Durban – Up to 3.6 million deaths could be avoided each year in 58 developing countries if midwifery services are upgraded by 2015, and 38 of 58 countries could miss their Millennium Development Goal 5 (on maternal health) targets without 112 000 more midwives being brought on board.
These findings formed part of a new report released by the United Nations Population Fund (UNFPA) and its partners presented at the Triennial Congress of the International Confederation of Midwives (ICM).
The meeting is being held at the Durban ICC from June 19 – 23.
The first ever State of the World’s Midwifery 2011 report unveiled new data confirming that there is a significant gap between the number of midwives practicing and those needed to save lives.
Each year, 358 000 women die while pregnant or giving birth, some two million newborns die within the first 24 hours of life. There are 2.6 million stillbirths, all because of inadequate or insufficient health care.
Unless an additional 112 000 midwives are trained, deployed and retained in supportive environments, 38 of the 58 countries surveyed might not meet their target to achieve 95 percent coverage of births by skilled attendants by 2015, as required by the MDG5. Globally, 350 000 midwives are still lacking.
Poor regulation, weak professional associations, an incomplete policy environment, and the omission of midwifery from human resource costing plans for maternal and neonatal health are significant challenges faced by the developing world.
“Ensuring that every woman and her newborn have access to quality midwifery services demands that we take bold steps to build on what we have achieved so far across communities, countries, regions and the world,” said Ban Ki-moon, Secretary-General of the United Nations, in his foreword in the report.
Executive Director of UNFPA, Dr Babatunde Osotimehin, said: “The report points to an urgent need to train more health workers with midwifery skills and ensure equitable access to their life-saving services in communities to improve the health of women and children.”
If adequate facilities were accessible to deal with complications at their onset, many deaths could be averted – nearly two thirds of all maternal deaths, almost half of stillbirths, and three in five newborn deaths.
The report added, if midwives are in place and can refer the most severe complications to specialised care, up to 90 per cent of maternal deaths could be prevented.
Among the 38 countries most desperately in need of midwives, 22 need to double the workforce by 2015 – seven need to triple or quadruple it.
Nine countries including Cameroon, Chad, Ethiopia, Guinea, Haiti, Niger, Sierra Leone, Somalia and Sudan all needed to dramatically scale up midwifery by a factor of between 6 and 15, the report said.
Most deaths or disabilities occur in low-income and marginalised areas where there is no access to functioning health facilities or to qualified health professionals, notably those with midwifery skills.
The report has made recommendations to assist countries increase the number of midwives.
It has urged governments and regulatory bodies to reinforce the status of midwifery and called for competency-led continuing education of existing midwifery personnel.
There is a need for countries to graduate additional midwives to rapidly scale up workforce supply.
A profile on South Africa, one of the countries included in the report, showed that many midwives need retraining in required maternity and obstetric skills and quality assurance needs strengthening.
There is a staff shortage with too few midwives being trained and poor mentorship of practice leading to skill deficits.
The report highlights that midwifery is not considered a specialty; the midwife title is protected but the training is one year of a four-year nursing programme. Midwives do not qualify for additional scarce skills allowance so salaries are low.
Working conditions are often poor, especially in rural facilities.
But there are developments on these fronts: there is community follow-up of pregnant mothers, waiting homes for at-risk mothers, and enhancement of community sexual and reproductive health services.
Midwives now also do community service following their training.
There is closer collaboration with academic institutions and the award of the midwife certificate is competency-based. – Kemantha Govender, BuaNews