Health workforce

Does the world have enough midwives?

Geneva February 2015, As the United Nations Secretary-General’s Global Strategy for Women’s and Children’s Health undergoes a revision for launch in September 2015, the global community in Geneva came together for a Geneva dialogue on midwifery aimed to inform the UNSG New Delhi Consultation taking place on 26-27 February. The event was hosted by United Nations Population Fund (UNFPA); World Health Organization (WHO); the International Confederation of Midwives (ICM), along with eight permanent missions to the UN Canada, France, Nepal, Morocco, Senegal, Sweden, Zambia and Zimbabwe.

Opening the event was, Swedish Ambassador to the UN in Geneva, Jan Knutsson, who launched a global campaign to support midwives called Midwives4all ("www.midwives4all.org”). The welcome was followed by the President of the ICM, Frances Day-Stirk who articulated that an increase in quality of midwifery services can help countries reach universal health coverage because “midwives are where women are” and can cover 87% of the essential RMNH interventions by providing a full set of midwifery competencies. Jim Campbell, Executive Director of the WHO’s Health Workforce Department described the global context and the need for a contemporary Global Strategy on human resources for health to meet the health goals of the SDGs. He also discussed the key findings of the Midwifery Lancet series and the SoWMy report, reminding us that “educating midwives is the best buy in primary health care” (NICE study, UK)

"the world does not have enough midwives"

Dr. Babatunde Osotimehin, said

Following the introductory and context stetting remarks, was the Ambassador’s panel comprising of Ambassadors (France, Zambia, Senegal, Morocco, Zimbabwe and Nepal) with the Executive Director of UNFPA, Dr Babatunde Osotimehin and the Director-General of WHO, Dr Margaret Chan. Dr Babatunde Osotimehin, Executive Director UNFPA reminded us that midwives are not a luxury, they contribute to ensure access to Universal health coverage and if investments are made at the right point countries can provide a minimum package of care for everyone. “Health is not a cost, it is an investment and health care workers are a part of that” he said. WHO Director-General Dr Chan articulated “failure to provide high quality maternal care is a political liability”. She also emphasized the importance of midwives in providing respectful and compassionate care.

In Africa and in most developing countries, nurses and midwives in urban areas represent 63% of the health workforce whereas in rural areas this number reaches 37%. H.E. Ambassador Encyla Tina Chishiba Sinjela, Zambian ambassador stated that many African countries are struggling to recruit and retain midwives impeding access of all women to midwifery quality cares in rural areas. Midwives need not only to be educated but deployed and retained with adequate remuneration. In Senegal, the capital city Dakar concentrates 52% of health professionals delivering services to only 23% of the total population of Senegal. In response to this issue, the Government of Senegal adopted an innovative nomadic midwifery strategy to attract and retain midwives at community level, explained H.E. Ambassador Bassirou Sene, Permanent Representative of Senegal.” Midwives are the cornerstone of any economic development”, he stated.

Despite a growing awareness over the importance of midwives as agents of changes, the insufficiency of financial resources negatively influences countries motivation and actions. H.E. Ambassador Mohamed Auajjar, Moroccan ambassador for instance expressed his concern about health and education budgetary cuts to reduce deficit in country. These cuts slow down progresses in Morocco resulting in a failure to achieve targets and to meet citizen’s expectations (4 midwives for 1000 births). France elaborated its commitment to MNCH issues through its financial commitment to support a joint WHO/UNICEF/UNFPA/UN-Women initiative aimed at reinforcing health systems to reduce maternal, newborn and child mortality. H.E. Ambassador Taonga Mushayavanhu, Permanent Representative of Zimbabwe declared that training and retention associated with adequate working conditions are essential to reduce maternal and neonatal mortality. Ambassador Deepak Dhital, Permanent Representative of Nepal emphasized that the strengthening and consolidation of midwifery services make a difference in the delivery of quality health services in health care systems.

Concluding the discussions, Dr. Babatunde Osotimehin, said “the world does not have enough midwives”. He added that midwives can be agent of changes to improve universal health coverage and achieve a more equitable world for women and girls. Dr Margaret Chan articulated health is an investment as regard to sustainable development and emphatically stated “we need midwives, we need midwives, we need midwives” because “no woman in this world should die giving birth. Giving birth should be a precious and pleasant experience.”!