A global shortage of nearly a million midwives is leaving pregnant women without the basic care needed to prevent harm, including the deaths of mothers and babies, according to new research.
Almost half the shortage was in Africa, where nine in 10 women lived in a country without enough midwives, the researchers said.
Anna af Ugglas, chief executive of the International Confederation of Midwives (ICM) and one of the study’s authors, said: “Nearly 1 million missing midwives means health systems are stretched beyond capacity, midwives are overworked and underpaid, and care becomes rushed and fragmented.
“Intervention rates rise, and women are more likely to experience poor-quality care or mistreatment,” she said. “This is not only a workforce issue, it is a quality and safety issue for women and babies.”
For all women to receive safe, good-quality care before, during and after pregnancy, an additional 980,000 midwives would be needed across 181 countries, the study found.
According to previous research, universal access to midwife-delivered care could prevent two-thirds of maternal and newborn deaths and stillbirths, saving 4.3 million lives annually by 2035.
The ICM said the issue was not only a lack of training places for midwives, but also a failure in many countries to employ trained midwives where they were needed and to retain those who were working in health services.
Prof Jacqueline Dunkley-Bent, ICM’s chief midwife and another of the report’s authors, said: “In many settings, midwives are educated but not absorbed into the workforce or not enabled to practise fully, compounding this already serious and universal shortage of midwives, and still leaving women without access to the care that midwives are trained to provide.”
More than 90% of the global midwife shortage was in low- and middle-income countries.
Africa has only 40% of the midwives it needs, the eastern Mediterranean only 31%, and the Americas just 15%, researchers found. Shortfalls were much smaller, although still present, in other regions including south-east Asia and Europe.
The study, published in the journal Women and Birth, estimated the number of midwives who would be needed to carry out a list of basic midwifery tasks for all eligible women and babies in 181 countries. The tasks included counselling on contraception, antenatal care and screening, and care during childbirth.
It then compared that total with current workforce numbers. The researchers noted some uncertainty because of the lack of adequate data.
Although midwife numbers were increasing, the gap between what was needed and the available workforce looked likely to “persist well into the next decade”, the researchers said – beyond the 2030 deadline set by global sustainable development goals to reduce maternal mortality and end preventable deaths of newborns and under-fives.
The ICM called on governments to take urgent action to strengthen midwifery workforces in their countries, calling for signatures on a global petition urging investment in the profession.
“When midwifery is a respected and well-supported profession, more women are motivated to train and stay in the workforce,” said af Ugglas. “That is how countries improve health outcomes and build stronger, more sustainable health systems.”
