Petra ten Hoope-Bender, Director RMNCH, ICS Integrare.
June 03, 2014.
Over the last 12 months, my days, nights and weekends have been occupied with the research, writing and development of a critical report on sexual, reproductive, maternal and newborn health: The State of the World’s Midwifery 2014: A Universal Pathway. A Woman’s Right to Health (SoWMy 2014). The report is launched today, 3nd of June 2014, at the International Confederation of Midwives 30th Triennial Congress in Prague and is available to download here.
SoWMy 2014 takes inspiration from the United Nations’ Secretary-General Ban Ki-moon’s Every Woman Every Child initiative. The main objective is to provide an evidence base on the state of the world’s midwifery that can: support policy dialogue between governments and their partners; accelerate progress on the health Millennium Development Goals; identify developments in the three years since SoWMy 2011 and inform negotiations for the post-2015 development agenda.
The SoWMy 2014 report is honored to have the United Nations Secretary-General provide a foreword, in which he highlights:
“The midwifery workforce, within a supportive health system, can support women and girls to prevent unwanted pregnancies, provide assistance throughout pregnancy and childbirth, and save the lives of babies born too early.”
“I fully support the vision articulated in this report…Its implementation will help governments to deliver on women’s right to health, ensure that women and newborn infants obtain the care the need , and contribute to our shared, global ambitions to end preventable maternal and newborn deaths.”
The report is a multi-agency collaboration with 31 global development partners that worked with government representatives and national stakeholders in 73 low- and middle-income countries included in the “Countdown to 2015” reports. These countries account for more than 92% of global maternal and newborn deaths and stillbirths but have only 42% of the world’s maternal and newborn health workforce. Within these countries, coverage in terms of workforce deficits are often most acute in areas where maternal and newborn mortality rates are highest. The report makes it clear that:
- Only 4 of the 73 countries have a midwifery workforce that is able to meet the universal need for the 46 essential interventions in sexual, reproductive, maternal and newborn health that are known to save lives.
- Midwives, when educated and regulated to international standards, can provide 87% of the essential care needed for women and newborns.
- Accurate data on the midwifery workforce enables countries to plan effectively. This requires a minimum of 10 pieces of information that all countries should collect: headcount, percentage time spent on SRMNH, roles, age distribution, retirement age, length of education, enrolments into, attrition and graduation from education, and voluntary attrition from the workforce.
- Investing in women is known to generate positive socio-economic benefits. The return on investment from the education and deployment of midwives is reported by Tim Evans at the World Bank as a “best buy” in primary health care.
To prepare for the future and reduce gaps in midwifery services, the report proposes a vision for Midwifery2030 where:
- All women of reproductive age, including adolescents, have universal access to midwifery care when needed (the first and second components of UHC).
- Governments provide and are held accountable for a supportive policy environment.
- Governments and health systems provide and are held accountable for a fully enabled environment.
- Data collection and analysis are fully embedded in service delivery and development.
- Midwifery care is prioritized in national health budgets; all women obtain universal financial protection (the third component of UHC).
- Midwifery care is delivered in collaborative practice with health-care professionals, associates and lay health workers.
- First-level midwifery care is close to the woman and her family with seamless transfer to next-level care.
- The midwifery workforce, in communities, facilities and hospitals, is supported through quality education, regulation and effective human and other resource management.
- All health-care professionals provide, and are enabled to deliver respectful, quality care.
- Professional associations provide leadership to their members to facilitate quality care through advocacy, policy engagement and collaboration.
The last 12 months have been a challenge, long hours and hard work. I have been privileged to work with some excellent colleagues in this period. Our hope is that the report will inform policy dialogue and change in some of the 73 countries, to improve midwifery services and ensure that there are sufficient, well-educated and motivated health workers to provide quality care. Adolescents and women have a right to high-quality sexual and reproductive health, the challenge remains to make this a reality.