By Alison Herman
On June 17, midwives from 113 countries could be found parading through the streets of Toronto, marshalling in the annual International Confederation of Midwives congress. These essential practitioners do much to lead the march forward toward global development goals, providing life-saving care to mothers and infants. The investment and attention paid to these healthcare workers is not always commensurate with their value.
Alana Kibbe, among the marching midwives, told the Toronto Star, “We are a group of almost all women providing care to almost all women. That’s a gender equity issue.” Gender equity issues permeate even the top levels of leadership. Roopa Dhatt and her colleagues observe, “Women are under-represented across the WHO political space—just over one out of four of member state Chief Delegates to the World Health Assembly (WHA) and Ministers of Health are women.” They refer to such a paucity of women as “striking, particularly when contrasted with the fact that in some countries women make up 75% of the health workforce.”
Beyond their patients, midwives provide support to strained health systems. Midwives reach into the most isolated communities, providing treatment outside of the strictures of a health facility. Jerker Liljestrand writes in Time “As a part of a team of physicians, nurses and obstetricians, midwives can alleviate . . . pressures, providing woman-centered and supportive care that goes beyond childbirth.” In fact, maternal mortality is widely regarded as a sensitive indicator of the fitness of health systems, since it reflects access to emergency facilities, surgical capacity, and routine care before and after pregnancy, a reflection of the population’s health-seeking behaviors. In fact, writing for The Journal of Midwifery and Women’s Health, Jenifer Fahey proposes that maternal mortality serve as a “benchmark for development efforts.”
Indeed future investment would be well spent on midwifery training. Dr. Jakaya Mrisho Kikwete explains, “if all women gave birth with a midwife in a facility capable of providing basic emergency care, it is estimated that 56 percent of maternal, fetal, and newborn deaths could be prevented.” Perhaps we would see this important proposition move forward more quickly with more equal representation of women in the global leadership. Whatever the case, the week-long conference in Toronto provides an occasion to extend our appreciation and to reflect on future expansion of this important line of work.
Carson, A. 2016. “Midwifery around the World: A Study in the Role of Midwives in Local Communities and Healthcare Systems.” Annals of Global Health 82 (3): 381.
Dhatt, Roopa, Ilona Kickbusch, and Kelly Thompson. 2017. “Act Now: A Call to Action for Gender Equality in Global Health.” The Lancet 389 (10069): 602.
Fahey, Jenifer. 2015. “Midwives in Global Health: Championing Maternal Health in a Time of Shifting Development Paradigms.” Journal of Midwifery and Women’s Health 60 (4): 341–42.
Liljestrand, Jerker. 2016. “Midwives Are Essential to Global Health.” Time, May 5.
McCintosh, Emma. 2017. “Midwives from 113 Countries Kick off Convention with March through Toronto.” The Toronto Star, June 18.
Mrisho Kikwete, Jakaya, and Toyin Ojora-Saraki. 2017. “Opinion: Invest in Midwives to Improve Global Health.” Devex, June 19.