In the post-COVID period, a strong midwifery workforce is more essential than ever
A World Health Summit panel calls for investments in midwifery to achieve Universal Health Coverage and resilient health systems
According to the State of the World’s Midwifery 2021 report, midwives can deliver 87% of the essential sexual, reproductive, maternal, newborn and adolescent health services needed across the life course. Universal access to midwife-led interventions could avert roughly two-thirds of maternal and neonatal deaths and stillbirths in low- and middle-income countries.
At present, however, the world is missing the equivalent of 1.1 million health workers, including midwives, to meet these vital needs. Given the clear evidence of the ‘return on investment’ when it comes to midwives, why is the world still falling short in terms of its backing for this essential profession?
As the Right Honorable Helen Clark, the former Prime Minister of New Zealand and the chair of the Partnership for Maternal, Newborn and Child Health (PMNCH), put it during a panel discussion at this year’s World Health Summit: ‘A profession as important as this one absolutely has to be supported and strengthened.’
Investments in midwifery can help achieve the Agenda 2030 goals
On October 26, the German Federal Ministry for Economic Cooperation and Development (BMZ) joined forces with PMNCH and the United Nations Population Fund (UNFPA) to co-host a digital panel discussion on ‘Investing in Women and Resilient Health Systems’ at the 2021 World Health Summit.
Chaired by Dr Anshu Banerjee, Director of Department of Maternal, Newborn, Child and Adolescent Health and Ageing at the World Health Organization, the session brought together representatives of governments, multilateral institutions and civil society to discuss how the global community can work together to ensure all women, children and adolescents have access to the quality, affordable health care they need to survive and thrive.
‘Access to maternal and child health, and other services related to sexual and reproductive health, is fundamentally important to achieve the goals of Agenda 2030, including Universal Health Coverage,’ said Dr Maria Flachsbarth, Parliamentary State Secretary at BMZ. ‘To achieve this, we must continue to invest in maternal and child health professionals.’ She also highlighted the need for high-quality midwifery education, equal pay, and the protection of midwives and health professionals in the context of crisis and humanitarian settings.
Through both bilateral development cooperation programmes and contributions to multilateral institutions – such as UNFPA, the International Planned Parenthood Federation (IPPF), and the Global Financing Facility (GFF) – Germany supports sustainable investments in human resources in the health sector, including the midwifery workforce.
During the session, Dr Flachsbarth announced that Germany will support UNFPA Supplies in 2021 with 750,000 Euros and the UNFPA Maternal Health Thematic Fund, which plays a pivotal role in the education and training of midwives and the reduction of maternal deaths, with 2.5 million Euros.
COVID-19 has highlighted systemic problems in the provision of essential services
The effects of the COVID-19 pandemic on essential health services for women and adolescents – and upon midwives as front-line health workers – was a major topic of discussion during the session.
‘We know that the COVID pandemic has had both direct and indirect effects on the sexual and reproductive health of women and adolescents,’ said Anneke Knutsson, the chief for Sexual and Reproductive Health at UNFPA. Lockdowns and other restrictions have prevented many women from accessing the services they need – whether this be contraceptives or maternity care – and have exacerbated women’s vulnerability to gender-based violence. Among others, this has contributed to increases in unintended pregnancies, unsafe abortions and maternal morbidity and mortality.
‘The pandemic has highlighted the deep fragmentations, inequalities and dysfunctions which already existed,’ Knutsson added. ‘It offers both a disruptive moment and a long overdue opportunity to fix systemic problems in maternity care and sexual and reproductive health and rights more broadly.’
Midwives, and the women they care for, were invisible during COVID
Dr Sally Pairman, the CEO of the International Confederation of Midwives, argued that the needs of women and adolescents, and the midwives who care for them, were not adequately supported during the pandemic. ‘This was a woman’s workforce, caring for women, that was invisible during COVID,’ she said.
Pairman spoke about how midwives were forced to innovate to provide care that kept themselves and their patients safe, especially given the difficulty they had in securing personal protective equipment (PPE). ‘We know that many midwives used phone and video calls, or even came to the windows of houses to do assessments of babies from outside,’ she said. ‘They were trying to find ways to provide services to women themselves, often in situations where they were not supported because community-based midwife services have not been part of the normal health system.’
These issues persist: Pairman pointed out that, nearly two years into the pandemic, ‘We still have a lot to learn about how to manage COVID and provide maternity services.’
Midwives must have a seat at the table during policy discussions
There was remarkable consensus among panelists about the investments and policy actions that are needed to strengthen the midwifery workforce and midwifery services going forward. As detailed in the State of the World’s Midwifery Report 2021, these include support for high-quality education and training to produce many more midwives, as well as the educators to teach them; health workforce planning and management; midwifery-led models of care which ensure that midwives can deploy their skills effectively; and midwifery leadership and governance.
According to Peggy Vidot, the Minister of Health from the Seychelles, having more midwives in decision-making positions could help to prioritise investments in these areas. ‘We need midwives to contribute to policies that affect their profession,’ she said. ‘And because midwifery should be seen as part of an integrated service, midwives should also be contributing to health policies and even policies in the social sector more broadly.’
Vidot endorsed the idea, which was supported by the other panelists as well, of designating a Chief Midwife – alongside the Chief Nursing and Chief Medical Officer – to represent the profession at the highest levels of government. ‘Without this, we don’t get the midwife’s voice at the level that is required,’ she noted. ‘We need this voice to advance the profession and to maximise its contributions in the health system.’
As we ‘build back better,’ voices of midwives must be heard
While the COVID pandemic is not over, it has already highlighted the urgent need to review what has – and has not – worked well in countries’ health systems. According to Helen Clark, the chair of PMNCH, recruitment, training and remuneration of frontline health workers, including midwives, must be grappled with as part of ‘building back better.’
She singled out the historical pay inequity which finds midwives, despite the skilled nature of their work, among the lowest-paid of the health professions. Raising the status of the profession and addressing pay issues would go a long way towards addressing challenges with recruitment and retention.
‘As we recover from the pandemic and work to make our health systems more resilient, it is really important that midwives’ views are fully incorporated,’ she said. ‘Midwives voices must be heard and their input must be facilitated.’