May 5th is the International Day of the Midwife. This year’s theme, “Midwives: A Vital Climate Solution,” acknowledges the role that midwives play by delivering environmentally sustainable health services, adapting health systems to climate change, and as first responders when climate-related disasters occur.  Empowering a resilient health workforce with midwives as first contacts for maternal health care can improve universal health coverage through reductions in environmental impact, as well as more efficient, less costly health systems, and stronger local economies.

In recognition of the International Day of the Midwife, the Wilson Center’s Maternal Health Initiative posed key questions to leaders working as midwifery focal points in Jhpiego country offices on how they see the role of midwives in climate resilience in their country.

At Jhpiego, we believe that understanding climate change is a lifesaving health intervention, and as a result, we have joined the Planetary Health Alliance (PHA) consortium to show our commitment to understanding and addressing global environmental change and its health impacts. We know that our association with PHA will allow us to strengthen approaches, impact, and collaboration to make a substantiative difference to the lives of mothers and babies.

Q1: In your country, how are midwives collaborating with community organizations and public health agencies to develop strategies and emergency preparedness plans for families impacted by climate change?

A1: Esther Banda, Registered Midwife, Zambia

In 2016, Zambia enacted a cross-sectoral National Policy on Climate Change to provide a framework for coordinating climate change strategies across disciplines. Midwives work with community health agencies and partners to identify areas that are most affected by climate change, including drought, flooding, and extreme heat waves. Once the areas are identified, action plans are developed to ensure access to essential reproductive health services, as well as measures to address the potential disruptions in healthcare infrastructure and supply chains.

Strategies to improve access include outreach and integrated services at both hospitals and rural health clinics and follow up in the community to offer vaccinations and family planning. Midwives in Zambia work with Safe Motherhood Action Groups (SMAGs) in the community to identify pregnant women and malnourished children for referral. Work with community agencies strengthens home visits to post-natal mothers who may not be able to visit the health facilities.  

The Zambia Midwives Association collaborates closely with community organizations and public health agencies to develop strategies and emergency plans for families affected by climate change. This involves advocating for policy changes to prioritize maternal and child health in climate adaptation efforts and educating families on potential risks, such as increased incidence of vector-borne diseases and food insecurity.

Q2: What do you see as the biggest challenges pregnant people face in your country due to climate change? 

A2: Rosemary Ngougu, Registered Midwife, Kenya

Climate change significantly impacts pregnant individuals in Kenya, exacerbating existing challenges and introducing new risks to maternal and fetal health.   Extreme climate-related changes have disrupted agricultural productivity, leading to increased levels of food insecurity and malnutrition. Malnutrition has many impacts on pregnancy and fetal development; and increases the risk of maternal mortality, fetal growth restriction, and birth defects.

Malnutrition, coupled by water scarcity and poor sanitation, leads to an increased risk of waterborne diseases, such as cholera and typhoid. Both of which can have severe consequences for pregnant women, fetal development, and newborns. Vector-borne diseases like malaria and dengue fever, pose additional risks to pregnant women. Malaria is a significant concern for maternal and infant mortality in malaria endemic areas. Changes in temperature and rainfall patterns can create conducive environments for prolific mosquito breeding and increased transmission of malaria.

Addressing these challenges in Kenya will require coordinated efforts from governments, policymakers, midwives and additional healthcare providers, and communities.

Q3: In your country, what are the biggest climate-related challenges faced by midwives? 

A3: Eugenia Mensah, Registered Midwife, Ghana

‘‘I solemnly pledge that I will do my best.” This is the first statement of the midwives’ pledge. In Ghana, midwives are entrusted with the noble responsibility of ensuring the health and well-being of mothers and their newborns. Heat stress is identified as a significant climate-related health concern. With temperatures, particularly in the northern regions of Ghana, reaching 43.9°C (111°F), pregnant women, newborns and midwives face heightened risks of dehydration and heat exhaustion. Such conditions not only endanger the health of mothers-to-be, but also impair the midwives’ ability to perform their duties effectively, thereby exacerbating the challenges in providing optimal maternal and neonatal care services.

Pregnant women who suffer heat-related illnesses such as cerebrospinal meningitis (CSM), add another layer of complexity to the already strenuous roles of midwives. With documented cases of periodic CSM outbreaks in the northern parts of Ghana, midwives at the frontline play supportive roles in education pregnant women and new mothers on how to protect themselves and stay healthy during such intense weather periods. Midwives need increased protection from these disease outbreaks and from climate-related adversities.

Q4: In your country, how are midwives collaborating with community organizations and public health agencies to develop strategies and emergency preparedness plans for families impacted by climate change?

A4: Angeline Houman, Registered Midwife, Ivory Coast

The Ivory Coast created a National Adaptation Plan (NAP) to address climate change and it integrates human health into its strategic. The 2023 National Climate and Development Report highlights the impact of climate change on maternal and child health and highlights the resurgence of malaria, dengue fever, and water-borne diseases as particular risks.

As midwives, we do group care lessons to discuss health topics relevant to climate change and to develop rapport with clients. Any time there is a health-related event, midwives take advantage of group counseling opportunities to inform women who may be affected by these situations. There are also “couples’ chat sessions” organized by midwives to inform them of issues like malaria in pregnancy, dengue fever and pregnancy, as well as how they impact childbirth. There is now more focus on raising awareness and advice on water-borne diseases and other pathologies linked to climate change. 

In remote rural areas, midwives use advanced strategies to identify the specific needs of rural women and their families related to climate change to better care for them. We are working to develop new standards and procedures for all midwives to address climate change in their practice and we hope to help create sustainable solutions to this phenomenon.

Q5: In which ways do midwifery practices and teachings help to mitigate the impacts of climate change on maternal and infant health globally?

A5: Pandora Hardtman, Chief Nursing and Midwifery Officer, Jhpiego

Midwifery prides itself on being a high-touch and low-tech profession. As an often cited saying, this core midwifery philosophy guides midwives to contribute to the mitigation of the effects of climate change.

For example, most high-tech professions require a lot of packaging. Midwives produce less medical waste. Think of all the drapes, towels, and sterile packaging that are thrown away in a costly cesarean section. Midwives focus on low-risk supportive practices such as walking during labor and birth, which results in more vaginal births, reducing unnecessary cesarean deliveries.

Midwifery also strongly supports a full 1-2 years of breastfeeding, which reduces the environmental impact of packaging, manufacturing, and shipping of formula, bottles, nipples, etc. that are necessary in formula feeding practices. In addition, we need to consider the reduced risks associated with breastfeeding in extreme-weather disasters since formula feeding with contaminated water can lead to extreme illness and even death.

In short, Midwifery is rooted in low-risk care, prevention, public health, and empowerment for change which is the best climate solution.