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Continuity, Respect, Equity: MMOC at WHA79
At the Seventy-Ninth World Health Assembly, we convened the first ever official side event on midwifery models of care (MMOC), bringing together global leaders, Ministers of Health, UN agencies, and civil society representatives to reflect the political leadership and momentum that governments are advancing to transition to the model at: “Continuity, Respect, Equity: Midwifery Models of Care for People-Centred Health Systems to Achieve Universal Health Coverage”
Convened by ICM together with the Governments of Bangladesh, Egypt, Ethiopia, Luxembourg, Nepal, Sweden, the United Kingdom, and Zambia, the event marked the first-ever official WHA side event dedicated specifically to MMoC.
Opening the session, WHO representatives and ICM highlighted the urgency of accelerating action to reduce maternal and newborn mortality, emphasizing that many countries remain off track to meet the Sustainable Development Goals by 2030. The high-level roundtable focused not only on why countries should invest in midwives, but critically on how governments are operationalising the transition to MMoC in different health system contexts.
The key takeaway was clear: Advancing midwifery models of care and investing in midwives is essential to achieving universal health coverage and reducing preventable maternal and newborn deaths worldwide.
WHO Director-General, Dr Tedros, opened the session by acknowledging both progress and persistent challenges:
" Over the past 25 years, the world has made incredible progress on maternal and newborn health, but in recent years, that progress has slowed and, in some countries, reversed. Yet: the evidence is clear. Continuity of care from a known competent midwife improves outcomes for women and newborns. It reduces unnecessary interventions, strengthens experiences of care, and uses resources more efficiently."
Dr Pascale Allotey, Director of WHO's Department of Sexual, Reproductive, Maternal, Child, Adolescent Health and Aging, presented compelling evidence supporting midwifery models of care, highlighting the latest Cochrane evidence, the Global Position Paper on Midwifery Models of Care and the Implementation Guidance on transitioning to Midwifery Models of Care. She reflected the need for political leadership to turn the evidence to action:
“Midwifery models of care are amongst the most cost-effective investments any health system can make. Guidance documents do not deliver babies. They do not reform workforce regulations, nor unlock financing mechanisms, nor change how ministries budget for maternal health. That is what you do, and that is what this moment requires. Universal health coverage means that the quality of care a woman receives during pregnancy and childbirth should not be determined by where she lives, what she earns, or who she is.”
ICM Chief Executive, Anna Af Ugglas, reinforced the magnitude of the global midwifery gap and the impact of addressing it:
“Every 2 minutes a woman dies giving life. Over 60% of maternal deaths occur in humanitarian and fragile settings. That's a staggering figure. And nearly half of pregnancies are mistimed or unintended. The world is missing 1 million midwives, which have the power to reverse these trends. Universal midwifery coverage could save 4.3 million lives every year by 2035. Midwives can provide up to 90% of sexual, reproductive, maternal, newborn, adolescent child health services across the life course of the woman from a girl's first menstruation to menopause."
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The Government of Zambia was the moderator for this official side-event; kicking off the high-level roundtable to offer their national insights on their transition to MMOCs. Through investments in midwife-led birth centres and the institutionalisation of a Chief Midwife role, Zambia demonstrated how strengthening midwifery leadership can improve maternal and newborn survival while building more resilient health systems. The Zambian delegation emphasized that transitioning to MMoC requires political will, financing, workforce planning, and regulatory reform.
Dr. Kennedy Lishimpi, Permanent Secretary for Technical Services at Zambia's Ministry of Health, shared his country's transformation through strategic investments in midwifery:
“We started by the law, we reformed the regulatory framework in 2019 to create the Nurses and Midwifery Council of Zambia, elevating midwifery as a distinct profession. The country then overhauled midwifery curriculum to align with international competency standards, deliberately employed 11,000 new health workers (including 3,000 nurses and midwives) in 2022, and invested in infrastructure through presidential directives requiring maternity annexes with running water and electricity at every health facility. As a result, Zambia's maternal mortality decreased from 257 per 100,000 live births in 2018 to 187 in 2024, with preliminary 2025 data suggesting further drops to approximately 107 per 100,000. Neonatal mortality fell from 27 to 17 per 1,000 live births during the same period.”
