Frances E. Likis, CNM, NP, DrPH, FACNM
Originally published in 2011
Approximately 48 million women per year do not have a skilled attendant, such as a midwife, nurse, or physician, at their birth. While the proportion of births in developing regions attended by skilled personnel rose from 55% to 65% between 1990 and 2009, this still leaves 1 in 3 women who gives birth without a skilled attendant present to help her. This is in stark comparison to developed regions where 99% of women giving birth have 1 or more skilled attendants with them throughout their labor and birth. Today more than 2 million women give birth each year with no one else present: no skilled birth attendant, no family, no friends.
It is almost unfathomable that there can be 2 million women—unique individuals with names and faces and loved ones—who have no one with them as they labor and give birth. Even more tragic is the fact that each year greater than 350,000 women die during pregnancy, birth, or in the first 6 weeks postpartum, and 2 million newborns die within the first 24 hours after they are born. Most of these women and newborns die in low-income countries, and many of their deaths are preventable. Two new reports, Missing Midwives and The State of the World's Midwifery 2011: Delivering Health, Saving Lives, recommend increasing the number of midwives in the world as one of the best ways to reduce maternal and neonatal mortality worldwide.
Save the Children's Missing Midwives describes the many ways in which midwives save lives, including preventing infections and asphyxia, 2 of the most common causes of neonatal death. The report notes that approximately 1.3 million newborn deaths could be prevented by filling the shortage of midwives in the poorest countries, which lack funding for midwife recruitment, training, and salaries. Governments must invest in educating and retaining midwives to save lives and improve health. The report concludes with 4 recommendations for governments: “support countries to recruit more midwives and health workers, ask the UN Secretary-General to host a health worker event at the UN General Assembly, make the International Monetary Fund support flexibility on public sector spending, and respect the international recruitment code of practice.”
The State of the World's Midwifery 2011: Delivering Health, Saving Lives begins with an overview of the midwifery profession around the world including its development, education, regulation, and service delivery. The overview is followed by a description of the midwifery workforce, education, and policies in 58 developing countries that accounted for 58% of the world's births in 2009. A summary for each of these countries that includes key health indicators and the state of midwifery in that country is provided. Most importantly, more than half of all births worldwide occur in these 58 countries yet they have a disproportionate amount of birth-associated mortality and skilled personnel. Ninety-one percent of maternal deaths and 82% of neonatal deaths occur in these countries yet they have less than one-fifth (17%) of the world's skilled birth attendants. The State of the World's Midwifery 2011: Delivering Health, Saving Lives presents recommendations for governments, regulatory bodies, schools and training institutions, professional associations, international organizations, donor agencies, and civil society. These bold steps call on partners to “maximize the impact of investments, improve mutual accountability, and strengthen midwifery services.”
Both reports discuss the Millennium Development Goals, which all United Nations member states agreed to try to achieve by 2015. Millennium Development Goal 5 to improve maternal health includes the target of reducing the maternal mortality ratio by 75%. As of 2008, the maternal mortality ratio had decreased by 34% in developing regions from 440 deaths per 100,000 births to 290. Millennium Development Goal 4 is to reduce child mortality and includes the target of reducing the under-5 mortality rate, of which 38% occurs during the first 4 weeks of life, by two-thirds. As of 2009, the global under-5 mortality rate had decreased by one-third from 89 per 1000 live births to 60.
As the Millennium Development Goals deadline approaches, goals 4 and 5 remain far from their targets. In 2010, the United Nations General-Secretary, in conjunction with multiple partners, developed the Global Strategy for Women's and Children's Health to identify steps to help move closer to Millennium Development Goals 4 and 5. This document along with Missing Midwives and The State of the World's Midwifery 2011: Delivering Health, Saving Lives is bringing new attention to the work that is left to be done to improve maternal and child health.
Read the rest of the story on the Journal of Midwifery and Women's Health.