Fully investing in midwives by 2035 would avert roughly two-thirds of maternal, new-born deaths and stillbirths, saving 4.3 million lives per year.
Millions of lives of women and new-borns are lost, and millions more experience ill health or injury, because the needs of pregnant women and skills of midwives are not recognised or prioritised.
The world is currently facing a shortage of 900 000 midwives, which represents a third of the required global midwifery workforce. The COVID-19 crisis has only exacerbated these problems, with the health needs of women and new-borns being overshadowed, midwifery services being disrupted, and midwives being deployed to other health services.
These are some of the key takeaways from the 2021 State of World’s Midwifery report by UNFPA (the UN sexual and reproductive health agency), WHO (World Health Organization), International Confederation of Midwives (ICM) and partners, which evaluates the midwifery workforce and related health resources in 194 countries.
The acute shortage of midwives is exacting a terrible global toll in the form of preventable deaths. An analysis conducted for this report, published in the Lancet last December, showed that fully resourcing midwife-delivered care by 2035 could avert 67 per cent of maternal deaths, 64 per cent of new-born deaths and 65 per cent of stillbirths. It could save an estimated 4.3 million lives per year.
Despite alarms raised in the last State of the World’s Midwifery report in 2014, which also provided a roadmap on how to remedy this deficit, progress over the past eight years has been too slow. The analysis in this year’s report shows that, at current rates of progress, the situation will have improved only slightly by 2030.
Gender inequality is an unacknowledged driver in this massive shortage. The continued under-resourcing of the midwifery workforce is a symptom of health systems not prioritising the sexual and reproductive health needs of women and girls, and not recognising the role of midwives – most of whom are women – to meet these needs. Women account for 93 per cent of midwives and 89 per cent of nurses.
Midwives do not just attend births. They also provide antenatal and postnatal care and a range of sexual and reproductive health services, including family planning, detecting and treating sexually transmitted infections, and sexual and reproductive health services for adolescents, all while ensuring respectful care and upholding women’s rights. As numbers of midwives increase, and they are able to provide care in an enabling environment, women’s and new-borns’ health improves as a whole, benefitting all of society.
For midwives to achieve their lifesaving and life-changing potential, greater investment is needed in their education and training, midwife-led service delivery, and midwifery leadership. Governments must prioritise funding and support for midwifery and take concrete steps to include midwives in determining health policies.
Dr Franka Cadée, President of the International Confederation of Midwives:
“As autonomous, primary care providers, midwives are continually overlooked and ignored. It is time for governments to acknowledge the evidence surrounding the life-promoting, life-saving impact of midwife-led care, and take action on the SoWMy report’s recommendations. ICM is committed to leveraging the strength of our global midwife community to carry forward these powerful findings and inspire country-level change. However, this work is not possible without commitment from decision makers and those with the resources to invest in midwives and the quality care they provide to birthing women.”
Dr Natalia Kanem, UNFPA Executive Director:
“The State of the World’s Midwifery report sounds the alarm that currently the world urgently needs 1.1 million more essential health workers to deliver sexual, reproductive, maternal, new-born and adolescent health care, and 80 per cent of these missing essential health workers are midwives. A capable, well-trained midwife can have an enormous impact on childbearing women and their families – an impact often passed on from one generation to the next. At UNFPA, we have spent more than a decade strengthening education, enhancing working conditions and supporting leadership roles for the midwifery profession. We have seen that these efforts work, but they need greater investment.”
Dr Tedros Adhanom Ghebreyesus, WHO Director-General:
“Midwives play a vital role in reducing the risks of childbirth for women all over the world, but many have themselves been exposed to risk during the COVID-19 pandemic. We must learn the lessons the pandemic is teaching us, by implementing policies and making investments that deliver better support and protection for midwives and other health workers. This report provides the data and evidence to support WHO’s longstanding call to strengthen the midwifery workforce, which will deliver a triple dividend in contributing to better health, gender equality and inclusive economic growth.”