Sweden highlighted midwifery as both a health systems and gender equality priority. Swedish representatives underscored the importance of sustained investment in midwives through development cooperation and global health financing, framing Midwifery Models of Care as a cost-effective pathway toward stronger primary health care and universal health coverage. Sweden also reiterated the importance of embedding women’s leadership and rights within health system transformation efforts.
Dr. Björn Eriksson, the Director General for the National Board of Health and Welfare, Sweden, shared how sustained investment transformed his country from having 900 maternal deaths per 100,000 live births to just four per 100,000 today – among the world's lowest rates. Sweden's journey began in the 1930s with free maternal health care for all women and has evolved to position midwives as primary providers for uncomplicated pregnancies, responsible for prescribing over 80% of contraceptives and managing all aspects of pregnancy, childbirth, and postnatal care. Notably, Sweden appointed a national chief midwifery officer in 2023, ensuring that perspectives of both women and midwives are reflected in health planning, policies, and regulations – a governance innovation other country are now considering.
Dr. Magda Robalo, Former Minister of Health Guinea-Bissau, Executive Director of Women in Global Health and Co-Chair of UHC2030, delivered a powerful intervention on the structural barriers facing midwives globally:
"Women comprise over 70% of the global health and care workforce, providing care to over 5 billion people, meaning more than half of humanity actually relies on the services provided by midwives, yet they remain concentrated in lower status roles, face persistent discrimination and violence, and continue to experience significant gender gaps."
She emphasised that while nursing and midwifery are complementary professions, midwifery requires dedicated policy, regulatory, education, and leadership frameworks to fully realise its contribution to health systems and gender equality. She warned that continuing to group nursing and midwifery under a single strategy risks diluting critical midwifery priorities and slowing progress toward universal health coverage.
Julia Bunting, Director of Programmes from UNFPA, stressed the urgency of closing the global shortage of midwives and presented key tools available to support countries transitioning to MMoC. UNFPA emphasised that without urgent investment in education, deployment, and retention, countries will struggle to meet growing maternal and newborn health needs.
UNFPA representatives introduced several critical tools to accelerate systemic transformation: the newly launched Investment Case Framework which provides a seven-step roadmap for calculating workforce requirements and economic returns; the Midwifery Accelerator, designed to fast-track transitions to midwifery models of care; and highlighted the MMOC position paper and implementation guides bridging policy and practice.
With momentum building, tools ready, and evidence undeniable, the global health community is poised to champion midwives as central to achieving universal health coverage and ensuring that every pregnancy is wanted, every birth is safe, and all mothers and babies not only survive but thrive.
Zambia’s chief midwife, Daphne Shamambo, gave a strong closing intervention highlighting that throughout the session, speakers repeatedly reinforced that midwifery is not simply a workforce issue, but a proven model of care linked to continuity, respectful maternity care, reduced unnecessary interventions, and improved outcomes for women and newborns:
“If we are serious about reducing maternal and newborn mortality, strengthening primary health care, and achieving universal health coverage, then we must move beyond broad workforce commitments and finally recognize midwifery for what it is — a distinct profession, a distinct model of care, and a distinct health systems solution. Midwives are one of the strongest investments in healthier families, stronger communities, and a key to advancing the sustainable development agenda”
The event concluded with a strong collective call to action urging Member States to work with WHO and its Executive Board toward the development of a standalone global midwifery strategy beyond 2030, separate from nursing, to fully operationalise MMoC worldwide.
The side event demonstrated growing political momentum behind midwifery leadership and signaled an important shift in how countries are approaching maternal and newborn health: not through fragmented services, but through integrated, people-centred models of care led by midwives.
If you missed the event, watch the recording here.
