Global midwife shortage raises rates of maternity intervention, report warns | Global development

A global shortage of nearly a million midwives is depriving pregnant women of the basic care needed to prevent harm, including death to mothers and babies, according to a new study.

Nearly half of the shortage was in Africa, where nine in 10 women lived in a country without enough midwives, researchers said.

Anna af Ugglas, chief executive of the International Confederation of Midwives (ICM) and one of the study’s authors, said: “Almost a million missing midwives means health systems are strained, midwives are overworked and underpaid, and care becomes rushed and fragmented.

“Intervention rates are increasing and women are more likely to experience poor quality care or mistreatment,” she said. “It’s not just about labor, it’s about quality and safety for women and babies. »

For all women to receive safe, good-quality care before, during and after pregnancy, an additional 980,000 midwives would be needed in 181 countries, the study found.

According to previous research, universal access to midwifery care could prevent two-thirds of maternal and neonatal deaths and stillbirths, saving 4.3 million lives per year by 2035.

The ICM said the problem was not only due to a lack of training places for midwives, but also the inability of many countries to employ qualified midwives where they were needed and to retain those working in the health service.

Professor Jacqueline Dunkley-Bent, ICM Chief Midwife and another author of the report, said: “In many contexts, midwives are educated but not integrated into the workforce or allowed to practice fully, exacerbating this already serious and universal shortage of midwives, and still leaving women without access to the care that midwives are trained to provide.

More than 90% of the global midwifery shortage was in low- and middle-income countries.

Africa has only 40% of the midwives it needs, the Eastern Mediterranean only 31% and the Americas only 15%, researchers say. Deficits were much smaller, although still present, in other regions, notably Southeast Asia and Europe.

The study, published in the journal Women and Birth, estimates the number of midwives needed to complete a list of basic tasks for all eligible women and babies in 181 countries. Tasks included counseling on contraception, prenatal care and screening, and care during delivery.

He then compared this total with current numbers. The researchers noted some uncertainty due to the lack of adequate data.

Even as the number of midwives increases, the gap between what is needed and the available workforce appears likely to “persist well into the next decade”, researchers say – beyond the 2030 deadline set by the global Sustainable Development Goals to reduce maternal mortality and end preventable deaths of newborns and children under five.

The ICM has called on governments to take urgent action to strengthen the midwifery workforce in their countries, calling for people to sign a global petition calling for investment in the profession.

“When the midwifery profession is respected and well supported, more women are motivated to train and stay in the workforce,” said af Ugglas. “This is how countries improve health outcomes and build stronger, more sustainable health systems. »