Midwives Globally: Inequalities and Solutions Revealed in Maps


Maternal Health

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Each day, more than 800 women die from pregnancy and childbirth-related complications—90 percent of which are preventable deaths—and 99 percent of which occur in developing countries.

As an undergraduate at Stanford University studying global health issues, I was familiar with these alarming statistics — however, prior to my summer fellowship at Direct Relief, I didn’t know that the most significant intervention for preventing maternal death is the presence of a skilled and equipped healthcare provider, such as a midwife, during pregnancy and childbirth.

To learn more, I turned to The State of the World’s Midwifery 2014Countdown to 2015, Trends in Maternal Mortality: 1990 to 2013, and World Health Statistics 2014.

And the statistics are staggering —  37 percent of the world’s countries account for 96 percent of the world’s maternal deaths, 91 percent of the world’s stillbirths, and 93 percent of the world’s neonatal deaths — yet, these countries have access to only 42 percent of the world’s midwives, nurses, and physicians — but they’re still statistics.

I wondered, how would such inequality look on a map?

From data in the reports mentioned above, I created three maps to illustrate better the global distribution of midwives by workforce availability, global maternal mortality ratios, and global neonatal mortality rates.

The maps, which are color-coded by severity, offer a new perspective and insights into the data; most notably, they emphasize the divide between the developing and developed world.

I next wanted to understand the maternal health and midwifery landscape in the countries where Direct Relief works. To do that, I created another series of maps that focus on the countries that have received Direct Relief Midwife Kits*: Mexico, Liberia, Sierra Leone, Somaliland, Togo, and the Philippines. To bring the information to life, I placed the country-level maps alongside stories and pictures from Direct Relief’s local partners.

Direct Relief’s impact suddenly became crystal clear.

Direct Relief staff were considering where to send the next shipment of Midwife Kits. With that in mind, I decided to map areas for potential program expansion: Haiti, South Sudan, Malawi, and Nepal.

Once compiled into a single story-map, the final product revealed the big picture and the finer details of Direct Relief’s role in global midwifery. The map brought to life the amazing impact and potential of Direct Relief Midwife Kit program, allowing me to follow the thinking behind programmatic decisions. It also offered greater clarity into the enormous inequality that exists in the realm of maternal and neonatal health across the globe.

*Direct Relief, in consultation with experts from the International Confederation of Midwives (ICM), designed the first-ever Midwife Kit endorsed by ICM as a standard for midwives trained to ICM’s competency standards. Each Midwife Kit contains the 59 essential items a midwife needs to perform 50 facility-based deliveries. The Midwife Kits, valued at $1,250, or roughly $25 per safe birth, are provided free of charge to midwives in resource-constrained settings.

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