By: Mapule Motsopa
Africa-Press – Lesotho. In the highlands and valleys of Lesotho, midwives are quietly reshaping the nation’s health landscape.
Once considered an exclusively female profession, midwifery is now attracting men, non-binary practitioners, and women alike.
These caregivers navigate remote communities, scarce resources, and deeply rooted gender stereotypes to provide life-saving care.
Their work is not just about delivering babies; it is about breaking barriers, earning trust, and strengthening a health system that has long struggled with staffing shortages and uneven maternal care.
One such is Karabo Lelimo, a former Registered Nurse Midwife at the Lebakeng Health Centre in Qacha’s Nek.
“Nursing wasn’t my childhood dream. I was passionate about technical fields, especially electronics, and aspired to be an engineer,” he said.
His path shifted one November afternoon when he watched a programme called Ntataise on Lesotho Television, featuring students from Paray School of Nursing. “Something clicked inside me. I enjoyed the programme, and I knew that’s what I wanted to study,” he said.
Around the same time, his grandfather returned from eye surgery at Queen ‘Mamohato Memorial Hospital. “I helped him with his medication, and every time he called me, I felt genuinely fulfilled. That simple act awakened in me a deep desire to care for others,” Lelimo explained.
At the start of the new year, he applied to all nursing schools in Lesotho, and Maluti Adventist College responded first, a sign he took as confirmation. Lelimo began practicing midwifery in August 2018 as a volunteer at Berea Hospital.
By October, he joined a private hospital in Maseru, gaining exposure to higher clinical and ethical standards. In August 2019, he moved to Lebakeng Health Centre, a Christian Health Association of Lesotho-affiliated institution, where he felt prepared for the emotional and ethical demands of midwifery.
“I learned to view patients holistically, not just as clinical cases, but as people with emotions, fears, and dignity. That foundation has always helped me serve with compassion,” he said.
Initially, Lelimo faced skepticism in the private sector due to being a male midwife, where clients are often more informed and assertive.
“But I embraced the challenge and earned their trust through professionalism and respect. At Lebakeng, clients were often illiterate and underserved, yet humble and welcoming. They had never experienced care marked by respect and empathy. When they did, they embraced me fully, not just as a caregiver but as someone they could trust.”
Despite the hardships, Lelimo finds magic in the work: walking with a woman from antenatal care to childbirth and postnatal care. “It’s a miracle every time. The pain of labour, the first cry of the newborn, it never stops being magical. Science can explain it, but the sacredness of birth remains a mystery.”
Many might assume that being a male midwife in a multicultural, largely illiterate community like Lebakeng would be difficult. “But my experience has been the opposite. People observe you closely at first, but once they see that you are professional, respectful, and genuinely there to serve, they open up. Trust is universal; it’s not about gender. It’s about integrity, humility, and care,” he said.
Lelimo also reflects on the gender dynamics of the profession.
“Midwifery is female-dominated, and sometimes male voices are hardly heard. This can result in division and limits our ability to give advice, especially when decisions are driven more by emotion than logic.”
Another male nurse midwife, Ha-Thube native, Seeiso Taunyane, who works at Mosafeleng Health Post, Qacha’s Nek, said his love for helping people drew him to nursing.
“Often, people need help with their health, so I wanted to offer that help and be part of a larger community providing care,” he said. He was aware that nursing involves midwifery. “Every successful childbirth is fulfilling. The feeling of seeing a child take their first breath is unmatched, and that first cry is magical, it’s exciting,” Taunyane said.
Gender norms did not influence his decision, even though he comes from a community where midwifery is “still considered women’s work.” “It is not socially acceptable for a male to be a midwife, but that didn’t stop me because this is the career I chose, and here I am today,” he said.
He has not faced many stereotypes from patients. He notes that many patients, even women, sometimes prefer male midwives, appreciating the compassion and professionalism they bring, reinforcing that trust transcends gender.
