Increasing global midwifery interventions could save millions of lives says new study
Over 4 million lives of mothers and babies could be saved every year by increasing global midwife numbers and investing in their training, says new research published this week.
Birte Harlev-Lam, Executive Director for Professional Leadership at the Royal College of Midwives, said: “Skilled midwifery care saves lives, and those skills and care are desperately needed by women right across the globe, right now. This research provides compelling evidence of this and it cannot be ignored because it is a matter of life and death. We urge governments around the world to look at this study and act on it. Investing in midwives is an investment not only in the health of women, but in the health of the whole nation.”
The study in The Lancet Global Health says that investing in midwives and midwifery interventions, particularly for middle and low-income countries, could significantly improve the survival of mothers and babies. The report’s authors add a caveat saying that to achieve this, midwives will require sufficient training, need to be part of a supportive and skilled team, and work in an environment with adequate water, sanitation, and medical supplies.
“There are numerous barriers to fulfilling this level of scale-up, particularly in low to middle income countries,” said the study’s lead author Dr Andrea Nove from Novametrics Ltd. “Supported by appropriate professional education, regulation and improved working environments, it is possible to achieve a substantial increase in the level of provision of essential interventions delivered by midwives. These include inequitable distribution of qualified midwives, poor transport links, lack of supplies and equipment and, in some countries, a lack of trust from the public. There is need for greater recognition of the importance of supporting and enabling this service to reach its potential,” She added.
The researchers used four scenarios to estimate the impact of midwifery interventions, running from a 10% increase in midwifery numbers and interventions every five years to 2035, to universal global coverage of skilled midwifery care for women by 2035. At the lowest estimate 93,000 maternal deaths, 448,000 stillbirths and 718,000 new-born deaths would be avoided every year by 2035. With universal coverage 280,000 maternal deaths, 2.1 million stillbirths and 2 million neonatal deaths could be prevented by the same date. The report also estimated a 2% decrease in midwifery interventions, which would lead to over half a million more maternal and new-born deaths per year by 2035.
Thirty essential midwifery interventions were used in the reserach. These included family planning, hypertension screening, assisted labour and the use of antibiotics for new-born sepsis.
In a linked comment to the research, Professor Mary Renfrew from the University of Dundee, said: “These new findings build on and strengthen existing evidence on the impact of quality midwifery care in averting deaths and improving health and wellbeing outcomes. They should command the attention of the global community in the same way that a new drug or innovative technical intervention would. There is serious and longstanding under-investment in international-standard midwifery. Gender, social, professional, and economic disempowerment of midwives and the women they care for all contribute to this. It is time to overcome the barriers and ensure all women and new-born infants have access to quality care by midwives.”
The full study and commentary from Dr Mary Renfrew can be read at http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30397-1/fulltext.
For the full list of midwifery interventions used in the research visit http://www.thelancet-press.com/embargo/midwivesAPPX.pdf.
The RCM's Global Midwifery Position Statement can be read at https://www.rcm.org.uk/media/2297/global-midwifery.pdf.