By ICM Africa Regional Board Members, Dicko Fatoumata S Maiga and Hilma Shikwambi
Board members representing the Africa Region, International Confederation of Midwives
More than half of all midwives’ associations across Africa are calling on their governments to commit to addressing the global shortage of midwives during the upcoming U.S.-Africa Leaders Summit in Washington, D.C (Dec 13-15). As recent evidence demonstrates, the world is currently facing a shortage of 900,000 midwives, which is most severe in low-income countries and in Africa. The COVID-19 crisis has only exacerbated this shortage, with the health needs of women and newborns being overshadowed, midwifery services being disrupted, and maternal and neonatal mortality rates increasing across Africa, and around the world.
In letters to their Ministries of Health, the leaders of these associations have outlined why and how their countries’ decision-makers should prioritise funding for more midwives as a key approach to pandemic preparedness, addressing the need for quality, affordable, community-based care and saving the lives of millions of women and newborns each year.
As African-based health advocates working with International Confederation of Midwives — the global body representing the African midwives’ associations — we are committed to amplifying the demands of midwives and women across our continent. Like our African midwives’ associations, we believe that building strong, resilient health systems and economies is contingent on addressing the midwifery workforce shortage. The starting point for this work begins with African leaders acknowledging the life-saving potential of a strengthened midwifery workforce and working with partners in the US and elsewhere to action the recommendations in the letters written by our midwives’ associations. These actions include:
Centring midwives in building stronger, more resilient health systems that protect community members from the worst impacts of ongoing and future pandemics:
Although we often think of midwives as health workers who help women deliver babies, this is only one area of the lifesaving care they provide to families. Data shows that midwifery care can improve over 50 health-related outcomes, including detection and management of sexually transmitted infections, immunization, breastfeeding, malaria, TB, and HIV. In the context of pandemics like COVID-19 and Ebola, midwives are essential health educators who can provide information and monitoring to help stop the spread of disease, and if needed, they can administer vaccines to whole families. All this in addition to teaching people about hygiene and healthy lifestyles that can prevent other diseases, too.
If we want to build a resilient, sustainable health system, we need to action the evidence demonstrating the life-saving impact of midwifery and invest in midwives and their low-resource, easily deployable health care model that centres women and their families. This is what midwives and other healthcare experts are telling us is essential to ensuring the health and wellbeing of Africans and all people.
Investing in midwifery education, on-the-job training and improved pay and working conditions to address the global shortage of 900,000 midwives:
Midwifery is an extremely cost-effective approach to improving health care for entire families. In fact, funding and legislation to support midwife education, training and regulation can produce up to a 16-fold return on investment. They are highly skilled health professionals who can save the lives of mothers and children during childbirth, but also provide care before, during and after pregnancy. When we invest in well-educated midwives integrated into the health system, we invest in a workforce that can provide 87% of the essential care for women and newborns.
Establishing a well-resourced Chief Midwife role in every Ministry of Health to ensure the needs of women and families are met:
Across Africa, the failure to include the demands and needs of midwives in the COVID-19 pandemic response has led to a denial of human rights for childbearing women, midwives working without pay and in risk high-risk situations that threaten their lives, and midwives leaving the profession as a result of burnout and exhaustion. Midwives are key to pandemic preparedness and prevention, but they need a seat at the decision-making table. Put simply, if these vital frontline workers continue to be left out of health decision-making, our country and its future will suffer.
Midwives are a very special kind of primary healthcare professional – they care for mothers and newborns, ensuring the future and health of our nations; they provide full-spectrum reproductive health services, ensuring that people can grow their families in health and dignity. As trusted health community workers they are uniquely positioned to provide information on disease prevention, monitor the health of communities and if needed, administer medications and vaccines – all critical to pandemic prevention and response programmes. To do this, they need to be educated, resourced and given a seat at critical decision-making tables.
The case for midwives is clear – it’s time for action.