High quality midwifery care has an enormous positive impact on women and families. As core members of the sexual, reproductive, maternal, newborn and adolescent health workforce (SRMNAH), midwives are instrumental in driving progress towards sustainable development goals. Strong evidence supports that investing in midwives leads to better health outcomes by reducing maternal and neonatal deaths and stillbirths, and stimulates economic activity. An increase in coverage of midwife- delivered interventions (10% every five years) for instance,
could avert 23% of maternal and neonatal deaths and 14% of stillbirths.
The pandemic however, has generated steep challenges for SRMNAH workers. Throughout the Covid-19 pandemic, midwives have become even more essential in meeting the reproductive health needs of women and adolescents, taking on often dangerous tasks that have reduced virus transmission, such as enabling births away from hospitals. In partnership with the World Health Organization, the United Nations Population Fund (UNFPA) recently released its2021 report on the State of the World’s Midwifery (SoWMy). The report outlines a number of key issues with the state of global midwifery, the first of which is a global SRMNAH worker shortage.
The authors estimate that an additional 1.1 million full-time SRMNAH workers are needed globally, with midwives making up the largest shortage (900,000). This shortage is most critical in low-income countries (particularly in Africa), where the SMRNAH workforce currently addresses only 41% of needs. Staff redeployment for Covid-19 relief has also had a major impact on SRMNAH worker availability.
Beyond a lack of numbers, varying levels of quality of education and training, limited qualified educators, and ineffective regulation also prevent midwives and SRMNAH workers from meeting this need. In a survey of midwifery educators conducted by the WHO in 35 low and middle income countries, all respondents cited that the regulation of education programmes did not effectively ensure quality nor facilitate standardization in midwifery education, and that “varying levels of skills were being taught through differing pathways.” In many countries, midwives also do not have the authority to perform tasks that are typically considered part of the midwife’s scope of practice. The pandemic has also disrupted midwife education; over half (54%) of responding associations in the 88 countries surveyed by the authors reported that midwifery education courses had been closed in their countries.
To close the gap between low-income countries and high and middle income countries, 1.3 million positions need to be created in the next 10 years -- with most being midwives, and mostly in Africa. The authors note that bold investments are needed to achieve this, specifically in terms of education and training, health workforce planning, management and regulation, leadership and governance and service delivery.
With regards to workforce planning, the authors propose that countries organize their healthcare workers so that midwives can provide the majority of SRMNAH interventions, such as basic emergency obstetric and newborn care services at the primary health-care level. Countries can also deploy midwives and other SRMNAH specialists such as sexual health nurses and neonatal nurses closer to where women and adolescents live. To improve midwife education, they recommend that countries create and strengthen accreditation mechanisms for education and training providers, and invest in midwife leadership and governance. Engaging midwives in the process could generate vast improvements in quality of care. Positions can also be created at national level within national ministries so as to engage midwives in the decision-making process.
By Laila Rodenbeck
1. State of the World’s Midwifery Report 2021, World Health Organization
Now as a next step, we ask what could be done to lower the costs of the implementation of the E-MOTIVE bundle? The most obvious answer is to consider displacing the tens of thousands of disposable plastic drapes with a purpose-built reusable device.
Fortunately one of the obstetricians involved in the E-MOTIVE study, Dr. Justus Hofmeyr, had been innovating around this very issue, designing a tray with wells that could fit under a woman’s buttocks, collect and accurately measure the. blood. This tray, theMaternaWellTraywas conceived as a device that could be sterilized and reused, and is manufactured in South Africa by Umoya.
The Pumani bubbleCPAP was designed to meet this need for Malawi and is now widely available through Maternova. We had a few questions about post-research phases of the Pumani bubbleCPAP which we posed to Jocelyn Brown, inventor of the Pumani bubbleCPAP, and Molly McCabe, Director of Product Management.