Reflecting on his first experience assisting in childbirth, a mother who was not giving birth for the first time, he recalled, “She was very welcoming, maybe because she had previously been assisted by a male midwife. She was even excited to be helped by me.”
Taunyane observed a noticeable shift in the profession. “Although midwifery has traditionally been female-dominated, more males are now joining. When I attended the National University of Lesotho around 2018, educators were very supportive, and my class was male-dominated for the first time.”
A female nurse midwife from Kolo Health Centre, Mafeteng, Mathabo Thabisi* said she had wanted to be a nurse since age five, inspired by seeing nurses in their uniforms as a child, a fascination that grew into a passion for caring for others. “Even after completing Form E, I applied for nursing only. I didn’t know about midwifery until I became a student nurse. After general nursing, midwifery was compulsory,” she said, raising concerns about the requirement.
On gender-based stereotypes, Thabisi said she had not personally faced many, perhaps because she is female. She observed that some patients believe male nurse midwives are gentler, though she herself has never faced resistance due to her gender.
She added that some patients assume male nurses are doctors, which sometimes creates challenges for female midwives who must assert their role.
From a non-binary perspective, Lethabo Noosi*, a nurse-midwife in an urban clinic, added: “Being non-binary in midwifery comes with unique challenges. Some communities react with surprise or discomfort initially. But patients eventually see that care is about skill and empathy, not gender. Witnessing a safe childbirth and knowing I contributed is profoundly rewarding. Diversity in midwifery isn’t just about equality; it improves health outcomes for everyone.”
Noosi* reflected on their own motivation: “I became a midwife because I care about women and newborns. Every birth I witness safely reinforces why this work is so critical. It’s challenging but deeply rewarding.”
These personal stories illustrate a national challenge: Lesotho has one of Southern Africa’s highest maternal-mortality rates.
According to the Roma College of Nursing team, including Principal Nurse Educator Mrs. Lydia Keketsi-Mokotso, College Rector Ms. Mabataung Litsebe-Ts’uhlane, Clinical Supervisor Ms. ’Matumisang Rapitse, Head of Midwifery Programme Mr. Kabelo Koaatsa, and Senior Nurse Educator Ms. Thato Tsiane, female midwives still outnumber male midwives significantly.
“However, the number of males enrolling in nursing is increasing over time, and many pursue post-basic midwifery, even though females still outnumber them,” said Mrs. Keketsi-Mokotso.
She explained that policy changes and opportunities in the profession have driven this shift. Previously, the National Manpower Development Secretariat (NMDS) mandated a quota for male students in government-sponsored programmes, though later selections were based on merit regardless of gender.
Higher Education guidelines and Sustainable Development Goals 4 principles promoting equitable and inclusive education have further supported access for all genders.
Midwifery is compulsory in Lesotho due to the country’s challenging terrain, ensuring that nurses can provide a wide range of services, including maternal care, wherever they are deployed.
Mrs. Keketsi-Mokotso noted, however, that male nurse students sometimes lack interest or coping mechanisms for midwifery, and academically, male nurse midwives often perform below their female counterparts. She also observed incidents of document forgery during clinical placements among some male students and noted that male midwives can be vulnerable to gender-based violence.
“Training and support are carefully designed to address these challenges. Students undergo orientation where stereotypes are discussed, and guidance is provided on psychological support and respectful maternity care, including cultural sensitivities and client choice. During home visits, male midwives often pair with female midwives to reassure families uncomfortable with male caregivers.
Networking with peers and mentorship from experienced male midwives helps trainees navigate clinical placements successfully,” she said.
To encourage gender diversity, Roma College has increased quotas for male candidates and considered off-campus recruitment to attract a broader range of students. Community outreach and engagement are integral to the programme, helping students gain acceptance and clarify their roles regardless of gender.
