On International Midwives’ Day (5 May), the crucial role of midwives – particularly in humanitarian crises – needs recognition, and their voices need to be included in planning and policies.

Being pregnant, giving birth or having a newborn are times of change and challenge – but when a woman is also facing a humanitarian crisis, they can quickly become deadly. 

Sexual and reproductive health needs don’t stop in a crisis; despite this they are too often ignored in crisis preparedness planning and response. According to the latest United Nations estimates, countries affected by conflict or considered “fragile” account for 61% of maternal deaths globally, despite representing only 25% of global live births.

In many crisis-affected settings, midwives are among the first responders. Based in the communities they serve, they are able to provide essential care with limited resources, often before comprehensive response efforts can be mobilised.

“Some women gave birth in the water,” said Neha Mankani, a midwife from Pakistan, reflecting on her experience during the 2022 floods. “We saw fungal infections. We saw maternal deaths. The sheer amount of tragedy is something you couldn’t understand until you were there, on the ground.”

Neha’s story is one of four short documentaries shared during a global event for the International Day of the Midwife, highlighting the work of midwives in humanitarian settings — from Morocco’s earthquake response and Pakistan’s floods, to the refugee camps of Bangladesh and the overwhelmed maternity wards of the West Bank conflict zones.

Undervalued and overwhelmed

In the West Bank, two midwives often care for up to 20 labouring women at a time, a burden made worse by the stress of waiting for hours at checkpoints to get to work, or to get to a hospital in labour. This is made worse by the constant threat of violence.

In Pakistan, makeshift clinics meant for a few hundred people saw over 1,000 show up in a single day, overwhelming staff and resources. In Morocco, midwives were among the first to respond after the earthquake, in an area that was impossible to reach from the outside for days. Midwives had to deliver everything from antenatal care to psychological support for survivors of gender-based violence that is more common during crises.

Even though they are among the first to respond in a crisis, midwives are rarely included in official crisis response planning. As one advocate in Pakistan put it, “Strategies are being made. Frameworks are being made. But midwives are absent from all of it.”

“Sometimes your mental health suffers because you have no more energy and you just can’t,” shared a midwife from the West Bank, describing the emotional toll of working in understaffed facilities during periods of intense demand.

In Bangladesh, a midwife explained how food and basic supplies that were once distributed regularly in the Rohingya camps have now stopped arriving. Community trust is harder to maintain when essential needs go unmet. And for the midwives themselves, already working in extreme conditions, the lack of resources means doing more with less — or watching people go without the care they need.

Recent global aid cuts will only make these situations worse, further reducing the availability of essential goods and services in humanitarian settings. “We encouraged women to trust us and we earned their confidence in our work. In the beginning, we had only three or four deliveries each month. Now, we’re handling over 100,” said a midwife from Bangladesh. This trust can easily be broken if midwives are unable to provide the care that women need because of a lack of funding, supplies, or equipment, and women may give birth alone.

Midwives are not a luxury

In fragile and crisis-affected settings, midwives are not an optional add-on to the health system — they are the only health providers solely dedicated to sexual and reproductive health, often stepping in when other services are unavailable or disrupted. According to the International Confederation of Midwives, trained midwives can provide up to 90% of essential sexual, reproductive, maternal, newborn, and adolescent health (SRMNAH) services. They offer antenatal and postnatal care, help women birth babies safely, manage pregnancy loss and comprehensive abortion care, support breastfeeding, respond to gender-based violence, and offer contraception.

The documentaries show that midwives are often based in the communities they serve, speak the local languages, know where to obtain supplies and medicines, and are trusted by those most affected. They provide culturally competent care, rooted in local knowledge and community trust.

In crisis settings, where time and access mean the difference between life and death, midwives are an efficient, cost-effective solution. They deliver care even when infrastructure is damaged or missing. They educate communities, distribute clean birth kits, set up referral systems, and provide support through grief and loss. And as seen in Morocco, they also play a vital role in post-disaster recovery, helping women and children heal from trauma.

Include midwives in planning

Despite the evidence and best practice, midwives are too often excluded from national and international crisis planning efforts. Their voices are missing from policy and funding decisions. Their expertise is overlooked in disaster preparedness. And their personal safety and rights are not prioritised in crisis response.

They are expected to show up, and make do, with little or no support. The same is expected of the women who need their care. This gap has consequences.

“At full capacity, our antenatal clinic could see 300 people a day. But more than 1,000 showed up. There was a stampede. Many went back without getting anything,” said a midwife from Pakistan.

Better planning could have helped. So could recognising midwives as essential partners in preparedness and response.

This year’s theme for the International Day of the Midwife — Midwives: Critical in Every Crisis — is a call to action. If we are serious about reducing maternal deaths and building health systems that can respond to conflict, disaster, and displacement, we must invest in midwives. That means educating them, protecting them, and including them at every level of decision-making, everywhere. Creating an enabling environment for midwives to work to their full scope of practice, even during crises.

The next crisis is not a matter of ‘if’, but ‘when’. Midwives are ready. It’s time the world is ready, too.

Daniela Drandić is Head of Advocacy and Communications at the International Confederation of Midwives

 Ana Gutierrez is Communications Lead at the International Confederation of Midwives

Image Credits: International Confederation of Midwives.