The State of the World's Midwifery 2011

I don't generally post on stuff like this, but I, personally, think this is an extremely big deal:  the UN Population Fund (UNFPA) released the first ever State of the World's Midwifery Report.  It's the first ever comprehensive analysis of midwifery services and the countries where the need for midwives is the greatest, and a really important step in getting midwifery solidly onto the public health agenda (where it ABSOLUTELY belongs, and has belonged for hundreds of years).

The Senior Maternal Health Advisor at UNFPA, who headed drafting the report, said at the release, "Public health advisers and practitioners are not relying on the key health professional that can improve maternal mortality--the midwife.

This is why:  As the Chairperson of the Board of Trustees at the White Ribbon Alliance for Safe Motherhood – Malawi says, "The good news is that, when women are within reach of a midwifelikelihood of dying from the complications of childbirth drastically reduced, but also the midwife becomes the critical link to well-baby care and health care for the entire family.  We must prioritize investment in midwives to deliver life-saving care in the communities where mothers are needlessly lost.”  And this report puts a number to those lives needlessly lost:  it says that up to 3.6 million deaths could be avoided each year in 58 developing countries if midwifery services are upgraded by 2015.

Among other things, the report says the world lacks some 350,000 skilled midwives, including 112,000 in the neediest 38 countries surveyed alone, to fully meet the needs of women around the world, and details how the world might go about building up this "key workforce."  (Me!  Me!  I'm on it!)  In order to reach the Millennium Development Goal of 95% of births being assisted by a skilled birth attendant*, of these 38 countries that need midwives the most, 22 need to double the workforce by 2015; seven need to triple or quadruple it; and nine (Cameroon, Chad, Ethiopia, Guinea, Haiti, Niger, Sierra Leone, Somalia and Sudan) need to dramatically scale up midwifery by a factor of between 6 and 15.

Let me say that again.  These countries need 6 to 15 times as many midwives as they currently have.

The report recommend things like recognizing midwifery as a distinct profession, increasing investment in the number of schools, trainers and tutors for midwifes, and making adequate budget allocations for midwifery services in national health plans. But given that capacity for training more midwives hovers somewhere between zero and nothing in some countries, and between very little and little in many more, there's some serious work needing to happen in the next few years.

So I think this report is amazing, but the hard part comes now:  getting humanitarian aid donors, humanitarian organizations, and recipient governments all excited and motivated to take these recommendations to heart, take the time and energy to invest wisely and make changes meaningful, and ultimately creating a vibrant, dedicated and skilled new workforce of midwives. 

*Right now about 50% of births worldwide have a skilled birth attendant present at the birth, but there are huge rural/urban developed/developing nation disparities reflected in this.