Midwifery improves in many countries but investments still needed in education of midwives — Report
Midwives are a critical workforce within a health system. Their role of providing assistance throughout pregnancy and childbirth, supporting women and girls to prevent unwanted pregnancies and saving the lives of babies born too early is evident that midwifery can dramatically accelerate progress on sexual, reproductive, maternal and newborn health (SRMNH), as well as universal health coverage.
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Recognising that midwifery is a key element of sexual, reproductive, maternal and newborn health care, governments and professional associations are acting to support midwives to contribute to the shared global ambition to end preventable maternal and newborn deaths.
Report
This vision is within the reach of all countries at all stages of economic and demographic transition, according to ‘The State of the World’s Midwifery 2014’ (SoWMy) report on the theme: “A Universal Pathway”. A Woman’s Right to Health”, which was launched this month at the International Confederation of Midwives’ Triennial Congress in Prague, the Czech Republic.
The report, a joint effort of the United Nations Population Fund (UNFPA), International Confederation of Midwives (ICM), World Health Organisation (WHO) and several global partners, discloses the latest data from 73 countries that account for more than 92 per cent of global maternal, newborn and child deaths.
The new data improve the evidence base in this area and is expected to help mobilise leadership and action in highly burdened countries to strengthen maternal and newborn health services and facilitate the provision of quality midwifery services to pregnant women and their babies.
The report, which is the second of its kind, links two specific areas of focus: first, maternal and newborn health and second, the overarching principles and values of the post-2015 development agenda, providing new evidence for decision makers.
In the report, a midwife is defined as–the health services and workforce needed to support and care for women and newborns, including sexual and reproductive health and, especially, pregnancy, labour and postnatal care.
Key messages
The report says that tangible progress has been made in improving midwifery in many countries since the first SoWMy 2011 report. However, only 42 per cent of the world’s medical, midwifery and nursing personnel are available to women and newborn infants in these countries.
Within these countries, workforce deficits are often most acute in areas where maternal and newborn mortality rates are highest and only four of the 73 countries have a midwifery workforce that is able to meet the universal need of the 46 essential interventions for sexual, reproductive, maternal and newborn health.
It noted that countries were endeavouring to expand and deliver equitable midwifery services but comprehensive, disaggregated data for determining the availability, accessibility, acceptability and quality of the midwifery workforce were not available.
Furthermore, it said, midwives who were educated and regulated to meet international standards could provide 87 per cent of the essential care needed for women and newborns.
“Investing in midwifery education with deployment to community-based services could yield a 16-fold return on investment in terms of lives saved and costs of caesarean sections avoided and is a ‘best buy’ in primary health care,” the report indicated.
Additionally, investing in midwives frees doctors, nurses and other health cadres to focus on other health needs and contributes to reducing infections, as well as ending preventable maternal and newborn deaths .
In order for midwives to work effectively, however, facilities need to be equipped to offer the appropriate services, including equipment for emergencies (safe blood, caesarean sections, newborn resuscitation).
The report also reinforced that accurate data on the midwifery workforce enabled countries to plan effectively, while legislation, regulation and licensing of midwifery allowed midwives to provide the high-quality they were educated to deliver and, thus, protects women’s health.
Ghana
An important section of the report is the chapter on country briefs where reported country data have been used to calculate needs-based planning estimates and projections for 2030.
Touching on Ghana, the report said in 2012, of an estimated total population of 25.4 million, 6.5 million were women of reproductive age and the total fertility rate was 3.9. By 2030, the population is projected to increase by 39 per cent to 35.3 million.
To achieve universal access to sexual, reproductive, maternal and newborn care, midwifery services in this country must respond to 1.1 million pregnancies per annum by 2030, 59 per cent of these in rural settings.
The health system implications include how best to configure and equitably deploy the SRMNH workforce to cover at least 83.8 million antenatal visits, 16 million births and 64.1 million post-partum or postnatal visits between 2012 and 2030.
International Day of Midwife
Meanwhile during the observance on the International Day of the Midwife, which was held last May at Goaso in the Brong AhafoRegion, the acting UNFPA Representative in Ghana, Ms Dennia Gayle, emphasised that concerted efforts were required to scale up cost-effective interventions in educating midwives and other professionals with midwifery skills to accelerate efforts at improving maternal health and achieving MDG on maternal health, one of the goals lagging farthest behind.
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She said midwives must be celebrated because of their “contribution to the miracle of birth and for the myriad other things they do every day to contribute to the well-being of each and every individual family the world over.”
Ms Gayle noted that more than 30 per cent of women in Ghana gave birth without skilled care, increasing the risk of death and disability for both the mother and the newborn, adding that “Ghana needs midwives now more than ever.”
However, she said , there were grave challenges with more than 50 per cent of practising midwives above the age of 50, coupled with the high failure rate of more than 40 per cent across all cadres at licensure examinations.
Investments in midwives in Ghana can help avert a significant number of the nearly 300 maternal deaths and several newborn deaths that occur every year due to the lack of well-educated and regulated health workers and adequate facilities.
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Midwives also provide other life-saving reproductive health information and services, including antenatal, postnatal care and family planning.
Divided front of midwives
Ms Gayle pointed out that UNFPA had worked over the past five years on midwifery programming in Ghana and was very worried about the divided front of the Midwives in the country, “as we have had the opportunity to interact with both midwifery associations.”
“No amount of investment will yield any fruits if the midwives have a divided front,” she said, and appealed to the two midwifery associations to work together for the benefit of the country, and also urged the government to identify the root causes of the conflict and find an amicable solution to facilitate harmony and cohesion among the two associations.
Writer’s E-mail: rosemary.ardayfio@graphic.com.gh
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