“Midwifery is a fix, it is not an add-on,” said Franka Cadée, President of the International Confederation of Midwives (ICM) at the Nairobi Summit on ICPD25. The World Health Organization designated 2020 the Year of the Nurse and the Midwife in recognition of the invaluable contributions of these two professions.  To meet the Sustainable Development Goals by 2030, midwives and nurses must be valued and utilized as essential members of the health workforce.  Increased utilization of skilled midwives will also help countries achieve universal health coverage and improve access to sexual and reproductive health services, two key actions from the 1994 International Conference on Population and Development (ICPD).

The International Confederation of Midwives represents more than a million midwives globally. In the last year, there has been significant interest in the field, particularly in the Middle East, which saw a 7 percent increase in registered midwives. But many places still lack the midwives and other healthcare workers needed to optimize their health systems. Reports show that nine million more midwives and nurses are needed by 2030. If we don’t have enough healthcare workers trained, competent, and distributed where needed, we will never be able to make our commitments, said Dr. Lale Say, Coordinator of the Adolescents and at-Risk Populations Team at the World Health Organization (WHO). “The health workforce is the backbone of health systems and achieving UHC (universal health coverage),” said Say.

Unique Role of Midwives

Midwives do more than deliver babies. Well-trained midwives can deliver 87 percent of all essential sexual, reproductive, maternal, and newborn health services. “The bedrock of UHC is SRHR [sexual and reproductive health and rights],” said Cadée. “When it comes to SRHR, it is midwives who stand next to women.”  When trained to meet ICM standards of care, midwives are able to provide many services. Incorporating midwives in care increases the well-being of new mothers, according to research. When midwives provide SRHR services, women have a greater chance of survival, fewer C-sections, and fewer morbidities. WHO estimates that 83 percent of all maternal deaths, stillbirths, and newborn deaths could be averted with full midwifery care.

Birth needs to happen at the right time when women want it, when they are able to flourish, and when they are able to ensure that their family will have a healthy future, said Cadée. “Midwives are uniquely placed to address these issues and just so agile and passionate and confident in the areas of care we need,” said Dr. Rhona Mahoney, the Executive Director of Women and Children’s Clinical Academic Directorate of Ireland.

Midwives are particularly important because they reach those most likely to be left behind by the traditional health system and healthcare clinics. We often say that people live far away from health care, but actually we are far from the people, said Cadée. “And I think that’s why community workers, midwives, and people who work in the community are so important—because we need to go to where people live,” she said. Midwives, including indigenous midwives, provide consistent support to women and often share traits similar to the women they work with, which helps them provide not just medical support, but also culturally supportive care in the women’s native tongue.

Support Midwives to Make the Dream Team a Reality

“Midwives save lives, especially when they are well-educated and supported,” said Say. And when such competent, motivated health workers demand effective health systems, it can help improve the health of nations, said Minister of Health of Myanmar, U Thien Swe. But more support, in many forms, is needed.

A lack of financial support makes it hard for low- and middle-income countries to achieve these objectives. Swe pushed for government support and investment in “human-centered development” to create a culture of lifelong learning, which can transform the future healthcare workforce.

Midwives must be supported in leadership roles. “Women make up 70 percent of the health workforce but only make up 25 percent of the leadership roles, and that’s a reality we must change,” said Roopa Dhatt, Co-founder of Women in Global Health. Clearly we need to listen to women and hear what they want. We need to see midwives as leaders and we need them represented on decision-making boards, said Dhatt.

To improve women’s health, a dream team will be needed, said Cadée. “The dream team is not just the medical team; it’s not just the obstetrician and the midwife working well together,” she said. She painted a picture of a dream team where the woman is at the front. Not only healthcare professionals and other healthcare workers, but also politicians, the media, policymakers, NGOs, the private sector, and women leaders surround her. “All kinds of people need to stand together,” said Cadée, “and together, we make the dream team.”