乐鱼体育

鈥淭his is real,鈥� said Franka Cad茅e, President of the International Confederation of Midwives (ICM). 鈥淎nd we can no longer get around it. And we can no longer linger.鈥� She spoke at a recent 乐鱼 体育 event, in partnership with the United Nations Population Fund (UNFPA) and Johnson & Johnson, launching a new study, , published in The Lancet Global Health. If any other intervention could have the same impact as midwives or midwifery, it would be implemented worldwide immediately, she said.

This study鈥攍ed by UNFPA, ICM, and the World Health Organization (WHO)鈥攊s part of a series of publications leading up to the 2021 State of the World鈥檚 Midwifery report. It provides new estimates on the potential impact of midwives on reducing maternal and neonatal mortality and stillbirths. This publication is particularly timely as the world faces the COVID-19 pandemic and its effects on women and girls, including diminished access to sexual and reproductive health (SRH) services. As the world reveres the , like midwives, they continue to work 鈥渁s the front-line workers they are, risking their lives to save others,鈥� said Anneka Knutsson, Chief of the SRH Branch of UNFPA.

Saving Lives and Sustaining Livelihoods

The study focused on the 88 countries that account for 95 percent of maternal and infant deaths worldwide. It then identified 31 鈥渕idwife-delivered鈥� essential interventions and estimated the number of maternal deaths, newborn deaths, and stillbirths that would occur in these countries between now and 2035 if coverage of these services remained the same. The authors then compared this baseline to four scenarios: a modest scale-up (a 10 percent increase in service coverage every five years), a substantial scale-up (a 25 percent increase every five years), universal coverage (at least 95 percent service coverage by 2035), and attrition (a 2 percent decrease every five years).

The  were striking, said Cad茅e. Even the least ambitious scale-up scenario, the modest option, would produce significant results, decreasing maternal and newborn deaths by approximately 20 percent and saving 1.3 million lives per year by 2035. If the universal coverage scenario were achieved, 4.3 million lives could be saved each year by 2035.  Such an approach could avert two-thirds of maternal deaths and more than 6 in 10 newborn deaths and stillbirths. By identifying the midwifery interventions, such as access to modern methods of contraception, that could have the largest impact on these 88 countries, the study provides critical guidance to policymakers and strengthens the evidence base midwives and advocates can use to make a case for greater investments in midwifery.

鈥�,鈥� said Chunmei Li, Director of Global Community Impact at Johnson & Johnson, 鈥淚nvesting in midwives is investing in children and the future of humanity.鈥� The benefits of this investment provide a 鈥渄ouble return,鈥� saving lives while also sustaining the livelihoods of midwives and the families they serve, said Petra ten Hoope-Bender, Technical Advisor for SRH at UNFPA, Geneva. This  could be especially pronounced in humanitarian and fragile settings, where 60 percent of preventable maternal deaths and 45 percent of preventable neonatal deaths occur, said Jihan Salad, SRH Specialist at UNFPA, Jordan.

Strengthening Midwifery

A passionate belief that midwifery is the best approach to save and improve the lives of women, newborns, and their families is not enough to ensure the best return on investment, said Elizabeth Iro, Chief Nursing Officer at WHO. Using good data is key. With that data, stakeholders must now focus on translating the study鈥檚 findings into practice, said Andrea Nove, Technical Director at Novametrics and lead author of this study. This process is not as simple as it appears, said Iro, as interventions must be adapted to meet the specific needs of each country, given their current landscape of midwifery practice and regulation.

What鈥檚 more, to increase access to midwife services, aspects of the practice must be improved. Midwives face many  in their day-to-day practice, including issues related to gender inequality and increased exposure to violence, said Salad. 鈥淲e cannot achieve universal access if we do not address the problems in midwifery education and practice.鈥� This could involve ensuring that every midwife is educated according to the standards set by ICM; regulating the use of the term, 鈥渕idwife;鈥� appointing a chief midwife in each country; ; and promoting pay equity. 鈥淚n the last year, we鈥檝e had a lot of clapping, a great amount of clapping,鈥� said Cad茅e, referring to the increased recognition midwives and other health care workers have received in the wake of COVID-19. 鈥淲onderful. But clapping does not buy bread.鈥� 

The Importance of Collaboration

In order to implement these changes, . This begins in the health sector. Although midwives provide a wide range of services, some patients require a higher level of care. Midwives must work with other health care providers, such as doctors and nurses, to ensure continuity of care in these scenarios. By working with doctors and nurses to refer patients, midwives can ensure that a country鈥檚 health resources are being allocated efficiently, with women receiving the appropriate level of care for their needs, said ten Hoope-Bender.

Similarly, others in the health care profession must respect midwives and recognize their contribution to women鈥檚 health. Because  from pre-pregnancy to the postpartum period, they provide a level of holistic care that is often not possible in other settings. Additionally, in countries where maternal health resources are especially limited, midwives can help fill gaps in care. In many countries, nobody鈥檚 attending the birth, said Nove. 鈥淎nd so it鈥檚 not about taking work away from nurses and doctors,鈥� she said. 鈥淚t鈥檚 about making sure that every woman is attended by someone who knows what they鈥檙e doing.鈥�  

Collaboration must extend to the women and communities being served. Putting information in the hands of women, so that they can make decisions about their own health care is crucial, said ten Hoope-Bender. Similarly, it is important for communities to be educated on the benefits of midwifery. This allows them to  and find the most appropriate solutions to their problems, said Salad.

Although much work needs to be done to achieve the potential outcomes outlined in the Lancet study, they are indeed attainable, said Nove. Several countries have previously achieved the 10 percent service increase reflected in the modest scale-up scenario, and the substantial scale-up scenario is feasible if countries undertake concerted efforts to prioritize midwifery services, said Nove. 鈥淚f we implement this evidence, the world would look brighter, not just for midwives and women,鈥� said Cad茅e, 鈥渂ut for humanity.鈥�  

Written by Sara Matthews, edited by Sandra Yin