“We need more Indigenous midwives,” said Claire Dion Fletcher, an Indigenous Potawatomi-Lenape Registered Midwife and co-chair of the National Aboriginal Council of Midwives (NACM), at a recent Wilson Center event with the United Nations Population Fund (UNFPA) and the International Confederation of Midwives about Indigenous midwifery. Globally, Indigenous women experience worse maternal health outcomes than non-Indigenous women. In the United States, risk of maternal death is twice as high for Native women than white women, while in Australia the risk is four and a half times higher.

“Achieving true progress on sexual and reproductive health and rights requires a comprehensive approach and a commitment to tackling deeply entrenched inequities and injustices of which marginalized communities continue to bear the brunt,” said Dr. Herminia Palacio, President and CEO of the Guttmacher Institute. She spoke at a recent Wilson Center event where speakers analyzed findings from the Guttmacher Institute on the state of sexual and reproductive health and rights (SRHR) globally.

“The world is at risk of losing millions of women and children due to reductions in coverage of essential services, reversing hard-earned progress towards the SDGs [Sustainable Development Goals] to date and posing catastrophic consequences for households and communities,” said Dr. Koki Agarwal, Project Director of the United States Agency for International Development’s (USAID) MOMENTUM Country and Global Leadership award, at a recent event on the importance of ensuring continuity of maternal, newborn, and child health services, voluntary family planning, and reproductive health care during the COVID-19 pandemic. The event was the first in a series of virtual country knowledge exchange discussions organized by USAID’s MOMENTUM Country and Global Leadership, led by Jhpiego and partners.

In just a single year, a 10 percent decrease in sexual and reproductive health services in low- and middle-income countries could lead to another 49 million women with unmet need for contraception, according to Guttmacher Institute estimates from April 2020. Other possible effects include another 15 million unintended pregnancies, another 28,000 maternal deaths and 168,000 newborn deaths due to untreated complications, and another 3 million unsafe abortions and 1,000 maternal deaths due to unsafe abortions. The implications are staggering in terms of unmet needs, unintended pregnancies, unsafe abortions, and maternal and newborn deaths in 132 countries that are home to more than 1.6 billion women of reproductive age (15–49 years).

With the arrival of COVID-19, countries are experiencing disruptions of health services of all kinds— health workers have been redeployed, supplies already in short stock are even more difficult to find, scarce financial resources for health are being reallocated, and routine health services are less, if at all, available. COVID-19 is causing facilities to lockdown in some settings, in part because many providers lack sufficient personal protective equipment (PPE) to safely provide services. At the same time, many clients—particularly those seeking family planning and reproductive health (FP/RH) services—cannot access services at all. This is due to a confluence of factors: police action is preventing movement; facilities are shutting their doors; many people are fearful of contracting the virus; in some cases, women are forbidden from leaving their homes by a partner. 

COVID-19 is having a profound impact on Latin American women. Gender-based violence increased drastically after governments imposed lockdowns, leaving policymakers and law enforcement scrambling to prevent attacks. Latin America was already one of the most dangerous regions for women, with the highest rate of sexual violence and some of the highest femicide numbers in the world. The Economic Commission for Latin America and the Caribbean registered 3,529 femicides in 2018, or one woman killed every two hours due to her gender. For many women living through the coronavirus pandemic in Latin America, the greater health risk might be staying home.

“Today is the International Day of the Midwife, a day when we come together as a global health community to celebrate midwives, and the commitment of the midwifery profession globally to saving lives and upholding the rights of women to a safe and positive birth,” write the authors of the Global Call to Action: Protecting Midwives to Sustain Care for Women, Newborns and their Families in the COVID-19 Pandemic. Midwives are essential to the health and protection of women and newborns. The World Health Organization (WHO) estimates that 83 percent of all maternal deaths, stillbirths, and newborn deaths could be averted with the full package of midwifery care.