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Bill & Melinda Gates Foundation

Leveraging Midwives’ Impact in the U.S. and Around the World

June 25, 2013

Just how different the pregnancy, childbirth and early childhood experience can be was strewn on their faces, illustrated in their stories and validated by their work experience. Four seasoned midwives – with a combined century of experience in building strong societies by promoting the health and safety of mothers and their babies – delivered a compelling case last week at a congressional briefing for the United States to lead a movement to strengthen midwifery at home and around the world.

First, the need. Briefing moderator Stembile Mugore – born in Zimbabwe, practiced as a midwife in the United Kingdom and now a senior advisor for IntraHealth International – repeated a statistic that, frankly, was worth repeating: 48 million women every year give birth without the presence of a skilled birth attendant – a major reason that every year about 350,000 women die while pregnant or giving birth, there are 2.6 million stillbirths and up to 2 million newborns die within the first 24 hours of life.

There is simply no reason that 48 million women should have to stare down that path every year – especially with the highly effective and cost-friendly intervention of trained and supported midwives ready and willing to deliver on the frontlines of health care, the panelists said.

Sheena Currie, a senior maternal health adviser for Jhpiego, provided a moving example of midwives power to transform maternal and child health in Afghanistan. During and immediately after Taliban rule in Afghanistan, the country was the worst place for a woman to give birth in the world. To turn things around for women and newborns in Afghanistan, the U.S. Agency for International Development (USAID) and other donors and partners focused on training and supporting midwives working directly in communities. 

 Shahrbanoo - An Afghan Midwife. Courtesy Jhpiego.

In 2002, Currie was part of a Jhpiego team who provided technical leadership along with other partners for a USAID-funded program that launched 27 midwifery schools in 29 provinces in six years—a nearly four-fold increase. More than 3,000 skilled midwives had graduated from the program by 2011 contributing to the huge decline in lifetime risk for maternal death in the country from 1 in 11 to 1 in 50.

When these training programs are amplified by the voices of midwives themselves and their communities, the potential is extraordinary – we learned from Theresa Shaver, president of the White Ribbon Alliance for Safe Motherhood. Theresa laid out an inspiring example from Tanzania, where a USAID project run by the Health Policy Project and the White Ribbon Alliance has led members of Tanzania’s Parliament to work with midwives, media and religious leaders to develop an action plan for employing more midwives and other frontline health workers. The group is not stopping there – draft legislation for the Tanzanian government to further strengthen its support of its women and newborns are underway.

Of course, investments in midwifery don’t just make sense in Afghanistan and other developing countries,  a point passionately underscored by  Suzanne Stalls, vice president of global outreach for the American College of Nurse-Midwives. The top five countries in Save the Children’s 2011 Mother’s Index – Norway, Australia, Iceland, Sweden and Denmark – all have midwifery as the frontline model of care for women. Inexplicably, the United States ranks 31st on that index despite spending more than $111 billion annually on care related to childbirth – twice as much as France, which ranks 10th on the index. Women in the U.S. have a higher risk of dying from pregnancy and birth related complications than in 45 other countries. Luckily, ACNM’s work has shown that increasing access to midwives, who work in collaborative, interdisplinary teams with physicians, can improve care and lower costs, Stalls said.

So, what’s Congress doing to harness this power of midwifery in developing countries and here at home? On the global front, a resolution (H Res 135) would call for a U.S. government-wide global health workforce strengthening strategy focusing on frontline workers like midwives. On the domestic side, a bill (HR 2286) would enable designation of a maternity care shortage so that critical workforce issues can be addressed, and another measure (S 425, HR 896) would aim to improve care for moms and babies by investing in inter-professional collaboratives and updating quality measures used by Medicaid.

An urgency to get this movement going cut across all of the panelists’ remarks. Suzanne of ACNM recounted the loss her grandfather, a small-town physician, felt when his wife died from a pregnancy-related complication that could easily have been treated today. As she thinks of that story, she has told her children she cannot rest easy until she knows that there is no longer a woman in a remote village in South Sudan who is bleeding to death by the side of a road for lack of a medication that costs several dollars, or a woman who dies from eclampsia in Pakistan because of the gender inequity which prohibits her from leaving her house to seek the care she needs.

Here’s to hoping a movement will be ignited so Suzanne can rest easy soon.

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