Looking ahead, Mrs. Keketsi-Mokotso advocated for optional midwifery training rather than compulsory inclusion after general nursing, and for a direct-entry midwifery programme. She emphasised the importance of rewarding outstanding performance, providing career advancement opportunities, and mentoring as strategies to strengthen the profession.
“Resource constraints remain, particularly the lack of male nurse educators or clinical supervisors, which could attract more men to midwifery. We must continue advocating for public education, support for students, and professional growth opportunities, including advanced midwifery skills and improved remuneration, to improve maternal care and the profession overall,” she said.
Retired midwife Mrs. Nelly Fobo, President of the Independent Midwives Association Lesotho (IMAL), said nursing in Lesotho, like in many other countries, started as a female-only profession. Over time, it has become more diverse, with increasing male participation.
“Of late, we have seen a rise in males joining the career. Interest among them grows every year as they understand the importance of the profession,” she said, noting that one advantage of being a midwife in Lesotho is that every nurse begins as a general nurse before obtaining midwifery qualifications.
“Although midwifery is mandatory for all nurses, many only practice it because it is required, not because they love it,” she explained. Within IMAL, the number of male members has grown significantly, with some taking leadership roles in the executive committee.
“The interest is increasing partly due to annual career guidance and expos organised by the Council of Higher Education, where students learn about health professions. Word of mouth from practicing midwives also promotes the rewards of the career,” she added.
Mrs. Fobo emphasised the satisfaction of working with mothers and children: “Delivering a child successfully is extremely rewarding, even though maternal mortality still exists.” She also noted that in many communities, male midwives are preferred.
“As females, we have experience and understand the physical pain of childbirth, but that does not automatically make us better at managing labour for others. Sometimes female midwives can speak harshly, which violates patient trust, whereas males tend to be more understanding and compassionate,” she said.
IMAL is working to address attitudes among female nurse midwives, acknowledging that systemic challenges remain due to limited representation on the Lesotho Nursing Council.
Mrs. Fobo highlighted persistent gender bias: “Although midwifery remains female-dominated, IMAL notes that male nurse midwives are increasingly preferred in some communities, and their contributions are vital for improving maternal care outcomes. In hiring and promotions, females often occupy the highest positions, even when males have the same qualifications.”
She added that policies for gender equality are largely informal: practices change into law over time.
She said IMAL actively advocates for male participation and has even headhunted men for leadership roles. “Their contribution is vital. Public feedback shows they are preferred by patients, and their presence helps improve maternal care outcomes.”
However, challenges remain. Some midwives hold certificates but only practice because employers require it, leading to compromised care. “Making midwifery compulsory has advantages, especially in remote areas, but it also risks maternal mortality when people do it reluctantly. We are preparing to discuss these issues with the Lesotho Nursing Council,” she said.
“While no formal gender equality guidelines exist, this is a wake-up call for us to advocate for inclusion. There is still a long way to go,” she concluded.
’Maneo Seisa, a mother of two children, said she prefers male midwives during labour.
“Those people are very kind. I am not sure why women can be bitter when helping another woman. Sometimes, during labour, female nurse midwives intentionally make situations worse rather than being compassionate. I believe this comes from thinking they know the pain, so they expect you to just toughen up and be strong,” she explained.
She added, “Men, not having experienced the pain themselves and only hearing about it from others, are more considerate and caring throughout the process. Men are naturally soft towards women.”
The mother reflected on her own experiences: “During both deliveries, I was assisted by male nurse and female nurse midwives. On both occasions, the female midwives were rude, and I prayed they wouldn’t help me. The male nurse midwives, on the other hand, were soft-spoken and comforting while staying professional.”
She expressed hope that female midwives would improve their attitudes.
Another mother, Thabisang Makoa, the parent of a teenager, offered a more mixed perspective. “I have heard some women prefer men because they are gentle, but I was assisted by a female who was still gentle, so I am no longer sure,” she said. She personally prefers female midwives, noting, “For me, it’s uncomfortable to be seen naked by a man, especially as a Mosotho woman.”
