Midwifery

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Overview

Midwives save lives. Well-trained midwives could help avert roughly two thirds of all maternal and newborn deaths, according to the most recent State of the World’s Midwifery report. They could also deliver 87 per cent of all essential sexual, reproductive, maternal and newborn health services. Yet only 42 per cent of people with midwifery skills work in the 73 countries where more than 90 per cent of all maternal and newborn deaths and stillbirths occur.

Since 2008, UNFPA has worked with partners, governments and policymakers to help build a competent, well-trained and well-supported midwifery workforce in low-resource settings.

UNFPA focuses on four key areas: providing a competency-based curriculum for all midwives; developing strong regulatory mechanisms to ensure quality services; establishing and strengthening midwifery associations; and advocating for increased investments in midwifery services.

Why are midwives needed?

The world has seen a steady decline in maternal and newborn deaths since 1990. Yet hundreds of thousands of women and newborns continue to die each year during pregnancy and childbirth. An estimated 289,000 women and about 3 million newborn babies died in 2013 alone. The vast majority lost their lives to complications and illnesses that could have been prevented with proper antenatal and delivery care – services provided by midwives.

The World Health Organization (WHO) advocates for "skilled care at every birth” by an accredited health professional, such as a midwife, doctor or nurse, who has been trained to manage uncomplicated pregnancies, deliveries and the immediate postnatal period. Skilled birth attendants also need to be able to identify complications and obtain timely emergency assistance.

As trusted health professionals, midwives play a critical role in averting maternal deaths and injuries, preventing newborn deaths, and collecting data when deaths do occur to help shape future responses. Midwives also help prevent mother-to-child transmission of HIV. Together, these activities help advance the global community’s progress towards reaching Millennium Development Goals 4, 5 and 6, the goals on reducing child mortality, improving maternal health and combatting HIV and AIDS, respectively.

What midwives do

Midwives – and people with midwifery skills – are the main caregivers for women and their newborns during pregnancy, labour, childbirth and in the post-delivery period. A well-trained midwife can provide comprehensive sexual and reproductive health information and services, including antenatal care, safe delivery care, and postpartum/postnatal care. Midwives also provide family planning counselling, services to prevent and treat malaria and tetanus, and services to prevent sexually transmitted infections, including HIV and congenital syphilis.

Midwives also help advance women’s and girls’ rights. By providing information and counselling, they can help to prevent female genital mutilation (FGM), and they can offer support and assistance to survivors of gender-based violence. They can also provide reproductive health services to adolescents, who are often denied access to these services at great cost to their health and rights.

Seventy-three countries have 96% of the world's maternal deaths, but only 42% of the world's midwives, nurses and doctors.

Credit: State of the World's Midwifery 2014Credit: State of the World's Midwifery 2014

The midwife shortage

Midwives, when properly trained and supported, offer the most cost-effective and high-quality path to universal maternal health care. Yet midwives are in short supply in many developing countries. And the deficits are highest in the areas where needs are greatest.

There are many challenges to increasing the availability of midwifery services. Despite the enormous responsibilities they bear, midwives – who are overwhelmingly women – frequently endure poor pay, low status and a lack of support. Those who work at the primary-care level, where they are most needed, often receive the least respect and support from the health system. Gender biases often play a role in the problems midwives experience.

What is UNFPA doing?

In 2013, nine interactive e-learning modules on midwifery skills and family planning were developed through a partnership between UNFPA and Intel. The lessons do not require an internet connection, and they can be accessed anywhere, at any time, free of charge, via low-cost laptops or netbooks that health workers will be trained to use. Reviewed and endorsed by the International Federation of Gynecology and Obstetrics, ICM, the International Council of Nurses and WHO, these modules can be translated into any language and the graphics can be adapted to suit local contexts.

UNFPA, together with a network of over 30 partners, works at the global, regional and national level to scale up midwifery services around the world. UNFPA and its partners also work to strengthen midwifery training, institutions, associations and regulations. For example, from 2008 to 2013, a joint programme by UNFPA and International Confederation of Midwives (ICM) placed 22 advisors in developing countries to support national midwifery efforts. UNFPA also builds expertise through the dissemination of guidelines and good practices, which helps policymakers and health professionals learn from experiences around the world.

Midwifery is a key focus of UNFPA’s Maternal Health Thematic Fundwhich helps train thousands of midwives each year. UNFPA has also provided books and equipment to over 200 midwifery schools, and has helped train over 7,000 tutors in life-saving skills, family planning information and teaching skills. With UNFPA’s support, over 40 national and sub-national midwifery associations have been strengthened, and midwifery curricula have been standardized or reviewed in over 30 countries. Higher education programmes - such as new bachelor’s degree programmes – have been launched in Cambodia, Ghana and Haiti, and a midwifery master’s degree programme has been introduced in Uganda. In 2013, UNFPA also helped to re-open the midwifery school in Haiti, which was destroyed by the 2010 earthquake.

Today, support for midwifery services is growing. Emphasis on midwifery in the UN Secretary-General’s Every Woman Every Child Strategy resulted in over 45 national commitments towards strengthening midwifery services. And the International Day of the Midwife is now celebrated around the world on 5 May, highlighting the importance of midwives everywhere.

The State of the World’s Midwifery

In 2011, UNFPA and 30 partners published the first-ever State of the World’s Midwifery report, with data from 58 developing countries. The report called for bold initiatives by governments, regulatory bodies, training institutions and others to scale up investments in midwifery services. The latest State of the World’s Midwifery, published in June 2014, offers data from 73 low- and middle- income countries, and highlights the acute shortage of midwives in the places where there the needs are greatest. 

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