38 of 58 countries surveyed could miss their MDG5 targets without112,000 moremidwives

GENEVA/DURBAN, South Africa, 20 June 2011 – Up to 3.6 million deaths could be avoided each year in 58 developing countries if midwifery services are upgraded by 2015, according to a major new report released here today by UNFPA, the United Nations Population Fund, and partners.

The State of the World’s Midwifery 2011, launched at the Triennial Congress of the International Confederation of Midwives (ICM) underway in Durban, South Africa, unveils new data confirming there is a significant gap between the number of midwives practicing and those needed to save lives.

“Ensuring that every woman and her newborn have access to quality midwifery services demands that we take bold steps to build on what we have achieved so far across communities, countries, regions and the world,” said Ban Ki-moon, Secretary-General of the United Nations, in his foreword to the report.

Each year, 358,000 women die while pregnant or giving birth, some two million newborns die within the first 24 hours of life and there are 2.6 million stillbirths, all because of inadequate or insufficient health care.

“The report points to an urgent need to train more health workers with midwifery skills and ensure equitable access to their life-saving services in communities to improve the health of women and children,” said Dr. Babatunde Osotimehin, Executive Director of UNFPA.

The State of the World’s Midwifery 2011 reveals that, unless an additional 112,000 midwives are trained, deployed and retained in supportive environments, 38 of 58 countries surveyed might not meet their target to achieve 95 per cent coverage of births by skilled attendants by 2015, as required by Millennium Development Goal 5, on maternal health. Globally, 350,000 midwives are still lacking.

If adequate facilities were accessible to deal with complications at their onset, many deaths could be averted – 61 per cent or nearly two thirds of all maternal deaths, 49 per cent or almost half of stillbirths, and 60 per cent or 3 in 5 newborn deaths. The report adds that, if midwives are in place and can refer the most severe complications to specialized care, up to 90 per cent of maternal deaths could be prevented.

The State of the World’s Midwifery 2011, coordinated by UNFPA, is the result of collaboration among 30 partners, whose collective aim is to strengthen midwifery practices to prevent maternal death and disability and improve the health of newborns, families, and entire communities. The report surveyed 58 countries, which together account for just under 60 per cent of all births worldwide, but 91 per cent of all maternal deaths. Among the 38 countries most desperately in need of midwives, 22 need to double the workforce by 2015; seven need to triple or quadruple it; and nine (Cameroon, Chad, Ethiopia, Guinea, Haiti, Niger, Sierra Leone, Somalia and Sudan) need to dramatically scale up midwifery by a factor of between 6 and 15.

“This report clearly identifies the need to create a competent, active midwifery workforce, working as a key part of an effective health-care system. In addition, ICM’s new global standards for midwifery education and regulation will assist governments and policy makers to address the report’s recommendations,” said Bridget Lynch, President of the International Confederation of Midwives.

Most deaths or disabilities occur in low-income countries and happen because women – often poor and marginalized – have no access to functioning health facilities or to qualified health professionals, notably those with midwifery skills.

Increasing women’s access to quality midwifery has become a focus of global efforts to realize the right of every woman to the best possible health care during pregnancy and childbirth. It is also at the heart of three health-related Millennium Development Goals – to reduce child death (MDG 4), improve maternal health (MDG 5) and fight AIDS, malaria and other diseases (MDG 6).

In addition to inadequate numbers of midwives, the report reveals that coverage within countries is unequal, as is quality. There is a shortage of training institutions and employment opportunities for midwives. In addition, poor regulation, weak professional associations, an incomplete policy environment, and the omission of midwifery from human resource costing plans for maternal and neonatal health are significant challenges.

The report makes a series of recommendations to governments, regulatory bodies, educational institutions, professional associations and international organizations that would help remedy these problems and reinforce the status of midwifery in the 58 countries surveyed.

“The good news is that, when women are within reach of a midwife supported by a functioning health system, not only is their likelihood of dying from the complications of childbirth drastically reduced, but also the midwife becomes the critical link to well-baby care and health care for the entire family,” said Lennie Kamwendo, Chairperson, Board of Trustees, White Ribbon Alliance for Safe Motherhood – Malawi. “We must prioritize investment in midwives to deliver life-saving care in the communities where mothers are needlessly lost.”