We all know that every woman has a basic right to accessible antenatal care, a safe delivery with a trained midwife, and quality perinatal care, but what happens when the number of midwives is far too few to deliver every baby? 92% of all maternal and newborn deaths, and stillbirths occur in 73 low- and middle-income countries. And yet those countries only have 43% of the midwife workforce, according to the newly-released State of the World’s Midwifery Report: A Universal Pathway: A Woman’s Right to Health. The report maintains that educated and well-trained midwives based on international standards can readily fulfill 87% of the service need. And, even more importantly, can reduce the number of maternal and newborn deaths by two-thirds.
Since the inaugural State of the World’s Midwifery Report was released in 2011, there have been marked improvements in global midwifery. Countries are scaling up education programs to train more midwives and are paying midwives more. They are attempting new and innovative ways to retain more midwives, especially in the rural areas, and are attracting more midwives to the profession. Professional midwifery organizations are also providing continuing education for midwives who need advanced training in quality care.
There are challenges, however.
Investments, resources, tools, and accountability are all needed in order to grow the number of midwives, especially in sub-Saharan Africa, where the number of pregnancies has increased by 50% since 1990. The population of Ethiopia, for example, is projected to skyrocket to 137.7 million in 2030 from 91.7 million people now. Without a large midwife workforce many deliveries will continue to be unattended by a skilled professional with the potential for millions of wholly preventable maternal and newborn deaths.
It’s no secret that midwives save lives and push countries further to achieve the Millennium Development Goals. Practically speaking, midwives’ training prevents sepsis and hemorrhaging in women. Midwives provide critical care for newborns and they also provide family planning awareness, education, and services. Without midwives’ professional, quality care many more women and their newborns would succumb to preventable causes. Midwives are critical to keeping women, babies, and children alive.
“Midwives make enormous contributions to the health of mothers and newborns and the well-being of entire communities,” said UNFPA Executive Director Dr. Babatunde Osotimehin.
“Access to quality health care is a basic human right. Greater investment in midwifery is key to making this right a reality for women everywhere,” he added.
Investments, as aforementioned, are critical to scaling the midwifery workforce among the 73 “Countdown to 2015” countries highlighted in the new report. Educating midwives has a 16-fold return on investment, but first countries must convince more women and men that being a midwife is a profession worth pursuing. Some countries have launched midwifery prizes and awards, such as the African Union’s Mama Afrika award to attract more midwives into the workforce, the report notes.
“I trained here as a nurse,” said Sister Regina Lutaaya, from Uganda, one of the countries covered in the report. “But I went into the rural areas, and there I discovered that we had only one midwife, that she could not do what she was supposed to do because of the overwhelming numbers of mothers.”
After that experience, Ms. Lutaaya decided to become a midwife.
There’s no question: the world needs more midwives. The Every Newborn Action Plan that was adopted by the 67th World Health Assembly on May 24 in Geneva has provided a roadmap for a continuum of care that places midwives at the heart of reproductive, maternal, newborn, and child health. And the new State of the World’s Midwifery report lays out a pathway for better health for women and their babies by 2030. Now, it’s just a matter of global implementation.