Many of the targets of Sustainable Development Goal (SDG) 3 are concerned with reproductive, maternal and child healthcare. Sexual and reproductive health is directly related to multiple human rights, including the right to live, the right to be free from torture, the right to privacy, the right to education, and the prohibition of discrimination. This means that countries should prioritize creating and implementing policies focused on the delivery of reproductive healthcare services that cover a wide range of needs including maternal and neonatal care; mother and infant nutrition; family planning consultation; sexual health care; prevention of infertility; and safe abortion services. To be able to provide high quality healthcare services and improve health outcomes, it is important to have comprehensive plans and apply integrated managerial concepts in terms of managing available resources and manpower. Midwives are considered the key personnel for the successful delivery of reproductive health services. Therefore, it’s important to know more about their roles and the challenges they face in their practice.
How important is the midwifery role in achieving SDG3?
According to WHO & UNFPA, the position of midwives is considered as an essential cornerstone towards achieving SDG3—Good health and wellbeing—and in accomplishing multiple targets that are related to reproductive, maternal and child healthcare. These are all aimed at reducing the global maternal mortality ratio to 70 maternal deaths per 100,000 live births, as well as the neonatal mortality rate to 12 neonatal deaths per 1,000 live births by 2030. Accordingly, midwives are assigned multiple tasks such as:
- Providing prenatal and postnatal care to pregnant women.
- Delivering appropriate management for miscarriages or abortions, and referring women or children experiencing serious complications to specialized healthcare.
- Giving newborn care and assisting in the promotion of successful breastfeeding.
- Providing pre-pregnancy advice, health education and health promotion activities during pregnancy. These include providing help for the cessation of smoking and illicit drug use, providing educational and advisory sessions on family planning and childcare, as well as raising awareness on the risks of teenage pregnancies.
- Providing care and advice on essential child immunization programs in communities, which helps in the prevention of common illnesses.
Are there any barriers ?
It is important to mention that midwives have been found to be the most resilient and efficient in service delivery, especially in humanitarian settings where there are additional life threatening conditions. Statistically, midwives are able to contribute to the 60% reduction of maternal mortalities, as well as 45% reduction of neonatal deaths. They can provide a wider range of services—about 80% of the service elements in the reproductive health service package; thus, helping in minimizing the hazards that women face during humanitarian crisis through providing health services and applying the Minimum Initial Services Package (MISP) for sexual and reproductive health. This is a combined set of priority life-saving SRH activities to be implemented at the onset of every humanitarian emergency (within 48 hours) to prevent excessive sexual and reproductive health-related morbidity and mortality, decrease the sexual and gender based violence and decrease the risk of HIV and sexually transmitted infections. Additionally, midwives work towards enhancing better maternal health through different cost effective acts. For example, midwife-led care has been found to decrease the rates of cesarean section delivery, which actually costs 50% more than vaginal birth, and they also eliminate the risk of long- and short-term complications that may result from repeated cesarean procedures. Another example on their cost-effectiveness is that they contribute to educating and encouraging women to breastfeed, instead of using milk formulas. The statistical analysis showed that the total healthcare costs for the breastfed babies in terms of medications and primary care is approximately €454.40- €503.50 lower than the healthcare costs for formula fed babies.
Despite the fact that the midwives’ role is crucial in strengthening public health systems, they continue to face multiple obstacles that disable them from the delivery of high quality services. Those barriers arise from social, professional, as well as financial factors. For instance, their role and skills are usually not adequately recognized by the other SRH team members; and they are only allowed to practice in a limited scope and rarely with inclusion in the policy setting. They are mostly paid low wages with inadequate housing and means of transportation. In addition, they may be exposed to gender inequalities and gender-based violence due to the fact that most midwives are women, and senior physicians and health managers are usually men. This perpetuates the gender-gap often seen in clinical healthcare. Moreover, the available educational and development opportunities for midwives are often times limited and subpar. This makes the number of highly skilled midwives less, especially in countries found in the global south. All these factors affect the delivery of sexual and reproductive healthcare services that women—especially those in the remote and rural regions—desperately need access to.
Methods and strategies to enhance the quality of midwifery role:
*Development of educational programs:
- Midwifery educational programs should be professionally prepared and regularly reviewed by local professional and experienced educators with great knowledge in reproductive health. This is in order to improve and enhance their skills and knowledge, and ensure relevance to their country’s situation.
- Ensure that there are legislations that direct recently graduated midwives to spend an adequate training period in specialized hospitals, prior to being exposed and deployed to the field.
- Implementation of obligatory, low-cost and accessible continuing education programs that continuously support and develop the skills and capacities of midwives who are already working in the field.
-Increase the awareness about the scope of work of the midwives and their different specialties. For example, there are specialist midwives who provide perinatal and postnatal mental care for pregnant women and their families. There are also midwifery specialists in diabetes, infant feeding and safeguarding as well as covering bereavement. This will increase massively increase the demand for the midwives’ services on the long-term.
-Increasing the public awareness through the media programs about the advantages of vaginal delivery (which is mostly lead by midwives) compared to cesarean sections.
*Management of midwives employment (Legislations and Policy) :
- Involve highly skilled, experienced and well-trained midwives with good evidence based scientific knowledge during policy development.
- Engage the midwives in managerial and leadership positions through enhancing workforce planning and development. This could include the development of new policies that increase the number of senior midwives including directors, consultants as well as specialists. Consequently, midwives will have the right to access managerial positions and act as board members and decision makers.
- Collaboration between different governmental organizations and civil society groups to develop policies that improve the payments and wages of midwives, whether they work in public or private healthcare facilities.
- Collaborative education: strengthen the intersection and interactions between educational institutions—both public and private—and a country’s health ministry. This is to ensure that the midwifery curricula are of quality level, and realistic enough to address the actual needs and experiences in the field.
In conclusion, countries need to investigate their health workforce needs according to their actual population—from the number of pregnant women ratioed with the available skilled healthcare providers, specifically midwives. Every effort should be done to ensure the presence of adequately trained midwives in all healthcare settings that provide reproductive healthcare services. This should be coupled with other health system resources that contribute to the enhancement of maternal and newborn health, and improve overall health outcomes. It is also important to increase community awareness about the roles of different healthcare providers, highlighting how midwives can help them in accessing easier, healthier and more cost-effective perinatal care. These moves will empower midwives to contribute more to public health initiatives and also give them the long-overdue recognition that they deserve. On The International Day of the Midwife, it’s time to enhance the midwives’ role in collaboration with other sexual and reproductive health team members and start paying regards to their effective actions in health education and promotion which will let us move forwards with a one-way ticket towards achieve more targets of SDG3.