The International Day of the Midwife (May 5) reminds us that safe birth is not a stand-alone event, but part of the broader continuum of sexual and reproductive health and rights

Most maternal deaths occur during labour, birth, or shortly after birth. Nearly 290,000 women died during and following pregnancy and childbirth in 2020, with 95% of these deaths occurring in low- and lower-middle-income countries. 

The major causes included severe bleeding, hypertensive disorders, infections, complications from unsafe abortion, and obstructed labour. Yet these events are largely preventable or treatable when skilled care, referral, medicines, blood, and emergency obstetric services are available. 

Midwives are often the first – and sometimes only – skilled provider able to detect and respond to such complications in a timely manner.  

But the world currently faces a shortage of up to a million midwives – part of a larger global health workforce crisis – that is concentrated in the countries and communities where maternal and newborn mortality is highest.

Although skilled birth attendance globally is around 80%, this figure hides severe inequities within and between countries. Women in rural areas, poor households, conflict settings, humanitarian crises, and marginalized communities are least likely to have access to a skilled midwife or other qualified birth attendant. 

Access is not only about whether a health care facility exists, but also depends on distance, transport, user fees, staffing, respectful care, medicines, referral systems, and whether women trust the system enough to use it.

Safe birth and post-natal care are not standalone events. They are part of the broader continuum of sexual and reproductive health and rights that includes health education, contraception, antenatal care, screening of sexually transmitted infections, safe birth, emergency response, postnatal and newborn care, breastfeeding support, and referral, as well as safe abortion and post-abortion care. 

High maternal mortality ratio

The current global maternal mortality ratio of 223 deaths per 100,000 live births is well above the Sustainable Development Goal target of achieving less than 70 deaths per 100,000 live births by 2030. 

Midwives can provide around 90% of essential SRHR care when they are educated, licensed, regulated, and supported to international standards. 

But in many low-resource settings, midwives are too few, poorly distributed, underpaid, ill-equipped, or not fully authorized to practice to their competencies.  

Scale-up to achieve universal coverage of midwife-delivered interventions is one of the clearest and most practical routes to faster progress and to averting a larger share of maternal and neonatal deaths and stillbirths. 

Investment in the workforce must include education, fair pay, regulation, safe working conditions and career pathways, supplies, data systems, and integration into primary health care. 

Policy settings need to remove financial barriers to care and treat SRHR as a complete package, rather than as a range of isolated services.

Countries are demonstrating increasing innovation in the midwifery field. In Sierra Leone, for example, structured preceptorship (mentorship) programmes are strengthening hands-on clinical skills and confidence among midwives, helping translate training into safer care at the bedside. 

In Ethiopia, a center of excellence in midwifery trains disadvantaged rural girls to become ethical and compassionate midwives in their own communities.  Efforts such as these are key to empowering midwives and the women and children they serve before, during and beyond childbirth.

Midwives already save lives every day. The task now is to ensure that they can do so for women everywhere.

Dr Teguest Guerma is the founder and CEO of LeDeG Midwifery College, established in 2015 to address critical gaps in maternal health across Ethiopia and beyond.

Image Credits: Elizabeth Poll/MMV, Twitter: @WHOAFRO.