An expectant teenage mother, Neo Makara shared a more troubling experience. She revealed that female nurses had stigmatised her from the start of her antenatal care.
“There was a time I wanted to stop going for regular check-ups because I couldn’t take it anymore. I am already being judged at home, and I thought at least there would be some sympathy at the clinic, being among people in similar situations… I really can’t wait to be done with this. Now I even regret keeping this baby,” she said.
She also recounted hearing stories of other young mothers facing harsh treatment. “One teen mom ended up losing her child because when she asked for help, the female nurses asked her what she knew about labour and told her to rest until it was too late,” she said, highlighting the serious consequences of unsympathetic care.
Globally, investing in a capable midwifery workforce saves lives.
According to UNFPA Lesotho, midwives provide essential sexual and reproductive health services, including family planning, often in hard-to-reach areas and humanitarian contexts. Yet a shortage of skilled midwives has halted decades of progress: every year, 287,000 women die during childbirth, 2.4 million newborns die, and 2.2 million are stillborn. Expanding universal access to midwives could prevent two-thirds of maternal and newborn deaths, potentially saving over 4.3 million lives annually by 2035 globally.
Evidence shows competent midwives can deliver 90 percent of essential sexual and reproductive healthcare, yet they provide only 10 percent of current services due to underutilization and shortage.
Midwife-led care improves health outcomes, patient satisfaction, and reduces costs. UNFPA has trained 350,000 midwives globally between 2009 and 2022 to improve service quality and strengthen health systems.
Meanwhile, Lesotho continues to face one of Southern Africa’s highest maternal-mortality burdens. WHO estimates 478 maternal deaths per 100,000 live births in 2023. While nearly all women give birth with a “skilled provider,” only 59 percent are attended specifically by a nurse or midwife, and the quality of care varies widely. Emergency obstetric care, essential for preventing deaths from complications such as haemorrhage and sepsis, remains unevenly accessible.
A 2024 health-workforce analysis reports only 20.7 health workers (doctors, nurses, and midwives) per 10,000 people in Lesotho, far below global thresholds for universal health coverage. Current staffing meets less than half of maternal-health service needs, highlighting the urgent shortage of midwives.
Lesotho’s National Strategic Development Plan (NSDP) I (2012/13–2016/17) and NSDP II (2018/19–2022/23) recognise maternal health, gender equality, and health workforce development as national priorities. NSDP I saw maternal mortality drop from 1,155 to 618 deaths per 100,000 live births, but failed to reach the target of 300.
NSDP II emphasises training, deploying, and retaining adequate health professionals, alongside gender mainstreaming. Despite these commitments, progress remains slow due to financial constraints, understaffing, and uneven rural deployment.
Nursing and midwifery in Lesotho remain overwhelmingly female. Male midwives are still a minority, concentrated unevenly across roles and facilities.
Training institutions produce graduates, but numbers are insufficient, and retention strategies lag, reducing service impact.
Research in Lesotho and Southern Africa shows nursing and midwifery are perceived as “women’s work,” with men facing stigma, restricted role opportunities, and pressure to move into other specialties.
WHO and the African regional office note that programmatic steps like maternal-death surveillance (MPDSR) and digital registers are in place, but maternal mortality remains above regional averages and SDG targets.
Maternal mortality reflects deep gender inequalities: when women die or suffer preventable complications, families, communities, and economies are affected. Strengthening midwifery is both a health intervention and an investment in women’s safety, dignity, and societal participation. Expanding midwifery in Lesotho is critical to achieving SDG 5 on gender equality and improving maternal and newborn outcomes.
Lesotho’s midwives are more than healthcare providers; they are agents of change, challenging gender norms, improving maternal health, and inspiring communities. With strategic investment, Lesotho could reduce maternal mortality dramatically, proving that gender-inclusive healthcare saves lives.
Source: MAPM
