UNITED NATIONS, New York – When trained and supported by a functional health system, midwives could provide 87 per cent of the essential care needed for women and newborns, and could potentially reduce maternal and newborn deaths by two thirds. This was among the findings of the State of the World’s Midwifery: A Universal Pathway – A Woman’s Right to Health, a report launched today by UNFPA, the International Confederation of Midwives (ICM), the World Health Organization (WHO) and partners.
Midwives do not only deliver babies; they provide a host of sexual, reproductive, maternal and newborn health services. Yet this essential care is often unavailable in poor, remote or marginalized communities. Investments in midwifery training – at international standards – could yield a 1,600 per cent return on investment, estimates the report.
“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.
Closing healthcare gaps
Although maternal and newborn deaths have been declining steadily since 1990, too many women and infants continue to die during or soon after pregnancy. In 2013, an estimated 289,000 women and 2.9 million newborns died – the vast majority due to complications or illnesses that could have been prevented with proper antenatal care or the presence of a skilled midwife during delivery.
The newly released report presents findings on midwifery from 73 low- and middle-income countries. These countries are home to 96 per cent of the global burden of maternal mortality, 91 per cent of stillbirths and 93 per cent of newborn mortality, yet they have only 42 per cent of the world’s physicians, midwives and nurses.
Today, 78 per cent of the countries have severe shortages in their ability to provide proper care to women and newborns. And as the global population grows, so do the gaps in healthcare resources and infrastructure.
“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.
Midwives need resources
But for her and other midwives to work effectively, they must have the necessary equipment and resources.
“We feel very alone, and we are a marginalized community,” said Maria Parez-Lopez, a midwife in Mexico, another of the countries included in the report.
“We don’t have materials to work with. Our community has no ambulance or car to drive to the hospital. Sometimes we can’t save women in time,” she added.
Still, there has been visible progress made since the inaugural State of the World’s Midwifery report was released in 2011. Thirty-three of the 73 countries covered in the report have implemented efforts to improve workforce retention in remote areas, and 20 countries are increasing the recruitment and deployment of midwives. Additionally, 52 of the countries have improved data collection to address health staff shortages and education standards, according to the latest report.
The latest State of the World's Midwifery also makes recommendations to help countries build upon this progress, including addressing issues such as child marriage and poor nutrition during pregnancy. The report also calls for ensuring pregnant women have access to four pre-birth care visits and for improving women’s access to emergency services when needed.