Global shortfall of nearly 1m midwives due to failure to value role, study finds

By Liz Ford

The world is facing a shortage of 900,000 midwives, with more than half the shortfall in Africa, where nearly two-thirds of maternal deaths occur, according to a new survey.

Insufficient resources and a failure to recognise the importance of the role mean there has been little progress since the last study in 2014, according to the State of the World’s Midwifery report, which looked at 194 countries.

There are an estimated 1.9 million midwives and associate midwives working globally, 90% of them women. The report, published by the World Health Organization, the International Confederation of Midwives and the UN population fund (UNFPA) on Wednesday, said little progress had been made to improve midwifery care in the past seven years and the Covid pandemic had exacerbated the shortage with midwives deployed to support other health services.

It called for greater investment in education and training, and urged governments to make support for midwifery a priority.

Midwifery, and roles caring for women and newborns, it said, were often undervalued, “leading to midwives having no voice and no place at the leadership table: this hinders respect, access to decent work and pay equity”.

In 2017, an estimated 196,000 women in sub-Saharan Africa died during pregnancy or childbirth compared with 740 in Europe. Research published in the Lancet last year found that investing in midwifery could prevent roughly two-thirds of maternal and newborn deaths and stillbirths.

Anneka Knutsson, chief of UNFPA’s reproductive health branch, said that, at the current pace of progress in making up the shortfall in midwife numbers, “we would end up with a gap that is still 750,000 by 2030, which is little improvement”.

She said: “Africa would be exactly the same, that’s the projection. [The progress] won’t keep pace with the fertility rate and unmet need in Africa. The improvement we see would happen in middle-income countries.”

Knutsson said trained and resourced midwives would be able to deliver about 90% of essential sexual and reproductive healthcare services.

Midwifery, in particular, is seen as “women’s work”, which often confuses and undervalues midwives’ economic and professional contributions to society

Dr Franka Cadée, president of the International Confederation of Midwives (ICM), said: “As autonomous, primary-care providers, midwives are continually overlooked and ignored. It’s time for governments to acknowledge the evidence surrounding the life-promoting, life-saving impact of midwife-led care, and take action.

“ICM is committed to leveraging the strength of our global midwife community to carry forward these powerful findings and inspire country-level change. However, this work is not possible without commitment from decision-makers and those with the resources to invest in midwives and the quality care they provide to birthing women.”

The report’s recommendations will be discussed at the World Health Assembly later this month.