Co-authored by Patsy Bailey
Worldwide, we have seen maternal deaths decline in recent years. In no small part, this is due to an underappreciated commitment by a highly valued global human resource: midwives. As the 30th Triennial International Confederation of Midwives (ICM) Congress begins in Prague, we must recognize that midwives provide a critical entry point for pregnant women and their newborns to receive life-saving health care services that are respectful and women-centered.
A range of services is necessary to protect and enhance women's health and well-being before, during and after a pregnancy. Most maternal deaths are caused by the underlying health conditions of the mother before or during pregnancy, or by poor quality care in the critical hours and days before and after a birth.
Four key services comprise the continuum of care during pregnancy:
1. Antenatal care with a skilled provider, ideally to include several visits beginning in the first trimester
2. Delivery with a skilled attendant, including the routine monitoring of the progression of the delivery and the availability of drugs, such as oxytocin, for the prevention of postpartum hemorrhage
3. Immediate emergency care for medical complications that arise during pregnancy and childbirth
4. Postpartum and postnatal care for the mother and baby shortly after birth to ensure both are healthy and that the baby receives essential newborn care while the mother receives family planning counseling
Midwives throughout the world are capable of providing a range, if not all, of these services. But their role is more crucial in health care systems in low- and middle-income countries. In some regions, midwives are already making a dramatic difference by providing pregnancy and delivery services in low-resource settings. We need to ensure that regions without such midwifery-led services receive equal access.
Globally, we have a pressing need to train more midwives. Across the developing world, many women do not deliver their babies in a health facility, with a skilled attendant. Wide regional variations exist, with the lowest proportion of institutional deliveries occurring in East Africa and the greatest proportion in South America. Whether in a hospital or at home, midwives can fill the gap in countries where skilled attendants are needed most.
One of the highlights of the ICM Congress in Prague is the launch of The State of the World's Midwifery 2014 report, an ambitious undertaking by ICM, the United Nations Population Fund, the World Health Organization, Instituto de Cooperación Social INTEGRARE (ICS Integrare), the University of Southampton and the University of Technology, Sydney. In addition, many technical collaborators, including FHI 360, and hundreds of contributions from 73 of the 75 Countdown to 2015 countries informed the report's findings.
The report calls attention to the remarkable contribution that midwives have made to the decline in maternal and newborn mortality and tracks achievements and progress since the first The State of the World's Midwifery report in 2011. With an emphasis on newly collected data, it provides an evidence base for assessing the current situation and identifies potential challenges, such as population growth and health care financing, until 2030. Two-page country profiles for 73 countries offer a tool to stimulate discussion about country-level needs for quality midwifery care.
The State of the World's Midwifery 2014 report will offer a blueprint for maximizing the contributions that midwives can make to health systems worldwide. We have seen the life-saving effect that midwives can have. It is time to put these competent health care professionals within everyone's reach.
Ward Cates, M.D., M.P.H., is President Emeritus with FHI 360
Patsy Bailey, Dr.P.H. is a Senior Scientist with FHI 360