Article from the Guardian's Poverty Matters Blog, by Sarah Boseley
The world needs 350,000 more midwives, says Save the Children, which is calling for more training and education on the importance of their role in saving lives
Tahiru, 37, lost his wife three months ago while she was giving birth to Nabia, in Katsina, northern Nigeria. In Nigeria, one in five women deliver their babies alone. Photograph: Pep Bonet/Noor/Save The Children.
One in three women around the world gives birth without the help of anybody who has been trained to help – and 2 million give birth entirely alone, according to a report called Missing Midwives from Save the Children. Often they can't get to a health centre with trained midwives or other skilled healthcare workers. Sometimes their husband or mother-in-law will not let them.
Save the Children is campaigning for more midwives to be trained around the world, to fill some of the estimated 350,000 shortage. In the UK, only 1% of women give birth without skilled help. In Ethiopia, the figure is 94% – almost all.
Every day, 1,000 women and 2,000 babies die of infections and other complications of childbirth. With the increased attention to maternal and newborn mortality – the millennium development goals now getting the greatest attention from donor governments and organisations – the numbers of skilled birth attendants, even if not professional midwives, have crept up. Save the Children points out that it has helped in the tripling of the number of midwives in Afghanistan – one of the most dangerous places in the world to be born. An additional 300 to 400 midwives are now being trained every year, although still only 14% of births take place in the presence of a skilled birth attendant.
But its analysis, like that of many other organisations, suggests there is a very long way still to go:
"In reality many women deliver at home, either completely alone, with relatives or with the help of a traditional birth attendant, who is likely to have had little or no medical training and whose only equipment may be a razor blade to cut the cord. Childbirth for many women means delivering their babies at home in an unsterile environment on a bed or on the floor, without running water, electricity or light."
The report underlines the need to educate men about the dangers childbirth can pose to their wives and daughters:
"The starkest example is Nigeria, where around one in five women deliver their babies alone – and this varies from 34.5% of the poorest women to 3% of the richest. Six million babies are born every year in the country, meaning every 30 seconds a woman in Nigeria is facing one of the most significant and most dangerous moments of her life on her own. A third of women in Nigeria said that one of their reasons for not going to a health facility was because their husband said it was unncessary."
The report urges the Department for International Development (DfID) to work with governments that have critical shortages of healthcare workers to get more midwives and birth attendants trained – and calls for a high-level political event on healthworker shortages at the UN general assembly meeting in September.
“This report from Save the Children clearly demonstrates that midwives are critical to saving the lives of mothers and newborn babies. Filling the global shortage of 350,000 midwives must be a global priority if we are to reduce the terrible rates of maternal and child mortality in the world’s poorest countries."
“Missing Midwives highlights the important role that the midwife plays within the wider health system, and lays out a range of solutions to recruit, train, support and deploy more midwives to the places where they are needed most. Save the Children tells us exactly what needs to happen both in developing countries and in terms of global political action. These recommendations cannot be ignored."
“Missing Midwives is essential reading for anyone concerned with reducing the burden of maternal and newborn deaths.”
Dr Tony Falconer
President, Royal College of Obstetricians and Gynaecologists
Photo Gallery: The impact of the global shortage of midwives