The case for training midwives to provide abortions

Nepalese midwife providing 15+ medical abortions each month exemplifies investment case for midwives as essential in advancing gender equality

September 21, 2023

By Sarah Shaw, Global Head of Advocacy at MSI Reproductive Choices 

Delivering babies is just one part of being a midwife. Midwives play an essential role in supporting the autonomy, choices and rights of women through a wide range of sexual and reproductive health experiences. 

In some cases, that will mean assisting a woman with the birth of their first child. In others, it will mean counselling them on the right contraception, supporting them to end a pregnancy or providing life-saving post-abortion care following an unsafe abortion. In every case, it means supporting people to make whichever reproductive choices are right for them and their future.

The support and care that midwives provide is vital for achieving gender equality. It allows women to take control of, if or when they have children. By supporting women and girls to make choices about if and when to become pregnant, girls can stay in school, graduate from university and build the future that they want.

Despite the benefits, the type of care that midwives can provide is still restricted. In many countries, abortion services must be signed off by multiple doctors, despite WHO guidance and evidence showing that midwives can provide abortion and post abortion care services safely; and midwives are often closest to the community where services are needed. That’s why it’s crucial that we continue to advocate for midwives around the world to have the right training and resources to provide a full range of sexual, reproductive, and non-reproductive healthcare services.

At MSI Reproductive Choices, our global cohort of MSI Ladies – trained midwives who deliver a range of sexual and reproductive healthcare in their communities - embody a commitment to gender equality. They go from door to door, carrying a blue backpack filled with life-saving healthcare. They are critical for bringing healthcare to remote areas and in some cases, even walk for hours to reach women. They are all connected by a shared commitment to bring choice, and the opportunities that choice brings, to everyone that they support.

Pragati’s story

Pragati is a trained midwife who works as an MSI Lady in Nepal and believes in the power of

reproductive choice. Every day, she carries a bag packed with hand sanitiser, medical equipment and abox with an assortment of pills that weighs an impressive 15kg. Some days she walks, other days shehitches a ride in a passing car or bus to reach the remote communities in Nepal’s mountains above the clouds. It is here, in the Tanahun district that she provides contraception and safe abortion services to local women, men and their families.

For Pragati, being a midwife is more than just a job. “Family planning gives a woman control of her own body. They should have the right to do what they want with their own body,” Pragati shared. “[Medical abortion] is related to the dignity of women, it allows them to do this without all of the eyes on them. That’s why it is important to me.”

Each month she provides around 15 medical abortions and about 30 women receive a contraceptive service from her. These services are legal in Nepal, yet still highly stigmatised. So, to raise awareness, educate her community and help remove stigma for current and future generations, Pragati also provides counselling and discussion groups for women in her home.

By providing reproductive choice in communities with no other access, Pragati’s contraception and safe abortion services are changing lives and supporting futures. “Those who have used my services come to me and say I’ve saved their lives,” Pragati shared.

Without midwives like Pragati, people around the world would not have the support that they need to take control of their future. Midwives lend a supportive ear, provide high-quality advice and information on sexual and reproductive healthcare, and ultimately offer the full range of choices available for people to make an informed decision about their future. Their work is key to achieving gender equality.