflict on healthcare
Another challenge to maternity care in Somalia that Maryan has learned since the start of her career in 1987 is the ongoing war on healthcare facilities and workers. The protracted conflict in Somalia has devastated healthcare infrastructure. Many health facilities have been destroyed or are non-functional due to violence and instability. This has led to widespread displacement and a lack of access to essential health services for pregnant women. The insecurity affects the ability of midwifery students and graduates to practice safely; many are unwilling to accept job placements in remote or conflict-affected areas due to safety concerns.
Barriers to Education and Workforce Participation
Maryan strongly believes that lack of investment in healthcare education is another factor contributing to maternal deaths in Somalia. Midwifery education in Somalia is fraught with challenges. A rapid assessment revealed that “educational programs often do not meet national or international standards.” Factors such as inadequate training resources, poor infrastructure, and limited clinical practice opportunities significantly impact the quality of education received by midwifery students. Additionally, societal norms often prioritize traditional birth attendants (TBAs) over trained midwives, leading to distrust in young female practitioners who are perceived as lacking experience. In terrifying accounts of birth experiences in her facility and beyond, Maryan recalls a moment when she walked for five straight hours in the heat to reach a woman who was struggling to give birth in the countryside after hearing that the woman was experiencing labor complications. “I work everywhere and every time,” Maryan said, acknowledging the lack of resources and neonatal and maternity services in the country.
Societal Norms and Gender Roles
According to Maryan, cultural expectations place significant pressure on women in Somalia, often prioritising marriage over career aspirations. Many young women face discouragement when pursuing careers in midwifery due to societal beliefs that devalue women’s professional roles. Despite these pressures, many aspiring midwives express intrinsic motivation driven by a desire to improve maternal health outcomes in their communities.
The combination of a critical shortage of trained midwives, ongoing conflict affecting healthcare delivery, barriers within educational systems, and restrictive gender norms creates a multifaceted crisis for midwifery in Somalia. Addressing these issues requires comprehensive interventions aimed at improving educational standards, ensuring safety for healthcare workers, and changing societal perceptions about women’s roles in healthcare. Despite her age and environmental factors affecting her life, Maryan continues her work in Walanwayn, Lower Shabelle. When asked if she hopes to retire anytime soon, Marya ruled out any possibility of hitting the hay. “I want to keep working for as long as I can,” Maryan said, reflecting on the overwhelming nature of her work at her Centre as a midwife. “The work of a midwife is hard; you have to be on duty all the time, you never know when someone will arrive at the centre.” Currently, the Malable Health Centre, funded by UNICEF and the Somalia Humanitarian Fund (SHF), is the only free delivery service centre in Walanwayn district and surrounding villages. The health centre provides antenatal care, free delivery, child nutrition, and immunization services to an estimated 800 clients each month. Other services include a counselling and nutrition section where breastfeeding and malnourished mothers receive support.
The story of Maryan is a powerful testimony to the role of women in driving changes in the fragile healthcare system in Somalia. Maryan is grateful to her decades of work and described the 34-year long experience as “rewarding and fulfilling.” The work of Maryan is just more than a typical success story, it deserves attention and recognition of her decade-long community and health service. In celebration of the upcoming International Day of Midwife, New Ways urge UNICEF Somalia, Somali Ministry of Health, New Ways Organization, UN Women, World Health Organization and International Midwifery Association and other health organizations to recognise and celebrate the work Maryan has done for the Somali people for the last 34 years and counting.
Ahmed Abdi Abdulahi
New Ways Communications Officer, Somalia
April 2025
This article was previously published on the New Ways Organization website. Defying the Odds: Celebrating the Work and Legacy of a Somali Midwife. More about the charity may be found at https://new-ways.org.so/
Further information about the International Day of the Midwife #IDM2025 is available on the International Confederation of Midwives site. International Day of the Midwife 2025 Theme Announcement | International Confederation of Midwives
More about midwives in crisis situations is in this article https://maternityandmidwifery.co.uk/optimal-maternity-care-in-times-of-crisis-insights-from-new-zealand/