A return on investment of 16:1 should be irresistible. So why does midwifery keep losing the budget fight, and what would make funders and finance ministers finally move?

When a young mother in Mtendere, Lusaka, began bleeding heavily hours after delivering her baby, her life was in grave danger. Three midwives assessed her immediately, recognised she was experiencing postpartum haemorrhage and got her to specialist care in time. 

She survived. But the outcome was not luck. Postpartum haemorrhage kills tens of thousands of women every year. She survived because Mtendere Clinic is one of six facilities in Zambia where midwifery preceptors, experienced midwives who mentor and train the next generation in clinical settings, have been systematically trained and deployed in partnership with Seed Global Health. In 2025, there were zero maternal deaths in Mtendere Clinic.

Sustained investment in midwives, in training, mentorship and the environments where they work, allowed them to act decisively when it mattered most.

 This story is not unusual. Every day, in every corner of the world, investing in midwives is the difference between life and death. Yet, in too many places, that investment is lacking.

Preventable deaths

Globally, there are one million fewer midwives than needed, and this cost can be measured in the $1 trillion lost annually to the global economy from the women’s health gap. But most of these deaths are preventable. 

Governments and funders must act now – we know what works – and the cost of inaction is in lives and growth lost.

The evidence is overwhelming. Midwives deliver up to 90% of essential sexual, reproductive, maternal, newborn, and adolescent health services. 

Given the right training, support and environment, midwives can avert up to 67% of maternal deaths globally, 64% of newborn deaths and 65% of stillbirths. 

A very modest 10% increase in midwifery coverage could see over 1.3 million lives saved every year.

These lives saved do not speak only to the personal tragedies of a mother or newborn who dies during childbirth. Because when a mother dies in childbirth, the consequences extend far beyond her – children without a mother are more likely to die before their fifth birthday. Families fall into poverty. The ripple effect can last generations.

Investing in midwifery is one of the strongest actions a country can take, with an estimated return on investment of 16:1.

There are plenty of real-world examples which demonstrate what that return looks like. In Rwanda, a country that averaged 8.5% GDP growth while simultaneously halving maternal mortality in under a decade, the link between health investment and economic performance is not theoretical. It is well documented. 

Morocco and Laos show comparable gains, alongside fewer unintended pregnancies, better newborn outcomes, and more women in education and the workforce.

For ministers working within tight budgets, investing in midwives is one of the strongest ROI cases available in health or other sectors. And these benefits extend across the health system and beyond.

For rural or marginalised populations, midwives are often the only skilled health workers easily accessible, delivering contraception, safe delivery care, immunisations, and support for survivors of gender-based violence. 

For the 4.3 billion people currently lacking access to at least one essential sexual and reproductive health service, scaling midwifery is the fastest and most cost-effective route to closing that gap.

With 93% of midwives being women, investing in the profession directly advances gender equity – in pay, in leadership, and in workforce participation. These are not secondary benefits. They are additional economic returns on the same investment.

Yet despite all this hard evidence, investment is not being made at the scale required.

Midwives’ demands

This week, 3,000 midwives, funders and officials from every region of the world have gathered in Lisbon for the 34th International Confederation of Midwives (ICM) Triennial Congress. They are not here to debate whether midwives matter. They do. They are here to demand that governments and funders finally act on the evidence.

Their demands are clear and achievable:

 Fund one million more midwives and fund them properly. The million-midwife gap costs lives, prevents economic growth and widens every year without sustained investment.

Make midwifery central to your economic strategy not on the periphery of your health budget. Ministers can no longer ignore the productivity gains, workforce participation, and the impacts investments in midwifery make on the broader health system.

Commit to ICM Global Standards on education, pay, regulation, and leadership.
Midwives who are well-trained, fairly paid, and empowered to lead can avert up to 67% of maternal deaths globally. But only if the systems around them work. That means proper training pathways, enforceable regulation, and career structures that retain talent rather than drive it away.

Somewhere today, a family will experience a tragedy. A mother will die in childbirth. Not because her death was inevitable – it rarely is – but because the midwife who could have saved her was never trained. 

The mother was not given the information she needed to safely deliver her baby. She was not referred to a specialist service in time.

 That death is preventable. So is the next one and the one after that. The only question is whether governments or funders will finally make the investment that stops it.

Investing in midwives is an investment in the future of every country that makes it.

Anna af Ugglas is chief executive of the International Confederation of Midwives.

Dr Lwazi Manzi is head of the secretariat of the Global Leaders Network for Women, Children and Adolescent Health, Office of the President of South Africa

Dr Chikusela Sikazwe is Zambia Country Director of Seed Global Health

Rajat Khosla is executive director of the Partnership for Maternal, Newborn and Child Health

Image Credits: Elizabeth Poll/ MMV, International Confederation of Midwives.