A global shortage of 900,000 midwives threatens the lives of millions of women each year. In 88 countries, a total of 74% of the world’s population has access to just 46% of the world’s midwives, nurses, and doctors.
These are just two of the findings from the third State of the World’s Midwifery Report (SoWMy), a newly released document that gathers and analyzes data from all over the world to draw essential conclusions about the current state of practice for the roughly 1.9 million midwives working worldwide.
The report, the result of a collaboration between the United Nations Population Fund, the World Health Organization, and the International Confederation of Midwives (ICM), compiles data from two main sources: the WHO’s National Health Workforce Accounts and the ICM Global Midwives Associations Map Survey. The latter asked midwives’ associations around the world to provide information about the association, education, regulation, and leadership associated with the profession in their countries, which was accumulated and then analyzed to draw together a comprehensive picture.
The findings aren’t just striking in their own right. They will also be used as part of the foundation for the forthcoming Global Midwives’ Hub, a digital resource that midwives and their associations can use to draw actionable information about the state of the profession that will help them advocate for midwife-led care.
Despite the essential role that midwives play in maternal health care worldwide, the burden of demanding change often falls on these health workers and the communities for which they care. For that reason, data that can support effective advocacy efforts is an indispensable resource.
“We see the Global Midwives’ Hub as an essential tool in the grassroots efforts of midwives and midwife-advocates to illustrate the findings governments continually ignore: midwives are the answer to ending preventable maternal and newborn death,” said Dr. Sally Pairman, ICM’s chief executive.
Following the Data
Countries around the world rely heavily on midwives to provide care for women and infants – often without sufficient resources, staff, or recognition. Midwife-led care has been repeatedly shown to be a highly effective model, improving outcomes for women, infants, and larger communities. In addition to providing prenatal, delivery, and antenatal care, midwives frequently play important roles in advancing primary care and addressing reproductive rights, among other important interventions.
The 2021 report includes input from high-income countries that were not included in the earlier 2011 and 2014 iterations, recognizing that all countries confront challenges in meeting women’s sexual and reproductive health needs. If anything, the new report draws attention to the relatively little progress that has been made in addressing these challenges.
In addition, the report underscores the significant burden that Covid-19 has placed on the world’s midwives, many of them already working in under-resourced and under-staffed conditions.
Direct Relief contributed to the SoWMy report by supporting ICM’s data collection, collaborating on the creation of surveys, and hosting the survey, data editing, and survey response tracking. This data will be displayed on an interactive map, created by Direct Relief’s Research and Analysis staff, that will form a part of the larger Global Midwives’ Hub.
Midwives as Researchers
Both the report and the associated hub are unique in that they rely on data gathered by midwives
and midwives’ associations around the world, and are in turn designed to be used by midwives –positioning these vital health workers as researchers in their own right. “That, to me, is how progress happens. To do it openly and then to have a claim that this is your data – to me, that’s where data helps to provide a voice,” said Andrew Schroeder, Direct Relief’s vice president of Research and Analysis.
“Follow the Data: Invest in Midwives” is, not coincidentally, the theme of the 2021 International Day of the Midwife. The report and hub demonstrate the essential role that midwives can play in both providing and making practical use of the data related to their work.
While the report is designed to be informative – to draw on country-level data to create a cohesive picture of the state of midwifery worldwide – the hub will also be interactive, providing a platform for midwives and midwives’ associations to conduct their own research and perform their own advocacy.
The hub is already being used as an analytical tool by the Association of Malawian Midwives. The association’s members wanted to make sure that no one in the country was more than a distance of about five miles from a primary health care facility. They were also interested in finding strategic places to situate private clinics where midwives could support their communities.
“It would be useful to map the population of childbearing women and location of health facilities to demonstrate the need for more appropriately placed health facilities in line with the current population growth,” said Dr. Ann Phoya, the association’s former president.
“Who does the analysis makes the difference,” Schroeder said, explaining that midwives are in a unique position to ask informed questions about the communities they serve, to conduct appropriate research, and to advocate for health care needs in their communities. “If we help midwives to use data more effectively in a local context, they will come up with questions that we didn’t even think to ask. They will apply information to problems that we didn’t even know were there.”
“This work demonstrates that midwives are not only saving lives and contributing to healthier communities, but also the creators of open data and the resulting advocacy initiatives that stem from their contributions as midwives,” Pairman said.