Back 21 October 2015

Midwives Matter, Women Matter


Frances Day-Stirk, ICM President, has been speaking this week at the Global Maternal and Newborn Health Conference in Mexico about midwives as key members of the health-care workforce, and the central role that midwives play in global sustainable development. Her remarks are summarised below:

The ICM defines a midwife as “a person who has successfully completed a midwifery education programme that is duly recognized in the country where it is located and that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery’.

Midwifery is the one healthcare profession for which the scope of practice is equally responsible for women and newborns, and for keeping this important dyad together.

ICM’s midwifery education standards are based on seven competency domains, encompassing a framework of sexual and reproductive, maternal and newborn health which underpin the education and practice of a midwife. However, many countries do not meet these standards, although many aspire to them and are working towards them. 

Meanwhile the historical evidence from countries such as Sweden - and from the more recent past in Malaysia, Sri Lanka and Thailand - demonstrates the impact on maternal and newborn health that educated, competent midwives have made, and demonstrates that it is effective to invest in the education and training of competent midwives.  

In 2003, the authors of ‘Investing in Maternal Health – Learning from Malaysia and Sri Lanka’ outlined the critical strategies for reducing the maternal deaths as being to professionalise midwifery, monitor births and maternal deaths, and undertake high profile advocacy.

Yet in the ‘State of the World’s Midwifery 2014’ report there were 381 different cadres specified by countries which were grouped into eight broad categories: midwives, nurse-midwives, nurses, auxiliaries (midwives and nurses), associate clinicians, physician generalists and obstetricians gynaecologists. It noted that Midwives in 58 countries (79%) supervise Community Health Workers’ and Traditional Birth Attendants’ work concerning Sexual, Reproductive, Maternal and Newborn Health, maintaining important links between health facilities and the community, with opportunities to promote the continuum of care and to improve demand for, and utilization of services. 

"The slow progress on maternal health globally reflects gender discrimination and the low status of women"

I believe that the slow progress on maternal health globally reflects gender discrimination and the low status of women. The midwife population is more than 90% female; as women we are both providers and recipients of health care. For too long now, the most vulnerable women have been receiving care from poorly educated, often disenfranchised members of the health system.

Lancet Midwifery Series 2014 states  that “care led by midwives—educated, licensed, regulated, integrated in the health system and working in interdisciplinary teams—(have)  a positive impact on maternal and perinatal health… even when compared with care led by other health professionals in combination with midwives” . Furthermore, “educated, trained, licensed, and regulated midwives can provide the full scope of midwifery.”

The State of the World’s Midwifery 2014 also states that in terms of return on investment, midwifery is a “best buy”, while investing in midwifery education could yield a sixteen-fold return on investment. What’s more, evidence – from both the SoWMY 2014 report and the Lancet Series on Midwives - highlight the impact of midwives, and that  when educated and regulated to global standards they can provide 87% of the essential interventions that women and newborn need.

The World Bank is also encouraging investment in midwives, on the basis that our profession creates not only employment for women, but also empowerment and economic independence.

"Midwives, like women in many societies, remain unrecognised, undervalued: economically, socially, politically and culturally"

Yet despite increasingly compelling evidence of the value of midwives to sexual, reproductive, maternal, newborn and adolescent health, midwives continue to be undervalued. Midwives remain invisible in many countries while high level decision-making pay lip service to the need for change. Midwives, like women in many societies, remain unrecognised, undervalued: economically, socially, politically and culturally. They face difficult working environments – lack of commodities, insecurity and isolation.  

Midwives need to count and be counted. We can be, and are, available where there is poor geographical access to public health facilities and settings where other care providers are reluctant to work due to harsh conditions and poor remuneration. 

In February 2015, Margaret Chan emphatically stated: “We need midwives, we need midwives, we need midwives”. And midwives have a key role with the SDGs and the Global Strategy for Women’s, Children’s and Adolescent’s health. 

The Lancet Commission on Women and Health also upholds the recent shift in thinking from ‘Women’s Health’ to ‘Women and Health’, stating this “is important because unless the contribution women make to society is recognised, the new-post 2015 global goal of sustainability will be little more than a distant utopia." 

ICM fully supports this opinion and adds that unless the contribution that midwives make to sexual, reproductive, maternal and newborn health is recognised - the SDGs will remain a distant dream.  

Women matter; midwives matter. The health and well-being of all women and all their newborns matter.  The way forward is for midwives to be embedded in health systems, so that midwives become the norm and not a novelty.

Watch Frances being interviewed for Girls' Globe at the conference:


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