UNITED NATIONS, New York – Every two minutes, a woman dies in pregnancy or childbirth, according to UN estimates, adding up nearly 290,000 maternal deaths each year. Nearly 3 million newborns die each year as well. Most of these deaths are entirely preventable: Prenatal care and the presence of a skilled attendant at birth – services provided by midwives – could avert as many as 3.6 million deaths a year.
The International Day of the Midwife, on 5 May, commemorates the work of midwives around the world.
“The world needs midwives now more than ever,” said Dr. Babatunde Osotimehin, the Executive Director of UNFPA, the UN Population Fund.
Yet there remains too little support for midwives. Many are working in decrepit health facilities, lacking basic equipment and life-saving resources.
“My challenges, there are so many,” Anthony Kiplagat, a midwife, said from his clinic in Kenya.
“The population is overwhelming… but you are not able to provide for all of them,” he said.
Every pregnancy is accompanied by risks – some of them deadly. Sepsis, obstructed labour and post-partum haemorrhage are among the major causes of maternal death.
The presence of a skilled birth attendant is one of the most important factors in the survival of a mother and her baby. Yet about a third of all births continue to take place without a midwife or other skilled attendant.
“My interest in midwifery came as a result of seeing my community back at home, in the rural village, suffering – women dying because of pregnancy-related issues,” Mr. Kiplagat said.
In addition to delivering care throughout pregnancy, during childbirth and in the post-delivery period, midwives also provide comprehensive sexual and reproductive health services, such as family planning counselling. All of these services reduce maternal death rates and improve child survival.
But with insufficient investment in health care, and too few healthcare personnel, midwives often find themselves overburdened.
“Where I’m working, there are four midwives. And those four midwives, they have to cover maternity – that is their part – [as well as the] paediatric ward, female ward, children’s ward,” said Enis Banda, a midwife in Malawi.
“Those midwives, they are trying their best to work day and night... To them, it is a very difficult situation,” she emphasized.
“The issue is lack of proper working equipment… especially in the [area of] supplies. Sometimes in our facility, we experience shortages of drugs. Yes, we provide good services, but if you don’t provide the drugs, at the end of the day, you have not really helped that woman,” Mr. Kiplagat said.
“We get burnout,” he added.
Investment, support needed
Midwives do not only need supplies and equipment. They also require extensive training to safely manage childbirth and to be able to recognize life-threatening complications.
UNFPA supports midwives through the provision of clean delivery kits, funding and supplies for healthcare facilities, and training programmes. Between 2008 and 2013, UNFPA supported the training of over 10,000 midwives.
But much more investment and support are needed at every level, from governments, civil society organizations and community leaders.
The second-ever State of the World’s Midwifery report, set to launch in June 2014, will offer further evidence of the steps required to ensure all women and families have access to quality midwifery care. The report – a joint effort of UNFPA, the International Confederation of Midwives, the World Health Organization and other partners – will offer new data from 73 countries that account for more than 95 per cent of all maternal, newborn and child deaths.
Yet even as they struggle to manage overwhelming caseloads, midwives know their work is invaluable.
“I am proud of my profession,” Ms. Banda said. “I like to work as a midwife because I know that for those people who are like a president, a doctor or a teacher, life starts in the hands of a midwife.”