In collaboration with the White Ribbon Alliance and the International Confederation of Midwives, the World Health Organization recently published the 2016 Midwives’ Voices, Midwives’ Realities report. The report is based on qualitative data about the experiences and perspectives of 2,470 midwives working in 93 different countries.
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.” Midwives play a crucial role in providing high quality care to mothers and newborns around the world, but they face a number of barriers that have not been adequately reflected in research, policy and practice.
Social barriers
“…We have really low status because we do night work and it is not considered ‘proper’ for women to be out after dark.”
A number of societal issues lead to unsafe, unsupportive work environments for midwives. In many settings, unequal power relations due to gender norms negatively impact their ability to excel. About one in four midwives in the sample said that they were treated poorly as a result of gender inequality and discrimination, referencing experiences of sexual harassment, violence and social isolation. The majority expressed frustration about their voices not being heard and exclusion from decision-making processes.
Economic barriers
“One of the problems is the high level of corruption that means money allocated to health services is not used as specified [at all levels] and in the past health workers have been poorly paid/delayed to be paid and even unpaid.”
One in five midwives who participated in this study relied on a supplemental source of income to survive, preventing them from maintaining a healthy work-life balance. Midwifery salaries were generally lower than other comparable professions, and midwives working in low-income countries often did not receive their salaries regularly. In addition to salary, other benefits related to housing, transportation and other basic needs tended to be inadequate. As one woman suggested, perhaps the lack of sufficient funding for midwifery reflects society’s failure to recognize the vital role that midwives play in improving maternal and newborn health.
Professional barriers
“Midwives should be given as much respect for their expertise in pregnancy and normal birth as the obstetric doctors are given for their expertise in abnormality of pregnancy and birth. Midwives should be able to practice in a truly autonomous way. Micro-management does not make for good practitioners.”
Common professional barriers included inadequate training and leadership opportunities, poor management, a shortage of healthcare staff and supplies, ineffective policies, a lack of professional associations for midwives and the medicalization of birth.
Need for change
The participants provided numerous recommendations for improving midwives’ working conditions at both the facility and societal level. Changes that were most important to the midwives included better pay, opportunities for professional development and respect from senior health staff.
Midwives are capable of providing 87% of the essential care necessary for women and newborns, but they need adequate support. Investing in midwives is key to improving maternal and newborn health. The findings from this report present an opportunity for the global health community to listen, contemplate and act.
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Read an interview with the MHTF’s Technical Director Rima Jolivet about the importance of midwifery in ending preventable maternal mortality.
Watch “Call the Midwife: A Conversation About the Rising Global Midwifery Movement,” a panel discussion from the Advancing Dialogue on Maternal Health Series.
Access additional resources on global midwifery.
Are you a midwife working to provide high quality maternal and newborn health care? We want to hear your perspective!
Figure: World Health Organization. 2016. Midwives’ Voices, Midwives’ Realities