Consensus Forged on a Strategy to Strengthen Midwifery in Developing Countries

7 Juin 2010
Author: UNFPA
83 -years-old Imtiaz Kamal, from Pakistan, similes during the tribute to senior midwives. Photo: Moises Saman.

WASHINGTON, D.C. — Some 200 midwives, policymakers, UN agencies and other donors came together last weekend to galvanize support for strengthening midwifery services and increasing the number of midwives in developing countries. This is considered a key to meeting Millennium Development Goals on maternal and child health.

“This is history in the making,” said Vincent Fauveu of UNFPA, after the moving and energizing closing session. “Midwives and the importance of midwifery skills to reach the MDGs have never been acknowledged like this before at the global level.”

The Symposium to Strengthen Midwifery was co-hosted by UNFPA and the International Confederation of Midwives, along with six other partners, in the lead up to the Women Deliver conference, the G-8 and -20 Summits and the MDG+10 Summit this September.

During the symposium, Norway and Sweden announced continued support to the UNFPA-ICM Midwifery programme, and practicing midwives were honoured, acknowledged, and empowered in an unprecedented way.

A global Call to Action adopted at the symposium encourages governments to focus on the specific steps needed to strengthen midwifery services. These include: improving education and training; strengthening laws, regulations and midwifery associations; and enhancing the recruitment and retention of midwives. During the two days of knowledge-packed presentations and intense audience engagement -- 15 people or more lined up to give comments to virtually every panel -- these steps were the dominating themes. Participants called attention to positive developments, such as the decreasing maternal mortality rates in many countries as indications that strengthened midwifery services work to save lives of women and newborns.

Fistula survivor Awatif Al-Tayib, now a midwife from Sudan, addresses the symposium. Photo: Moises Saman

Mary Issaka, a midwife from Ghana, exemplifies the multiple roles midwives can play in the maternal and child health challenge. In addition to delivering babies, her work, which is featured in a recent video, has contributed to a dramatic decrease the number of unattended home births and adolescent pregnancies in her district. For this she was awarded with Johns Hopkins Program for International Education in Gynecology and Obstetrics  first annual midwifery award.

“I see myself as a link between the communities and the policy makers. I go to the villages and listen to the women and see their needs, and encourage them to go to the clinic and not risk their lives by delivering on their own,” Ms. Issaka said in a comment to her award. “I think this symposium has empowered us as midwives, so we can go home and get more involved in the decision making process,” she continued.

The most important conclusion from the symposium was probably that participants need to ensure that the Call to Action leads to concerted action and further investments in the midwifery work force – and that skilled midwives are empowered to become agents of change.

A key could be to start with the math. “We need to liaise more with economists to get the calculations right and then present cost-benefit analyses to policymakers, so they know exactly what the gains are, considering that midwives can provide sexual and  reproductive health services for girls and women that integrate HIV prevention, family planning and safe deliveries,” said Anneka Knutsson of SIDA, the Swedish International Development Agency.

The symposium participants strongly agreed that the fight for strengthened midwifery is closely linked to the fight for increased gender equality. In the opening session of the Women Deliver conference, UNFPA Executive Director Thoraya A. Obaid echoed many of the sentiments expressed at the symposium.

"The world needs midwives now more than ever," she said. "Countries need to make midwives a priority in plans and budgets. We need to move from speech lines to budget lines."

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