Midwifery

In most regions around the world, rates of maternal deaths have either stagnated or worsened. Every year, 287,000 women globally lose their lives due to pregnancy and childbirth, 2.3 million newborns do not survive the first month of life, and an additional 1.9 million are stillborn. Most of these lost lives are preventable with proper antenatal, childbirth and postnatal care – services provided by midwives. Furthermore, research shows that quality midwifery care improves 50 different health outcomes and increases the satisfaction that women and adolescent girls feel about their care. Midwifery care is the most cost-effective intervention, with better health outcomes, attributed to fewer unnecessary interventions such as Caesarean sections.

Midwives are the most appropriate care providers for women and their newborns during pregnancy, childbirth and the postpartum period. Midwifery care takes place in partnership with women to ensure respectful, women-centred care, using culturally appropriate practices and evidence-based interventions for optimal health outcomes. 

In emergency situations, midwives, in collaboration with interdisciplinary teams and networks of care, are pivotal to accessing life-saving treatments. In humanitarian crises, they are truly the first responders in providing care. Their roles are expanded to meet the most urgent demands by using the life-saving actions of the Minimum Initial Services Package to protect sexual and reproductive health and rights.

Midwives do not just deliver babies. Well-trained midwives can provide comprehensive sexual and reproductive health information and services, and they play a critical role in promoting health within their communities. They provide family-planning counselling and services, as well as screening and health education for breast, cervical and other reproductive health cancers, along with supporting the treatment. Midwives can help prevent and respond to female genital mutilation, other harmful practices and obstetric fistula; can support survivors of gender-based violence; and can provide sexual and reproductive health services to adolescents (who often face barriers in accessing these services at a great cost to their health and rights), thereby helping to avert teenage pregnancies.

Midwives, when properly trained and supported, offer one of the most cost-effective and person-centred approaches to achieving universal health care, yet the world is short of 900,000 midwives. Further, midwives often lack the skills and supportive environment to function at their full potential. Unsurprisingly, the deficits are highest in the areas where needs are greatest, particularly in Africa. Despite their importance, midwives face significant discrimination and challenges: They endure heavy workloads with poor pay and limited career-advancement opportunities, and they are often confronted with disrespectful attitudes. Ninety per cent of midwives are women, and gender inequality is often at the root of the problems midwives experience, leading to burnout and poor quality of care.

Together with partners, UNFPA works to strengthen quality midwifery education, enhance policies and regulations, and strengthen midwifery associations and leadership around the world. UNFPA’s support for midwifery now spans some 125 countries, including those with the highest rates of maternal mortality, which receive targeted support through the Maternal and Newborn Health Thematic Fund. Through the fund, UNFPA has educated and trained close to 550,000 midwives and equipped more than 1,600 midwifery schools with books, training equipment and materials. Close to 600 midwifery schools in developing countries are now accredited to national or international standards. A growing number of schools are launching higher-education programmes for midwives, such as bachelor’s and master’s degrees. Given that quality education begins with competent educators, UNFPA has supported the training of more than 75,000 midwifery educators as of 2023. 

Advancing their practice together, 80 national midwifery associations and more than 200 sub-national branches of midwifery associations globally receive UNFPA support. In collaboration with national nursing and midwifery councils and governments, UNFPA works to ensure that midwifery is a well-regulated and autonomous profession with a clear scope of practice and a defined title of “midwife.” UNFPA also advocates for workforce policies globally that ensure the equitable deployment of educated midwives in an enabling and supportive environment.

UNFPA, as an advocate of midwives, has been providing invaluable data on midwifery with the International Confederation of Midwives and the World Health Organization through the State of the World’s Midwifery reports since 2011 to demonstrate progress and trends and identify barriers and challenges to future investment. The latest report highlights findings from 194 countries and calls for bold investments in midwifery.

Since midwifery received attention within the Global Strategy for Women’s, Children’s and Adolescent’s Health launched by the Secretary General in 2015, more governments are recognizing the value of investing in quality midwifery care. Yet these investments remain inadequate. UNFPA has joined with several partners to continue advocating for enhanced and coordinated investments in quality midwifery education and services. 

One major advancement borne out of partnerships is the Alliance to Improve Midwifery Education, established in 2021; it comprises UNFPA, WHO, UNICEF, ICM, Liverpool School of Tropical Medicine, Jhpiego, Momentum, Laerdal Global Health and the Burnet Institute. This global partnership aims to improve quality of care for women, newborns and their families through the strengthening of midwifery education, continuous professional development and the enhancing of midwifery-faculty skills. Supporting countries’ implementation of the Framework of Action for Strengthening Quality Midwifery Education, the Alliance works with a consortium of global partners to create and develop tools, knowledge products and cross-country research, and to facilitate learning to accelerate progress in strengthening midwifery education. 

In 2023, working with more than 20 global partners, UNFPA organized the Fifth Global Midwifery Symposium at the International Maternal Newborn Health Conference. At the symposium, the partners launched a Global Call to Action and Commitment, highlighting the critical role midwives play in improving health outcomes worldwide and highlighting the importance of strengthening quality midwifery models of care. 

Building on this momentum, the development of the Global Midwifery Acceleration Roadmap in 2024 marks a new era of global partnerships, aiming to accelerate global and national financial and political commitments to midwifery and outlining necessary steps to making quality midwifery care more widely accessible.   

“Every woman has the right to life-saving health care. Midwives are critical to help make that happen,” UNFPA Executive Director Dr. Natalia Kanem has said. “A worsening climate crisis makes the need for midwives more urgent than ever.” Let’s champion the midwives who champion the health and rights of women and newborns. 

Updated 20 June 2024