A male midwife’s journey to ensuring healthy mothers and babies in Samoa

Tucked on a small hill overlooking the ocean is the Lufilufi Health Centre, a community health centre in Samoa that serves 24 villages with about 11,000 people, where midwife and nurse Fatumanavaoupolu Tuiuli Tagaloa is employed. He has been the Principal Nurse at this health facility for two years, overseeing 25 nurses and four midwives.

"Becoming a male midwife, it's a gift. For me, it's a gift from God," he said, reflecting on his path that was influenced by his grandmother, who was a traditional birth attendant.

Fatumanavaoupolu Tuiuli Tagaloa's journey to becoming a midwife is as inspiring as it is unique. As one of the few male midwives in Samoa, he has had his fair share of interesting experiences. He recalls an incident when there was a pregnant woman who came in, noticed he was a male midwife, and requested a female midwife instead.

"There are still instances where a mother that's new or not familiar sees you as a male midwife, and sometimes they might say they don't want [my service]. That's part of the job. You need to respect their dignity and their rights," he explained.

At Lufilufi, Tuiuli's role is multifaceted. He oversees both clinical and community health services, ensuring that Lufilufi Health Centre, which will soon be officially upgraded into a district hospital, operates smoothly while also providing outreach services.

"For my current position, I am overseeing our district hospital. Not only the clinical side but also the community side. I have my charge nurse for the clinical and a charge nurse for the community. So, we work together. We plan something to improve the service, not only the clinical, but back in the community," he said.

^{Fatumanavaoupolu Tuiuli Tagaloa, Principal Nurse and Midwife at Lufilufi Health Centre. Photo: WHO/Faizza Tanggol}

While his administrative responsibilities has increased in his current role, he continues to offer clinical services when necessary. He shared a recent experience: "Yesterday, before I left the facilities, there was a labouring mother. I went back home quickly, came back, and assisted in the delivery. This morning, there's a healthy mother and a healthy baby. They're all fine." Such moments bring to light the importance of having skilled, locally-based midwives in the community.

One of the most significant challenges Tuiuli faced was ensuring that expectant mothers received timely and consistent antenatal care by scheduling antenatal check-ups with the midwife to prevent avoidable complications. "While I'm working as a midwife back here in the community, there's a lot of challenges. First one, late bookings. Second one, the inconsistency of visits from the mothers. Third one, unbooking mothers come in for deliveries, but I haven't seen them before. And the fourth one, those we send as referrals to the main hospital, they come back without going to the hospital," he shared.

To address these issues, Tuiuli and his colleagues at Lufilufi Health Centre have established a community outreach team that works closely with the Komiti o Nuu (village councils) and families to promote early and regular antenatal visits. This initiative has helped decrease the number of expectant mums with late or no antenatal check-ups at the health facility.

Before pursuing a career in midwifery, Tuiuli worked as a theatre nurse at Tupua Tamasese Meaole Hospital in Apia for nearly a decade. His operating room experience with critical cases and surgical procedures gave him a solid foundation in nursing. However, in 2019, he decided to resign from his position to take care of his parents and return to his home village. This transition marked the beginning of his midwifery career, motivated by the need for more midwives in his community. "In 2020, I enrolled as a Midwifery student," he recalled.

The support from the World Health Organization (WHO) has been instrumental in Tuiuli's midwifery journey. Through the WHO Fellowships Programme, Tuiuli pursued his postgraduate degree in midwifery at the National University of Samoa. The WHO Fellowships Programmedevelops capacity in the Western Pacific Region by preparing health staff from countries to take on leading positions in their health services through technical capacity building, both in undergraduate and postgraduate courses as well as short-term and long-term programmes. Since 2012, WHO has supported over 100 fellows from Samoa in medical and allied health fields through undergraduate and postgraduate programmes, strengthening health workforce capacity in various health-related areas. To date, over 50 midwives from Samoa have received support through the WHO Fellowships Programme.

"By the help of that programme, the WHO Fellowships Programme, all my dreams have come true, and my vision of being a midwife has been fulfilled," he said with gratitude.

Pacific island countries, such as Samoa, are collaborating closely with WHO to enhance maternal health care throughout the Western Pacific Region, extending their efforts beyond individual capacity building. The Region has made significant progress in reducing maternal mortality, with the maternal mortality rate declining from 49 per 100 000 in 2010 to 35 per 100 000 in 2023. This progress is a testament to the leadership of ministries of health, the continuous support from partners like WHO, and the dedication of health professionals.

Midwives like Tuiuli are the backbone of primary health care, providing invaluable health services to women and newborns. With his ongoing commitment to midwifery as a career, Tuiuli remains motivated to support mothers and babies in his community.

"There's a lot of mothers that came in asked for me. So that tells me they all trust me with my service delivering the care," he said. "This profession is not very usual for men, but for me, I feel glad that I became a midwife to provide the quality service for our community."

^{Tuiuli (centre) alongside some of the nurses and midwives at Lufilufi Health Centre. Photo: WHO/Faizza Tanggol}

World Health Day 2025 raises awareness about the importance of ramping up efforts for maternal and newborn health, featuring the campaign theme, Healthy beginnings, hopeful futures. In Samoa, the Ministry of Health works closely with partners like WHO, UNFPA, UNICEF, Australia's Department of Foreign Affair and Trade, New Zealand's Ministry of Foreign Affairs and Trade and The Pacific Community to help improve maternal and child health.