International Day of the Midwife
May 5, 2015 – Although global progress continues to be made towards the fifth Millennium Development Goal – to reduce maternal mortality by 75% by 2015 – progress in Africa remains slow. The latest statistics from the World Bank indicate that in 2013, 62 per cent of maternal deaths worldwide (178,000 out of 262,000) occurred in sub-Saharan Africa, compared to 42 per cent in 1990.
The countries in this region are characterised by high fertility rates, a high unmet need for family planning, and low uptake of the recommended four antenatal care visits during pregnancy, which fuel the high maternal mortality rates. These countries are further characterised by early sexual debut, early marriages and high prevalence of teenage pregnancies.
Most maternal deaths can be averted by implementing programs and policies that support women’s access to affordable and high-quality family planning, antenatal, delivery and postnatal care. The main causes of maternal mortality are bleeding, hypertension and infection. Unsafe abortions also add to the high number of avoidable maternal deaths
Maternal deaths are also closely linked to infant deaths. Two-thirds of infant deaths in the region occur in the first 28 days of life (neonatal period), with the time immediately after delivery being the most risky period. In fact, the percentage of child deaths in the neonatal period in Africa has increased in the last decade. According to the Countdown 2014 Report (UNICEF/WHO), approximately 18,000 children globally still die every day, the vast majority living in disadvantaged populations. The leading causes of post-neonatal child deaths remain preventable infectious diseases such as pneumonia, diarrhoea and malaria.
Available evidence indicates that countries with a high proportion of births assisted by skilled attendants who are trained, qualified and accredited have low maternal mortality rates. It is noteworthy that a midwife can provide a broad spectrum of reproductive and maternal services to 500 women in a year. In light of this, Amref Health Africa through its Stand Up for African Mothers campaign has prioritized training of midwives as one of the key strategies to reduce deaths of mothers and their newborns in the countries with the highest maternal deaths in Africa. Unfortunately Africa has a shortage of midwives, both in numbers and competencies. The majority of midwives serving on the continent have only received basic training and require upgrading or further training in order to meet global standards for midwifery.
On the occasion of the International Day of the Midwife 2015, Amref Health Africa calls for increased investment in scaling up education and training of midwives to increase access to quality health services and reduce needless deaths of mothers and their newborn children.
Amref Health Africa further urges African Governments to
- Prioritise the strategy to strengthen human resources for health during the ongoing SDG Intergovernmental negotiations (September 2014 - August 2015)
- Reinforce the need to prioritise midwifery in human resources for health development under SDG 3
- Champion breaking down of indicators for SDG3 and strategy 3C by cadre to ensure that midwifery is allocated the resources required by Governments and development partners
Amref Health Africa also requests Ministries of Health in Africa to
- Scale up education and training of midwives by increasing physical space and adoption of eLearning
- Increase regional and national budgets for recruitment, deployment and retention of midwives in rural areas
- Strengthen midwifery regulatory bodies and associations to ensure that issues affecting this important cadre are addressed and their continuous professional development is institutionalised
Meet Martha, a Midwife in Ethiopia
(Photo: Amref Health Africa)
Martha is a midwife at the Jinka Zonal Hospital in the South Omo region of Ethiopia. She participated in Basic Emergency Obstetric Care (BEmOC) training thanks to an Amref Health Africa project supported by the Government of Canada through the Department of Foreign Affairs, Trade and Development (DFATD). The BEmOC program has enhanced her skills, making her a better midwife while improving her access to ongoing training and career advancement.
Though she went to school in Arba Minch, the main Health College in South Omo, Martha is from Jinka and is happy to be practicing midwifery in her home town. Not only is the training important for her work, but Martha’s eyes light up when she talks about the new skills she has learned. She particularly enjoyed learning about safe delivery, episiotomy, and malpresentation. As a midwife, Martha faces the joys and challenges of childbirth every day. Though many births are largely problem-free, emergency obstetrics are an essential skill in reducing child and maternal mortality wherever Martha continues to practice in her career. The world needs midwives now more than ever.