Maternal Death, The Midwife Crisis And COVID-19’s Impact

The COVID-19 pandemic has contributed to a global decline in maternal healthcare. An international review published in the Lancet Global Health journal found that the rate of maternal deaths and stillbirths has risen by approximately a third during the pandemic. In addition to infecting mothers with the virus itself, COVID-19 led to clinic closures, disruption of maternity services and insecure food supplies. These effects caused a decrease in prenatal and antenatal healthcare, a fear of going to healthcare facilities as well as making them more challenging to get to, and ultimately led to avoidable deaths of mothers and infants.

The global shortage of midwives is a major cause of gaps in maternal healthcare. The 2021 State of the World’s Midwifery (SoWMy) report, published in May by the United Nations Population Fund (UNFPA), the World Health Organization (WHO) and the International Confederation of Midwives (ICM), evaluates the midwifery workforce and healthcare in 194 countries. The report found that the world has a shortage of 900,000 midwives, meaning a third of the required global midwife workforce is missing. The skills and importance of midwives are vastly overlooked and the lack of recognition of their crucial role costs the lives of millions of women and newborns every year.

An analysis published in the Lancet journal for the 2021 SoWMy report estimated that fully resourcing midwife care by 2035 would save 4.3 million lives a year. However, the report also found that at the current rate of progress, the state of the global midwife workforce will only improve slightly by 2030. In the meantime, the midwife shortage is causing preventable deaths. During the pandemic, the health needs of women and newborns have been overshadowed and midwives were transferred to other medical services, which exacerbated the midwife shortage in addition to increasing maternal deaths.

The 2021 SoWMy report explains that midwives can provide 90% of the sexual, reproductive, maternal, newborn and adolescent healthcare (SRMNAH) but they currently account for less than 10% of the SRMNAH workforce. Since the first SoWMy report in 2011, the evidence supporting midwives’ importance has grown substantially. They provide crucial services, but governments and healthcare systems are not sufficiently recognizing and prioritizing them. The current SRMNAH workforce can provide for a maximum of 75% of essential SRMNAH care worldwide and only 41% in low-income countries.

The pandemic’s effects on maternal healthcare have hit low-income countries the hardest. Disparities in maternal healthcare and gender and economic inequalities have become more apparent. These gaps are projected to widen by 2030 if there is not substantially more investment in midwives and women’s healthcare. Gender inequality has also driven the midwife shortage, because this female-dominated profession is overlooked, and has placed women and girls’ healthcare in a less prioritized position. The SoWMy report explains that the lack of resources and support for midwives is a symptom of healthcare systems not prioritizing the sexual and reproductive needs of women and girls.

To increase and support the midwife workforce, the health needs of women and girls must be increasingly prioritized. The SoWMy report calls for investment in quality education and training, midwife-led improvements to care delivery, increasing midwifery leadership, and improving healthcare workforce management. Governments and healthcare systems must include midwives in healthcare decision-making and support their ability to deliver a wide range of care. Midwives do more than attend births; they provide many reproductive and sexual health services, including prenatal and antenatal care and STI detection and treatment.

The WHO Director-General, Dr. Tedros Adhanom Ghebreyesus, explained that strengthening the midwifery workforce “will deliver a triple dividend in contributing to better health, gender equality and inclusive economic growth.” Filling the global midwife shortage will improve women and newborns’ health, which not only saves lives but is beneficial to society broadly. Increasing the midwife workforce and their ability to deliver care has a remarkable return investment, as it increases labour supply, supports economic stabilization and has positive macroeconomic impacts. Prioritizing the midwife profession and women’s health needs will both improve healthcare and have positive effects on overall development. Organizations like the WHO, UNFPA and ICM are working to fill the midwife shortage and improve women’s healthcare. These efforts are working but to have a wider impact, governments and healthcare systems must invest in midwives and women’s health as well.