According to most recent reports, more than 350,000 women and 4 million newborns die needlessly each year and the Millennium Development Goals 4 and 5 (reducing child mortality and improving maternal health) are the least advanced ones. Midwives are essential to the delivery of quality services before, during, and after childbirth for women and newborns, but also provide services such as family planning. Despite this, recent analysis indicate that midwifery services are unequally distributed both between and within countries, states Assistant Director-General Family and Community Health at the World Health Organization Dr Flavia Bustreo.
“Midwives and nurses make up the largest health care workforce worldwide. Together, they bring unique experience and skill in delivering health care to individuals living in remote and under-resourced areas, navigating health care systems in their own regions, as well as understanding and addressing individual patients’ barriers to health, write the expert moderators of the Global Health Nursing & Midwifery community on GHDonline.org. Today, on the International Day of the Midwife, many–like the International Confederation of Midwives and ths 5km walks–reflect on these critical issues and advocate for increased access to midwifery services worldwide.
Dire shortages in nursing and midwifery workforce is one barrier to access, particularly in developing countries where 90% of maternal deaths occur. For example in Malawi, a country where the risks of women dying in childbirth are among the highest in the world, “around three-quarters of staff positions are vacant,” recently wrote Brigid McConville in a guest blog post in the Guardian, director of the White Ribbon Alliance for Safe Motherhood.
But the challenges to delivering maternal and newborn health care are multifold. “In my short experience,” writes Kimberley Chastain, a nurse practitioner with Planned Parenthood Federation of America currently working in Malawi as the volunteer clinical office administrator for Chimwemwe mu’bereki, or “Joyful Motherhood,” an NGO founded in 2007 to address the crisis of maternal, neonatal and infant mortality, “it has become clear [...] that it is not simply a matter of too few midwives or nurses, but how to get to them.” She goes on noting that poor infrastructure and lack of transportation are also big culprits for maternal deaths. It is commonplace for a woman laboring in her community to “wait half a day to locate someone with an oxcart to take her to the nearest hospital or health center, some 5 or 6 more hours away.”
Workforce shortages are symptomatic of other issues such as low salaries, lack of training, but also the isolation experienced by many health professionals in rural areas. Following a recent screening of No Woman, No Cry, a documentary that explores the risks of giving birth without adequate care directed by Christy Turlington Burns, maternal health advocate and founder of Every Mother Counts, panelists insisted that “a lot is going on that is hopeful and good, but there’s not a lot of information sharing across countries and within countries. We need to connect and work together.”
A multitude of new platforms for nurses and midwives have sprung up on the Internet, allowing them to connect and share knowledge. In addition to the GHDonline.org community where thousands of health care implementers from more than 1,500 organizations across the globe engage in problem-solving and in online expert panels, nurses and midwives can find useful resources in Maternova.net, which provides training videos on DVD, simple obstetric kits, and small power paks; in the Global Alliance of Nursing and Midwifery website; and in RH Reality Check, a comprehensive online publication serving individuals and organizations committed to advancing sexual and reproductive health and rights. By far a complete list, I invite you to share your links in the Global Health Nursing & Midwifery community on GHDonline.org.