Midwives Delivering Universal Health Coverage

Universal Health Coverage (UHC) means that “all people have access to the quality health services they need, when and where they need them, including during emergencies, without risk of financial hardship” (World Health Assembly, 2005).  World leaders have committed to achieving UHC by 2030, and it is imperative that midwives and midwives’ associations are included as part of UHC planning at all levels – local (including facility- and community-level), regional and national.  

Midwives are often the first point of contact for pregnant women and are strategically placed to provide care to women and their newborns across the childbirth continuum autonomously, collaborating as needed with other professionals.  Current data shows that progress on SDGs related to reducing maternal mortality and ending preventable deaths of children under 5 (SDG 3.1, 3.2) has stalled in most countries.  

Maternal mortality is not only related to planned pregnancies. Every year, 172 million women are not able to access the modern contraception options they want, leading to an increase in unplanned pregnancies, pregnancy and childbirth complications, and unsafe abortions.  

Achieving UHC and integrating midwife-led care into health systems has the potential to significantly contribute to solving these often-preventable tragedies and gaps in service provision. 

Data shows investing in universal midwife coverage brings positive economic, social and health returns 

Data shows that investing in midwives, can improve health outcomes for women and newborns, facilitate economic stability and have a positive macroeconomic impact (State of the World’s Midwifery, 2021). Ensuring universal midwife coverage by 2035 could avert 67% of maternal deaths, 64% of newborn deaths and 65% of stillbirths. Even a modest increase of 10% more midwife-led services every five years could prevent 22% of maternal deaths, 23% of newborn deaths and 14% of stillbirths. Overall, 4.3 million lives could be saved annually by 2035 if universal coverage of midwife care could be achieved. 

Instead of dealing with the tragedy and trauma of preventable maternal and newborn loss, communities would enjoy better health and wellbeing, and could focus on their development and growth.  

Despite these compelling statistics, midwives account for less than 10% of the global sexual, reproductive, maternal, newborn, child and adolescent health (SRMNCAH) workforce. Before the COVID-10 pandemic the world needed 900,000 more midwives, mostly in low-income countries and in Africa – that number is now certainly higher. 

The COVID-19 pandemic highlighted the need to build universal health coverage for times of crisis and calm, making clear that universal health coverage and global health security are two intertwined goals. In a post-COVID world facing intersecting crises including rising temperatures caused by the climate crisis, UHC is more important than ever. 

Every midwife and midwives’ association has a role in ensuring midwife-led care is included in UHC 

Midwives are at the forefront of ensuring that women and families have access to quality SRMNCAH. Midwives are even more critical in times of crisis because if they are enabled to work across their full scope of practice, they can ensure that women, gender diverse people and newborns get the quality primary health care they need, facilitating referrals to next-level care as needed. 

ICM therefore urges member associations to engage governments and policymakers at all levels to champion the inclusion of midwife-led care into UHC. The implementation of UHC is a unique opportunity for MAs to approach policymakers to act now to design and resource integrated approaches to support both universal health coverage and prevention, preparedness and response capacities for health emergencies within wider efforts to build equitable, resilient health systems. This can be done by: 

• Engaging governments and political leadership at all levels to include midwives in national UHC discussions, and integrate midwife-led UHC into the health system 
• Advocating for midwives to be enabled and resourced to work across their full scope of practice in a supportive and well-functioning health system 
• Advocating for midwives to have the opportunity to participate in all decision-making related to SRMNCAH and UHC 
• Showcasing the work of midwives in the media as a way of creating public support for midwife-led care,  
• Partnering with stakeholders including women’s groups, health professionals, policy makers, regional and international partners who can all advocate for midwife-led care to be embedded in UHC.