According to the World Health Organization (WHO), utilizing well-trained midwives could be a game-changer. Globally, midwives could decrease maternal, newborn and stillborn mortality by 83%. This is why WHO advocates for a midwife or other skilled health professional at every birth globally. Midwives are health professionals trained to manage uncomplicated pregnancies and deliveries and guide the family through the immediate post-natal period. More low-to-middle-income country (LMIC) midwives are needed to reduce maternal mortality rates.
Midwives can deliver 87% of the maternal health service need. However, only 42% of skilled midwives work in the 73 countries with 90% of the maternal, newborn and stillborn deaths. Further, a 2020 University of Dundee study found that midwifery is less effective in low-to-middle-income countries (LMICs). Where it does exist, there is a lack of standardization in education, training and regulation. Fortunately, organizations are focusing on increasing the number of LMIC midwives, midwifery education options and midwifery regulation.
Role of the Midwife
Not only do midwives deliver babies but they also play several other key roles. As members of their communities, they are culturally sensitive. Because they have community trust, they effectively promote strong health measures. Midwives help patients with family planning and breast and cervical screenings. They advocate for female rights and the elimination of genital mutilation practices. Midwives counsel teens on sexual and reproductive health and counsel victims of gender-based violence.
The midwife-led model of care is one in which the midwife is the lead medical provider for childbirth. According to a 2020 study, the holistic midwife-led model leads to more patient satisfaction and fewer unnecessary procedures. The study, however, suggests that the model needs stronger implementation in LMICs.
As the United Nations Population Fund (UNFPA) declares, “The deficits are highest in the areas where needs are greatest.” Luckily, the UNFPA and other programs are pushing to increase the number of LMIC midwives, midwifery education and midwifery regulation.
UNFPA: Supporting LMIC Midwives
Supporting LMIC midwives and building an LMIC midwifery workforce has been the focus of UNFPA since 2008. The organization works with more than 40 global partners and more than 300 national partners. Together they work on strengthening competency-based midwifery training and bringing it to scale. The focus is developing strong regulatory processes to analyze outcomes, supporting midwives in gaining a stronger voice through the creation of midwife organizations and increasing funding for midwife services. As of the end of 2018, the UNFPA trained more than 105,000 midwives and 8,500 midwifery tutors in 650 midwifery schools. This has helped create 250 midwifery associations and branches. The UNFPA’s midwifery support extends to more than 120 countries, including 39 countries with the highest global maternal mortality rates.
Tunza Mama: Midwifery Network in Kenya
While the UNFPA works globally, there are also national programs striving to support LMIC midwives. There is a shortage of midwives in public health facilities in Kenya because the government cannot afford to pay them. The African Medical and Research Foundation (Amref) International University launched the Tunza Mama network in 2018. This provides an alternative option to access midwives and improve the socio-economic status of Kenyan midwives.
Tunza Mama midwives visit women at their homes. Clients pay directly to the Tunza Mama bank account and the midwives get 95% of the fee. Tunza Mama spreads awareness of its existence using social media, which is how 70% of mothers came to know about the program. During the COVID pandemic, Tunza Mama is using mobile and e-learning digital platforms to reduce the need for in-person sessions by 75%. Some challenges include the fact that Tunza Mama is a paid service so only the middle-class can use it. The next steps include subsidizing the system so marginalized women can also gain access.
SWEDD Midwifery Training in the Sahel
In Mali, according to 2016 demographic data, the shortage of midwives and obstetric nurses is severe. There are only 1.4 midwives per 10,000 people versus the WHO recommendation of 23 doctors, nurses or midwives per 10,000 people. Also, according to 2018 data, 36% of teenagers have begun childbearing. Pregnancy and childbirth are the leading cause of death among adolescent girls.
Mali is part of the Sahel, the semi-arid region of north-central and western Africa. The Sahel also includes Benin, Burkina Faso, Chad, Cote d’Ivoire, Mali, Mauritania and Niger. The maternal and neonatal mortality rate in this region is one of the highest rates in the world. In response, in 2016, the World Bank began working with Sahel governments with support from the UNFPA to launch the Sahel Women’s Empowerment and Demographic Dividend (SWEDD) project, which provides midwifery training. Since the launch, more than 6,600 midwives have been trained. In addition to training LMIC midwives, SWEDD’s overarching goal is to achieve the “demographic dividend” by empowering women and girls through education, family planning and more.
Together, global organizations such as the UNFPA, local networks such as Tunza Mama and regional collaborations including SWEDD are pushing to boost the number of LMIC midwives. This will significantly lower maternal and newborn mortality in areas that need it the most.
– Shelly Saltzman