Strong call for better support of midwives on the frontlines delivered at ICM Congress
By Brigid McConville, White Ribbon Alliance for Safe Motherhood
Earlier this month, hundreds of White Ribbon Alliance (WRA) members from around the world were in Prague for the 30th Triennial Congress of the International Confederation of Midwives. The congress provided an opportunity for midwives to gather together, to share vantage points, and to strategize ways to improve the services and care that midwives are able to provide. The conference buzzed with the energy of midwives from all over the globe recognizing that they themselves can be the agents of change.
The State of the World’s Midwifery (SoWMy) 2014: A Woman’s Right to Health report was launched at the Congress. The SOWMy report reveals dangerous gaps in the midwifery workforce in 73 African, Asian and Latin American countries. Though maternal death rates in these 73 countries have declined by an average of 3% per year since 1990, they still have 96% of the world’s maternal deaths, 91% of stillbirths, and 93% of newborn deaths – yet only 42% of the world’s midwives, nurses and doctors. The clear message is that more needs to be done to address the severe shortage of midwives and other skilled birth attendants.
The SoWMy report recommends additional solutions to the barriers outlined in four key areas: availability, accessibility, acceptability and quality of midwifery services, and describes the positive results that have been seen. For example, 45% of the 73 countries have implemented measures to retain midwives in remote areas and 28% are increasing the recruitment and deployment of midwives, while 20% have implemented new codes of practice and 71% have improved information collection enabling countries to address shortages and education standards.
WRA representatives reported from the frontlines of the fight to increase numbers of quality, trained midwives and inspired midwives to lead this change during two very lively, packed-out advocacy workshops. Mary Chuwa from WRA Tanzania outlined a successful campaign which more than doubled the numbers of students signing up to train as midwives. She described how WRA advocacy activities prove that midwives themselves can be the strongest advocates for change, and showed how targeting youth in secondary schools can both improve the reputation of midwives, and dramatically increase the new generations’ interest in pursuing midwifery as a career. By addressing negative perceptions, WRA believes that youths can be inspired to consider midwifery as a career.
Lennie Kamwendo from WRA Malawi discussed the highs and lows of supporting WRA in Malawi - the achievements, such as changing the title of the “Directorate of Nursing” at the Ministry of Health to the “Directorate of Nursing and Midwifery,” and the concurrent struggles, such as the ongoing effort to encourage citizens to challenge authority and demand the rights that they are entitled to. The World Health Organization recommends one midwife for every seven pregnant women, but in Malawi, each midwife is responsible for 245 women – an impossible burden, and one that keeps WRA Malawi looking forward, striving for change. The presentation went on to describe WRA Malawi’s national advocacy campaign called Happy Midwives for Happy and Healthier Mothers, which persuades decision-makers to take specific actions to improve the status and working conditions of midwives, and supports the improved status and recognition of the profession.
Despite some progress, the ongoing lack of trained midwives means that hundreds of thousands of preventable deaths take place annually. Critical gaps in resources persist and urgent action is required. The report presents recommendations to close these gaps and allow mothers across the world the basic human right of access to quality health services. WRA members are working to close the gap between high level promises and the stark reality of health provision for women by holding leaders of the world to account on promises they have made to improve quality of maternal health care.
As we reach the 2015 target date to acheive the Millennium Development Goals, we must use these recommendations to pressure governments to commit more to supporting midwives, mothers and newborn babies internationally. USAID has invested in maternal and neonatal health and reproductive health care that serve approximately 27 million women around the world each year, but the SoWMy report shows that much, much more is required to address the burden of maternal mortality.
We look to the United States government to further address efforts to improve global maternal health through increased support to the frontline health workers who are so desperately needed on the ground. All women deserve to deliver their baby in a safe environment, with respect and dignity and we request, on the behalf of mothers across the world, further support in allowing this basic human right to become the reality.
The full SoWMy 2014 report is available to download here.