Global Midwifery Advocacy Strategy
In support of the Global Strategy for Women’s, Children’s and Adolescents’ Health 2016-30
Midwifery is “skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum throughout pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life. Core characteristics include optimizing normal biological psychological, social, and cultural processes of reproduction and early life; timely prevention and management of complications; consultation with and referral to other services; respect for women’s individual circumstances and views, and working in partnership to strengthen women’s own capabilities to care for themselves and their families.”
THE NEED FOR A GLOBAL MIDWIFERY ADVOCACY STRATEGY
At the policy level, not enough attention is paid to available evidence demonstrating that investing in midwifery provides the best quality care with the best outcomes for women and their babies.
Mothers, babies and their families throughout the world need the help of competent, caring and respectful caregivers to survive childbirth, thrive in the months and years after it, and realize their full potential to transform our world. UNFPA’s State of the World Midwifery Report reaffirms that midwives can provide up to 87% of pregnancy required services. If midwifery is universally scaled up, it could reduce up to 82% of the maternal and neonatal deaths and stillbirths.
The evidence further supports a shift from fragmented maternal and newborn care that is focused on the identification and treatment of illnesses to a holistic approach that provides skilled, women-centered care for all.
The 2014 Lancet Series on Midwifery showed that midwifery is associated with more efficient use of resources and improved health outcomes when women had access to midwives who are educated, trained, licensed and regulated. Midwives are more effective when integrated into the health system through effective teamwork and referral mechanisms and are provided with sufficient resources. Midwifery also reduces over medicalization by preventing unnecessary interventions. The World Health Organization lists supporting midwifery as an important strategy toward ending preventable maternal and newborn deaths and stillbirths as part of the effort toward the Global Strategy for Women’s, Children’s and Adolescents’ Health. The Global Health Workforce Alliance further articulates the need to focus on the recruitment, retention and motivation of midwifery personnel.
At the practice level, midwifery is not supported with sufficient planning, programming and financing to ensure resources necessary to support women’s rights to quality care.
In too many countries there is a stark difference between the policies and standards that are promoted versus what is implemented at the local and national level. The Lancet Series on Maternal Health reports that: “90% of maternal deaths happen in 58 countries with only 17% of the world’s midwives and doctors.” Data compiled from 132 countries revealed 64 did not meet the minimum critical threshold of 23 midwives, nurses, and doctors per population of 10,000 required to effectively implement primary care programs, including intrapartum care.
Evidence shows that all too often midwives are not respected. In the largest global survey of midwifery personnel to date, “Midwives’ Voices, Midwives’ Realities”, 2,470 midwives from 93 countries reported feeling disrespected and disenfranchised in their personal and professional lives, which ultimately lead to dissatisfaction in all aspects of their lives.
The report revealed that midwives are highly committed to providing the best care to women, babies and their families but are constrained by multiple barriers including a lack of an enabled environment, the absence of a fully functional team, insufficient integration of midwifery into and in support of the health system, a dearth of midwifery service referral mechanisms, inadequate pay, unsafe environments at work and at home, a general shortage of proper resources and supplies, and importantly, a lack of influence.
Evidence suggests the three reasons for this undervaluing of midwives are situated in gender inequality and hierarchical health systems and include professional, socio-cultural and economic barriers, ultimately contributing to provider distress and burnout.
The Midwives’ Voices, Midwives’ Realities report shows that there is a need to redress complex hierarchies of power and to transform gender dynamics that play a critical role in providing maternity services. Midwives highlighted that power, influence and status are important to them if progress is to be made in delivering quality care. The findings in this report indicate that, globally, midwifery personnel have an in-depth awareness of what is needed to improve quality of care, yet their voices are rarely heard in international, national and local policy dialogues and subsequently, key issues are absent from these discussions. The solution, per the report, is for political advocacy at national and global levels which reflects the voices of midwives and makes clear, for the first time, the realities of midwives’ lives and the resultant constraints on the care they can provide.
THE GLOBAL MIDWIFERY ADVOCACY CAMPAIGN
The goal of the campaign is to ensure that all childbearing women and newborns receive quality, dignified care provided by midwives who are educated and regulated to international standards and who are valued, respected, supported and integrated into the healthcare system.
The campaign seeks to demonstrate to policy-makers, donors and other stakeholders, that midwives can best provide the skilled care and support needed to ensure every woman and every baby, whatever their circumstances, receive quality, dignified, respectful maternity care.
The campaign will demonstrate that midwives are also the best people to lead the changes and deliver the creative solutions they know are so badly needed.
ACHIEVING THE CHANGE WE WANT TO SEE
To achieve this goal, the campaign will amplify the voices of midwives and focus on the contributions of midwives in leadership positions; engage other midwives, supporters and champions to join the cause; educate policy-makers about the vital contributions of midwifery to maternal and newborn survival, health and wellbeing; build the evidence and use our collective political capital to make the case for midwifery.
The Global Midwifery Advocacy Campaign is spearheaded by a multi-stakeholder group of more than 50 individuals from 25 organizations. It includes midwives, midwifery educators, researchers and advocates from national, international and UN organizations. This is a global campaign that will provide the framework for replication at the national and regional levels, guided by specific issues in each context. The global campaign will also unite national campaigns and connect advocates across geographies.
Through the work of the Global Midwifery Advocacy Campaign, we will help midwives make an even bigger difference in the lives of women and families around the world.
For further information, please read:
White Ribbon Alliance’s Campaign for the Promotion of Midwifery
Interested in joining the campaign? Please contact:
Elena Ateva, Maternal And Newborn Health Policy & Advocacy Advisor
White Ribbon Alliance