The World Health Organisation (WHO) and partners are calling for an end to the discrimination, harassment and lack of respect that hinder midwives’ ability to provide quality care to women and newborns.
The first global survey of midwifery personnel led by WHO, the International Confederation of Midwives (ICM) and White Ribbon Alliance (WRA), "Midwives' Voices, Midwives Realities: Findings from a global consultation on providing quality midwifery care", reports findings from 2,400 midwives who chose to complete an online survey in 93 countries and was funded by the United States Agency for International Development (USAID).
The organisations highlight the need to provide midwives with professional support (including better working conditions); stronger education and regulatory environments; and stronger advocacy around midwifery.
Every year, more than 300,000 women die while giving birth and 2.7 million newborns die during the first 28 days of life, many from preventable causes. Midwifery — the skilled, knowledgeable and compassionate care provided throughout pregnancy and childbirth — plays a vital role in preventing these deaths, but only when it is of quality and provided by midwives educated and regulated to international standards.
The challenges midwives face
One-fifth of midwives who answered the online survey depend on another source of income to survive, which adds to the pressure and exhaustion that they experience. Many combine the roles of work, motherhood and caring for others in their communities. The midwives reported that long and stressful hours badly affected their families, with over one-third stating they had no choice but to leave children under 14 years alone while they work.
Though most feel they are treated with respect, many midwives reported harassment at work, a lack of security and fear of violence. Disrespect in the workplace negatively affects midwives’ self-esteem and their ability to provide quality care to mothers and babies worldwide.
Professionally, many midwives are neither provided with adequate education, nor regulatory and legal support. Few national midwifery associations get the support they need to develop leadership skills. This lack of investment reinforces gender inequality and unequal power relations within the health system.
What needs to change
1. Provision of professional support: To improve working conditions for midwives and quality of care for women and newborns, midwifery professionals need salaries that adequately reflect the level of their skills and responsibilities, health insurance and social security systems, professional support networks, good living environments, and counselling services.
2. Better education and regulation: The report includes recommendations to strengthen education and regulatory environments around midwifery. Nine out of ten respondents think that recognition of midwives by the health service is important for changes to take place.
3. Advocacy for midwifery: Based on the findings of the survey, WHO, ICM, WRA, USAID, UNFPA and other partners are developing a "Global Midwifery Advocacy Strategy" aimed at addressing the barriers midwifery personnel face in order to improve quality of care. The strategy will urge global decision makers to value the evidence on the positive impact of quality midwifery care. It will encourage policy makers to draw on the expertise of midwives when making policy and strategy decisions that affect maternal and newborn care.