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Access to midwives could annually save 1.2 million lives in East and Southern Africa by 2035

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Midwifery is defined as skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum from pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life. Photo: iStock

In East and Southern Africa (ESA), universal coverage of midwife-delivered interventions could save 1.2 million lives per year by 2035, according to a new report.

The State of the World’s Midwifery 2022: East and Southern Africa was released by the United Nations Population Fund (UNFPA) and World Health Organization (WHO). 

However, such achievements depend on midwives gaining better education and training, along with comprehensive and supportive workplace regulation.


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A strong midwifery workforce is essential to the success of UNFPA strategies for improving sexual, reproductive, maternal, newborn and adolescent health (SRMNAH), the report said. 

SRMNAH is an essential component of UN-mandated Sustainable Development Goals (SDGs). The report included data from all 23 countries in the UNFPA East and Southern Africa (ESA) region. 

Angola, Botswana, Burundi, Comoros, Democratic Republic of the Congo (DRC), Eritrea, Eswatini, Ethiopia, Kenya, Lesotho, Madagascar, Malawi, Mauritius, Mozambique, Namibia, Rwanda, Seychelles, South Africa, South Sudan, Uganda, Tanzania, Zambia and Zimbabwe — were all covered. 

The ESA region has made significant progress over the last two decades in improving SRMNAH outcomes, the report noted, but progress has been uneven. As a result, inequity between and within countries remains and has been exacerbated by the COVID-19 pandemic.

Midwifery is defined as skilled, knowledgeable and compassionate care for childbearing women, newborn infants and families across the continuum from pre-pregnancy, pregnancy, birth, postpartum and the early weeks of life.

Of the 23 ESA countries, 20 reported the number of midwives/nurse-midwives in their health workforce. Angola, Namibia and South Sudan did not provide midwife headcounts. 

Across the 20 reporting countries, there are 146,000 midwives, giving a density of 2.5 midwives per 10,000 population. This is far lower than the global average of 4.4 per 10,000.

Further investment in midwives and midwifery to address the gaps and challenges in five main areas was suggested by the report. 

These areas are: 

  • Strengthening data systems and addressing the shortage of midwives,
  • Strengthening the quality of midwifery care, including education and training,
  • Encouraging interdisciplinary collaboration in SRMNAH care, 
  • Investing in midwife leaders and improved understanding of the value of midwifery,
  • Contributing to the research agenda.

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The region has a shortage of almost 300,000 midwives, with the largest shortages in DRC, Ethiopia, Mozambique, South Africa, Tanzania and Uganda, the report stated.

Several key issues like education, the policy and regulation environment, which are known to affect the quality of care and the enabling work environment for midwives, were highlighted by it. 

Without additional investment in midwife availability, eight countries in the region — Burundi, DRC, Eritrea, Madagascar, Malawi, Mozambique, mainland Tanzania and Zambia — are projected to have a worse midwife shortage in 2030 than they do today.

The policy environment for midwife education in the region is generally strong, but the implementation of the policy is challenging, according to the report. 

Out of 20 responding countries, 16 have a national policy or guideline on the education of midwifery care providers that is based on the non-governmental organisation International Confederation of Midwives (ICM) competencies.

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