The countdown is on: we have less than 500 days to meet Millennium Development Goals (MDG) 4 and 5, focused on improving child and maternal health. Sustained and focused efforts have resulted in impressive improvements in many countries. However, there is still a long way to go, and despite overall global reductions in child (under 5) mortality rates, infant mortality rates have actually risen. Midwives are fundamental in meeting these two MDG’s.
It is not difficult to see how midwives are critical to improving MDG 5 with its related indicators pertaining to:
• maternal mortality ratios
• proportion of births attended by skilled health personnel
• the contraceptive prevalence rate
• the adolescent birth rate
• antenatal care coverage
• the unmet need for family planning
It is estimated that a universal increase in midwifery (including family planning) in 78 of the world’s most resource-poor countries could result in up to 83% fewer maternal, fetal and newborn deaths. Family planning (easy access to contraceptives) allows women to choose when to start having children, as well as the timing and spacing of births. This is crucial in reducing adolescent pregnancies, known to be associated with a higher risk of complications for both the mother and baby.
The indicators of MDG 4 are reducing:
• under-5 mortality rate
• infant mortality rate
• proportion of 1 year-old children immunized against measles
At first glance, it may appear the only indicator that midwives directly impact is related to reducing the infant mortality rate. However, taking into consideration the fact that newborns account for 44% of deaths of children under 5, it is clear that inherent to tackling the under-5 mortality rate is lowering the infant mortality rate. Midwives can be instrumental in promoting childhood immunizations.
Midwives are ideally placed to provide specialized and integrated care for both mother and baby. They affirm birth as an essential rite of passage within the context of a woman’s community. In addition, central to the philosophy of midwifery is the empowerment of women, and empowered women positively impact communities.
Midwives are the unsung heroes of maternal and newborn health. They can prevent about two thirds of deaths among women and newborns. And midwives deliver much more than babies: They are the connective tissue for communities, helping women and girls care for their health, from family planning all the way through the postpartum period. –United Nations Population Fund
High-quality midwifery care for women and newborns saves lives and contributes to healthy families and more productive communities. –2014 State of the World’s Midwifery
Midwives who are educated and regulated to international standards are able to deliver 87% of the care needed for women and newborns and have been described as a cost-effective ‘best buy’ in primary health care. However, in spite of this, the midwifery profession is one that is frequently misunderstood and highly undervalued in far too many countries. More work is needed to improve both the supply and demand side of midwifery. Midwives are needed to provide universal coverage, and increase awareness among women and their families regarding the importance of utilising midwifery services. Improvements in midwifery education and ensuring systems of robust professional regulation and strong professional associations will result in a high quality midwifery service. Midwives need respect for the vital role they play in communities.
As the deadline for meeting the MDG’s draws near, this a great opportunity for governments and leaders at both international and regional levels to champion midwives and commit to strengthening global midwifery.
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