Does the World Have Enough Midwives?

Farasha Bashir

The practice of midwifery came to attention during the time of the Millennium Development Goals due to the global shortage of healthcare workers, with WHO predicting (in 2006) that an additional 4.2 million workers are needed, especially in developing countries. 

When a woman goes into labour, a million thoughts will run around in her head. Most of these thoughts will focus on the safe delivery and well-being of her child. For many women, these worries are often assuaged because they will likely have access to skilled birth attendants and the delivery would be in a medical facility.

However, in many countries these luxuries are not afforded to pregnant women and most will give birth with little or no quality care – a contributing factor to the high rate of maternal and child mortality; in 2015 the World Health Organization (WHO) estimated that approximately 303,000 women will die each year from complications related to pregnancy or childbirth. Sadly, most of the time, the deaths of mothers during childbirth (especially in developing countries) could be prevented if access to proper healthcare is established.

The practice of midwifery came to attention during the time of the Millennium Development Goals due to the global shortage of healthcare workers, with WHO predicting (in 2006) that an additional 4.2 million workers are needed, especially in developing countries. The United Nations Population Fund conducted a survey on 73 low-and-middle income countries and their findings are staggering: 93 per cent of the global maternal mortality occurs in these countries, while only 42 per cent of the world’s medical, midwifery and nursing personnel are available.

Midwives are trained specialists whose role is to look after a pregnant woman and her baby through antenatal care during labour and birth to post-natal stages.

These individuals are often sufficient in providing antenatal and postnatal care to a woman, and safe delivery provided there are no complications. Ensuring that women have access to quality care and support from a skilled midwife will go a long way in reducing the number of maternal and infant deaths.

However, Frances Day-Stirk (President of the International Confederation of Midwives) opines that simply increasing the number of midwives is not enough and they must possess essential competencies “where midwives are educated, regulated and supported”.

In Bangladesh, the situation is dire; only 31 in 100 women will have access to a skilled attendant or any healthcare worker during childbirth. In fact, Bangladesh is listed as one of the 30 countries which is in need of midwives. With around three million births annually, the country needs an estimated 21,000 midwives to ensure adequate coverage.

In 2010, Prime Minister Sheikh Hasina committed to develop 3,000 midwives by 2015. The following year, to affirm its commitment to the government, BRAC University decided to work with the Ministry of Health and Family Welfare to develop a strategy and meet the government’s target and thus contribute to the improvement of maternal and neonatal health system in Bangladesh.

Since 2013, BRAC University has been implementing a three-year Diploma in Midwifery (with financial support from UK Aid) at seven academic sites in six districts across the country, under the Developing Midwives Project (DMP). All academic sites have been approved by the Ministry of Health of Family Welfare and accredited by the Bangladesh Nursing and Midwifery Council (BNMC). This project endeavours to draw young women from disadvantaged rural and urban communities, and educate them to become competent midwives ready to provide quality maternal and neonatal health services.

DMP employs a two-pronged approach where the first prong is developing qualified midwives and the second one is developing faculty for midwifery education. Its innovative ‘hub and spokes’ model – wherein BRAC University is the ‘hub’ and the seven partner academic sites the ‘spokes’ – ensures that these young women are being developed to live and practise in hard-to-reach, under-served rural and urban areas of the country, eventually impacting the reduction of maternal and newborn mortality and morbidity. As of today, 131 graduates of BRAC University’s first midwifery batch are awaiting government posting, 163 of the second batch are continuing with their internship. There are 269 students who are undertaking the Diploma at present, with 1,317 midwives planned for this five-year project ending in 2021.

In low-to-middle income countries, midwives who are educated and monitored to match international standards, can provide 87 per cent of essential care for women and newborns and as eloquently stated by Dr Margaret Chan (Director General, WHO) “a focus on midwifery offers a way to improve coverage and quality at the same time…outcomes are enhanced when care is led by midwives who are educated, supervised, licensed, and regulated”.

Bangladesh still has a long way to go to meet the goal of developing a cadre of at least 3,000 midwives serving across the country. Data from BMNC shows, there are currently 1,185 registered midwives. But the government is determined to deliver on its promise; 3,000 posts for midwives have been created starting from 2014, with an additional 600 posts to be added each year until 2019. Thus, projects such as the one initiated by BRAC University are imperative to develop the country’s base of competent midwives.

Visit the Developing Midwives Project on their Facebook page here. 

Farasha Bashir is a communications and knowledge manager at BRAC James P Grant School of Public Health.