Midwives Make a Difference

Development Policy12 Feb 2014Frances Ganges

Talking about midwives in the development context may seem out of place at first, as many people might not be aware of the work they do. However, looking deeper it becomes clear that midwives play a vital role in development, especially with regard to the Millennium Development Goals (MDG). So what exactly is a midwife and what do they do? 

The word midwife literally means ‘with woman’. Based on the origins of this ancient profession the description of the midwife’s practice, as defined by the International Confederation of Midwives (ICM), begins as follows:

“The midwife is recognised as a responsible and accountable professional who works in partnership with women to give the necessary support, care and advice during pregnancy, labour and the postpartum period, to conduct births on the midwife’s own responsibility and to provide care for the newborn and the infant.”

A midwife supports and cares for women throughout the childbearing cycle. While this of course includes pregnancy, labour and birth, it also means that the midwife cares for the woman and her newborn during the days and weeks following the birth. In many settings, the midwife goes on to address the ongoing reproductive and contraceptive needs of the woman. The ICM definition notes that the midwife is a person who has successfully completed an education programme that is recognized in the country in which they are located and that is based on the ICM Essential Competencies for Basic Midwifery Practice and the framework of the ICM Global Standards for Midwifery Education; who has acquired the requisite qualifications to be registered and/or legally licensed to practice midwifery and use the title ‘midwife’; and who demonstrates competency in the practice of midwifery.

Having broadly defined the work of midwives, let’s look more concretely at why and how midwives contribute to development. Every year approximately 290,000 women die due to complications of pregnancy and birth. And over 90% of maternal mortality occurs in developing countries. One million newborns die within the first month of their life, three million within the first year, and another three million will not live to their fifth birthday. There are thousands of private tragedies behind these cold statistics, women who mourn the loss of their babies, men who are widowed, girls who are orphaned and have to leave school to run the household and look after their siblings. In addition, this also has an economic impact: 15 billion US dollars (11 billion euros) of productivity are lost every year through maternal or infant mortality. Hence the death of a mother or child is not just the demise of a person, but an event affecting the whole family, community and ultimately, the economy. In this regard it is true that the success of a country depends not on its wealth but on the health of its mothers and children.

But the story does not end here. The good news is that two-thirds of maternal deaths could be prevented if women were assisted in giving birth by a skilled and well equipped midwife. For instance, a major cause of maternal death is excessive bleeding after birth, or post-partum haemorrhage (PPH). A midwife knows how to help prevent or treat the bleeding – and save the life of the mother. One of the leading causes of newborn death is failure to breathe after birth. A midwife is trained to quickly recognize this and take appropriate action. These and many other complications would be appropriately averted or addressed with a professionally educated midwife.

Besides these emergency skills a midwife provides much more. Midwives also support the mother to initiate breastfeeding within the first hour after birth. Breastfeeding supports healthy growth and development and protects newborns from infections, pneumonia and diarrhoea. She or he can provide counselling on how to delay, space or limit pregnancies to achieve the healthiest outcomes for women, newborns, infants, and children. This healthy timing and spacing of pregnancies works within the context of free and informed contraceptive choice and takes into account fertility intentions and desired family size. This guidance enables families to plan for the arrival and amount of their children. Women are then better able to generate income and contribute to the family’s livelihood. Spacing pregnancies also directly contributes to newborn survival. It has been estimated that family planning may avert up to two-thirds of maternal deaths.

When a mother survives and is healthy, her children are much more likely to survive, escape poverty (MDG1) and be educated (MDG 2); and when female education goes up, so does economic growth.

With all these skills and competencies midwives contribute directly to MDGs 4 and 5 by reducing maternal and neonatal mortality. And in some geographical regions, addressing concerns such as malaria and HIV are an integral part of the midwife’s work (MDG 6). It is critical to note that midwives are also competent in the cultural and social context of maternal-newborn care. This expands their role beyond health-care provision to one of advocate, promoting empowerment strategies and human rights for women, including gender equity (MDG 3). There is much more, but by now you are beginning to see how midwives make a critical contribution to development. By its very nature, the work of the professional midwife both directly and indirectly influences women’s health and empowerment. According to UN Women, this is pivotal in accelerating and sustaining MDG progress and furthering all the goals. And since development depends on the well-being of women and children, the world indeed needs midwives now more than ever.