Today is International Day of the Midwife (IDM). Celebrated on May 5 worldwide each year, the theme for 2021 is Follow the Data: Invest in Midwives. This represents a coming together of the global midwife community to advocate for investment in quality midwifery care around the world, improving sexual, reproductive, maternal, newborn, child and adolescent health in the process.
In taking time to reflect on the progress made by this vital profession, this year's theme is timely because IDM coincides with the launch of the 2021 State of the World's Midwifery (SoWMy) Report.
This evidence-based initiative is co-led by the International Confederation of Midwives, the World Health Organisation and the United Nations Population Fund, formerly the United Nations Fund for Population Activities (a UN agency aimed at improving reproductive and maternal health worldwide). SoWMy 2021 provides an updated evidence base and detailed analysis on the impact of midwives on maternal and newborn health outcomes and the return on investment in midwives. This will enable global leadership to focus upon the ongoing and growing efforts to centre midwives as fundamental to improving quality maternal and newborn care, ending preventable maternal and newborn deaths, and achieving the UN's Sustainable Development Goal 3.1 to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030.
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"The International Confederation of Midwives alongside its members and partners, will spearhead global, regional and national efforts to engage stakeholders, shift policy and ensure better sexual, reproductive, maternal, newborn, child and adolescent health outcomes globally ... there is no more time to waste. The evidence is clear, and against the backdrop of a global pandemic that has seen many midwives and birthing women lose their lives and their rights ... it is time to hold donors, governments and policymakers accountable for following the data and investing in midwives." (Source: https://www.internationalmidwives.org/)
With a global shortage of 900,000 midwives and the world facing the continued challenges of a global pandemic, midwives remain critical. Covid-19 has dramatically affected all aspects of health systems, notably in relation to maternal, sexual and reproductive, and adolescent healthcare. Disruption to service provision in these areas has increased the risks relating to health outcomes, as well as increasing unplanned pregnancies, sexually transmitted infections, unsafe terminations and increased health risks for mothers, newborns and adolescents.
Midwives can deliver care for women, children and adolescents outside of health facilities in the communities where they live, which is particularly important amid the pandemic as it has alleviated pressure on medical services. Further to this, home births protect women and families from exposure to Covid-19 inside health facilities. Critical to the Covid response in healthcare facilities, we must refrain from deploying midwives from midwifery to nursing services to provide care to general patients with Covid-19 as this takes them away from their essential role working in partnership with women and further contributes to the global midwifery shortage.
Gender transformative policies are needed to challenge the underlying causes of gender inequality, with consistent global leadership required to end gender discrimination within the health sector. Comprehensive international research and SoWMy 2021 show that women comprise more than 70 per cent of the health workforce. Gender inequality affects the status of midwives, most of whom are women (93 per cent globally), as well as their recruitment, mobility, career development, pay rates and self-care.
This is evidenced by a lack of investment in training and the professionalisation of midwifery practice. Investing in midwives has the power to accelerate the human rights agenda. In fact, this investment would be one of the most cost-effective strategies – to achieving full sexual and reproductive health coverage and reproductive freedom for women and all who give birth.
* Carla Donson is manager of Women's Network Whanganui.