Alarm sounded over global shortage of midwifery and neonatal workforce

It estimated that the world’s sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workforce could meet only 75% of the global need for essential care.

“Midwives play a vital role in reducing the risks of childbirth for women all over the world”

Tedros Adhanom Ghebreyesus

But in low-income countries this falls to just 41% of the need, with the African and Eastern Mediterranean WHO regions least likely to be able to provide the required services.

The State of World Midwifery (SoWMy) report, published today on International Day of the Midwife, evaluated the profession across 194 countries.

The SoWMy 2021 review found a shortage of 1.1 million SRMNAH workers around the world, of whom 900,000 are midwives or nurse-midwives.

According to the report, the worst shortage was in the WHO African Region, which accounts for 56% of the global shortage of workers.

Most of the remaining shortages are in the Eastern Mediterranean and Americas regions, the report found.

SRMNAH is a key component of the UN’s sustainable development goals that member states are expected to work towards achieving by 2030.

There has been progress over the past two decades, but it remains uneven, the report stated.

Global estimates point to 810 maternal deaths every day, one stillbirth every 16 seconds and more than 2.4 million newborn deaths each year.

Almost one in five women gives birth without assistance from a healthcare worker and an estimated 217 million women have unmet needs for contraception, the report stated.

Midwives make up just 8% of the global SRMNAH workforce. But if midwife-delivered interventions were universally available two thirds of maternal and neonatal deaths and stillbirths could be avoided.

Achieving this level of access would save 4.3 million lives annually by 2035, the report estimated.

“As autonomous, primary care providers, midwives are continually overlooked and ignored”

Franka Cadée

Gender inequality was a driver of the shortage, the report argued, with the under-resourcing of the midwifery workforce a symptom of wider structural barriers to prioritising women and girls’ reproductive health needs.

Women account for 93% of midwives and 89% of nurses, compared with 50% of SRMNAH doctors, the report’s authors noted.

They said: “Midwives are more likely to be women; they experience considerable gendered disparities in pay rates, career pathways and decision-making power.

“Only half of reporting countries have midwife leaders within their national Ministry of Health. Limited opportunities for midwives to hold leadership positions and the scarcity of women who are role models in leadership positions hinder midwives’ career advancement and their ability to work to their full potential.”

The report warned that by 2030 the shortage of midwives and nurse-midwives around the world was projected to decrease to 750,000 (from the current figure of 900,000).

It means that by the end of this decade 82% of global needs will be met - an improvement of 7% - but these gains will not be universal.

Indeed, the report stated that the gap between low-income countries and the rest is projected to widen by 2030, increasing inequality.

Investment is urgently needed to address this shortage, it said.

To close the gap by 2030 a million new midwives, as well as 200,000 nurses will need to be employed in the next 10 years.

Most of these jobs will need to be created in Africa, according to the report.

Aside from staffing, there was also a need to improve the quality of care and reduce the incidence of disrespect and abuse towards patients using SRMNAH services, the report authors said.

For midwives to achieve their potential, they said greater investment was needed in four key areas – education and training; workforce planning, management, regulation and the work environment; leadership and governance; service delivery.

“The State of the World’s Midwifery report sounds the alarm”

Natalia Kanem

In many countries, workforce planning is hampered by poor health workforce data systems, the report stated.

The report was created through a partnership of the UN’s sexual and reproductive health agency, the World Health Organization and the International Confederation of Midwives.

Dr Natalia Kanem, executive director of the UN sexual and reproductive health agency UNFPA, said: “The State of the World’s Midwifery report sounds the alarm that currently the world urgently needs 1.1 million more essential health workers to deliver sexual, reproductive, maternal, newborn and adolescent health care, and 80% of these missing essential health workers are midwives.

“A capable, well-trained midwife can have an enormous impact on childbearing women and their families – an impact often passed on from one generation to the next,” she said.

Dr Franka Cadée, president of the International Confederation of Midwives, welcomed the report, saying: “As autonomous, primary care providers, midwives are continually overlooked and ignored.

Tedros Adhanom Ghebreyesus

“It's time for governments to acknowledge the evidence surrounding the life-promoting, life-saving impact of midwife-led care, and take action on the SoWMy report's recommendations,” she added.

Dr Tedros Adhanom Ghebreyesus, WHO director-general, said: “Midwives play a vital role in reducing the risks of childbirth for women all over the world, but many have themselves been exposed to risk during the Covid-19 pandemic.

“We must learn the lessons the pandemic is teaching us, by implementing policies and making investments that deliver better support and protection for midwives and other health workers,” he said.

“This report provides the data and evidence to support WHO’s longstanding call to strengthen the midwifery workforce, which will deliver a triple dividend in contributing to better health, gender equality and inclusive economic growth.”