To mark International Day of the Midwife, the Maternal Health Task Force (MHTF)’s Sarah Hodin interviewed Geeta Lal, a maternal health expert who coordinates the Global Midwifery Programme at the United Nations Population Fund (UNFPA).
S: First, please tell me a bit about yourself and your work.
G: I’m currently managing the Global Midwifery Programme at UNFPA and also focus on strategic partnerships related to human resources for health. I’ve been with this program since UNFPA first launched it in 2008 in collaboration with the International Confederation of Midwives (ICM). We started with about eight countries in 2008. Now UNFPA is supporting midwifery in roughly 120 countries, and we have more than 40 global partners. UNFPA’s core mandate is to achieve universal access to sexual and reproductive health and rights, and well-trained midwives supported by a functional health care system play a major part in that.
S: Why do you think midwives play an important role in improving maternal health?
G: I believe that midwives are the backbone of maternal health. Look at all of the work that midwives do—and not just around delivering babies. Midwives are capable of providing 87% of essential sexual and reproductive health services when they are educated and trained appropriately and supported by a high functioning health care system. Their scope of work includes family planning counseling and provision, prevention of mother-to-child transmission of HIV, malaria in pregnancy, fistula, sexually transmitted infections, post-abortion care, essential newborn care and many other health issues.
S: What do you think are the greatest challenges currently facing the global midwifery community and how can we address those challenges?
G: Some of the biggest challenges are the lack of recognition by governments about the value of investing in quality midwifery care. There is also a severe shortage of midwives in countries where maternal and newborn deaths are the highest. Where midwives do practice, the quality of care provided can be poor due to weak health care systems, inadequate training, poor working conditions and a lack of mentorship, regulation and supportive supervision.
Competency is another challenge. We need to address this by focusing on pre-service education of midwives and ensuring that their curriculum is aligned with global ICM standards. Proper clinical skills training, mentorship and supportive supervision are crucial components of improving competency.
Deployment and retention issues should be addressed from the time students are recruited for midwifery training. Especially in low-income countries, training midwives requires precious resources. A midwife should not be lost after she graduates, and her placement needs to be well thought-out.
Finally, we need conducive workforce policies and an enabling environment so midwifery can become a valued and motivating profession.
S: The evidence supporting midwifery-led care is overwhelming. Why do you think the midwifery model is not the standard in most countries around the world?
G: I often ask myself that same question. Midwifery-led care has been a standard in many high-income European countries like Sweden, the Netherlands and Germany for a long time, and they have brought down their maternal mortality rates dramatically. That’s why it is difficult to understand why midwifery-led care isn’t the standard in every country.
My sense is that gender probably plays a role, given that midwifery is a largely female-driven profession, and the fact that we are talking about women giving birth—so midwifery has tended to be undervalued.
Additionally, because of the issues around understanding the definition of a midwife, many countries are calling inadequately trained maternal health care providers “midwives,” which undermines the profession. This is a complex question, though, and I’m sure there are many other factors.
S: Is there anything else that you’d like readers to know?
G: It is important to remember that well-educated midwives supported by a functional health care system can deliver 87% of all essential sexual, reproductive, maternal and newborn health care services, which could help to avert almost two-thirds of maternal and newborn deaths. As a result of advocacy efforts by UNFPA, ICM and many others around the globe, midwifery is increasingly recognized as a central component of the global maternal health agenda. However, we have a lot more work to do. If we want healthy communities and to avoid preventable maternal and newborn mortality, we must invest in quality midwifery care. I would also like to take this opportunity to applaud all midwives for the great work that they do and wish them all a very happy International Day of the Midwife.
Access UNFPA’s most recent State of the World’s Midwifery report.
Read a summary of the 2016 Midwives’ Voices, Midwives’ Realities report on the MHTF blog.
Watch a video from “Call the Midwife: A Conversation About the Rising Global Midwifery Movement,” as part of the Advancing Dialogue on Maternal Health series.