Humanitarian crises are increasing worldwide, driven by conflict, displacement, climate change, natural disasters and growing fragility. In 2024 alone, 122.6 million people were forcibly displaced, while an estimated 2 billion people now live in areas affected by conflict and violence. Women and girls are disproportionately affected by these crises, facing heightened risks of maternal death, gender-based violence, unintended pregnancy, sexually transmitted infections and disruptions to essential sexual and reproductive health services. In 2023, 61 per cent of all maternal deaths occurred in countries experiencing conflict or high levels of institutional and social fragility.
This guidance positions midwives at the centre of humanitarian preparedness, response and recovery. Drawing on global evidence and UNFPA’s extensive operational experience in crisis settings, it outlines how midwives can serve as frontline providers and leaders of sexual and reproductive health services, including implementation of the Minimum Initial Service Package (MISP) for Sexual and Reproductive Health in Crises. Midwives are often among the few health professionals who remain within affected communities during emergencies, providing life-saving care under extremely challenging conditions.
The publication demonstrates how educated, regulated and supported midwives can deliver approximately 90 per cent of the life-saving interventions of the MISP. It further highlights the evidence that universal coverage of midwife-delivered interventions could prevent approximately two thirds of maternal deaths, stillbirths and neonatal deaths worldwide.
Structured around the emergency management cycle, the guidance provides practical and actionable recommendations for strengthening the midwifery workforce before, during and after crises. It aligns the Clinical Competencies established by the International Confederation of Midwives (ICM, 2024) with the objectives of the MISP and the strategic pillars of the Midwifery Accelerator, the global initiative launched by UNFPA, WHO, UNICEF, ICM and Jhpiego to strengthen and scale midwifery models of careDesigned for UNFPA country offices, ministries of health, national midwifery associations and humanitarian partners, the publication reframes investment in midwifery not only as a humanitarian intervention but as a core strategy for strengthening resilient health systems. It also includes a comprehensive package of technical resources, tools and implementation guidance to support programme managers and partners in planning and delivering effective humanitarian midwifery programming.
