The world needs midwives now more than ever. Every year, approximately 3,50,000 women die while pregnant or giving birth, up to two million newborns die within the first day of life, and there are 2.6 million stillbirths. Thousands more women live with the often debilitating consequences of pregnancy.
An overwhelming majority of maternal and newborn deaths and morbidity occur in countries marked by poverty. The loss of life is driven by gender inequality, inequity and bigotry, resulting in the most human of tragedies: death and injury in the midst of life’s reproduction. Maternal and child health is the casualty of choices: choices about where to invest, what policies to pursue, which facilities to build, what commodities to supply, who to train, what competencies to value, which labour forces to promote. Almost two-thirds of maternal and newborn deaths could be averted, roughly 3.6 million lives saved by 2015, if all women delivered were attended by competent, well-equipped midwives. And yet, more than one third of all births take place without a midwife or other skilled health staff.
Pivotal role
Midwives don’t just deliver babies. They enable effective family planning, prevent malaria in pregnancy and mother-to-child transmission of HIV. They are essential if we are to: eradicate obstetric fistula, provide culturally sensitive care, prevent deaths from unsafe abortions, address gender based violence, uphold human rights, and save millions of lives.
It is on the basis of this rich calculus that the United Nations Population Fund (UNFPA) understands there is no better health investment than in the spread, support, deepening and valuing of midwifery. In 2008, we partnered with the International Confederation of Midwives to strengthen midwifery. Five years later, our combined work is operational across 30 countries.
Optimism
Challenges remain, but in partnership with governments and donors, things are really moving. At the 2011 ICM World Congress in Durban, 30 partners with UNFPA launched the first ever State of the World’s Midwifery Report (SOWMy). The report has driven change at the national level. Over 35 governments have stood up to its challenge with commitments to strengthen their midwifery workforces, under the Secretary General’s “Every Woman Every Child Strategy.” Ethiopia, for example, has pledged to quadruple the number of midwives from 2,050 to 8,635, Bangladesh has pledged to train an additional 3,000 while Rwanda has committed itself to training five times more midwives, increasing the ratio from 1/1000,000 to 1/20,000.
There are growing examples of innovation — deployment of interventions, technologies and partnerships — driving new solutions. UNFPA, for example, is proud of its partnership with the Intel Corporation, Jhpiego and World Health Organization that is enabling the development and delivery of multimedia, interactive, e-training modules usable anywhere-anytime, with or without internet connectivity by midwives and front line health workers.
Hurdles
But challenges remain.
The demands for financial and human resources to enable trained tutors, well-equipped schools, suitable policies and strong midwifery associations are far from fully met. Most importantly, we must continue to advocate for policies that enable governments to deploy skilled midwives where they are needed most.
And ultimately we must be held accountable. In 2012, midwifery workforce assessments were conducted in eight high burden countries which bear the majority of maternal and newborn deaths: Afghanistan, Bangladesh, DRC, Ethiopia, Mozambique, Tanzania, India, and Nigeria. This year will see these results released and through them, the real test of our compound progress duly marked.
Midwives are irreplaceable for success in this struggle. And the struggle is to meet a deeply human and profoundly rights-based obligation to stand in life-altering solidarity with women and young people as they manage and enjoy their sexual and reproductive health and rights.
(Kate Gilmore is UNFPA Deputy Executive Director. This has been excerpted from her speech at the ongoing Women Deliver Conference in Kuala Lumpur.)
