More Midwives Could Avert Millions of Deaths

A modest increase in the number of skilled midwives in the world’s poorest nations could save the lives of a substantial number of women and their babies, according to a new study.

Researchers at the Johns Hopkins Bloomberg School of Public Health (Baltimore, MD, USA) used the Lives Saved Tool (LiST) to estimate deaths averted if midwifery was scaled up in 78 countries, classified and ranked using the Human Development Index (HDI), a composite statistic of life expectancy, education, and income indices. The researchers selected interventions in LiST to encompass the scope of midwifery practice, including pre-pregnancy, antenatal, labor, birth, and postpartum care, as well as family planning.

The results showed that modest (10%), substantial (25%), or universal (95%) scale-up scenarios from present baseline levels were all found to reduce maternal deaths, stillbirths, and neonatal deaths by 2025 in all countries tested. With universal coverage of midwifery interventions for maternal and newborn health, excluding family planning, for the 26 countries with the lowest HDI (as Ethiopia and Somalia), 61% of all maternal, fetal, and neonatal deaths could be prevented; family planning alone could prevent 57% of all deaths because of reduced fertility and fewer pregnancies.

Midwifery with both family planning and interventions for maternal and newborn health could avert up to a total of 83% of all maternal deaths, stillbirths, and neonatal deaths. The inclusion of specialist care in the scenarios resulted in an increased number of deaths being prevented, meaning that midwifery care has the greatest effect when provided within a functional health system with effective referral and transfer mechanisms to specialist care. The study was published on June 23, 2014, in the Lancet.

“Even deploying a relatively small number of midwives around each country could have a profound impact on saving maternal, fetal and newborn lives,” said study leader Linda Bartlett, MD, MHSc, of the department of international health. “Our study shows that maternal mortality can be prevented, even in the most difficult of places.”

Maternal mortality is a leading cause of death for women in many developing countries, and public health efforts to avert it have only made headway in a few countries. Elsewhere, progress has either never started or has stalled in recent years. Poor nations also have troubling rates of infant and fetal deaths. Midwives could play a crucial role in preventing the deaths of millions of women and children around the world who die during and around the time of pregnancy.

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Johns Hopkins Bloomberg School of Public Health