The majority of the world’s poorer countries, including Pakistan, which account for nearly all childbirth-related deaths among newborns and mothers, are facing a critical shortage of professional midwives who could ease the problem, global health experts said on Tuesday.
Among 73 lower and middle income nations, just four – Armenia, Colombia, Dominican Republic and Jordan – have adequate resources in place, according to a review led by the United Nations Populations Fund and the World Health Organization.
The countries included in the review range from China, India, Pakistan and Afghanistan to Central African Republic, Chad, Guatemala and Mexico, among others.
“More than three-quarters face serious shortages that will result in unnecessary deaths of women and babies,” Frances Day-Stirk, president of the International Confederation of Midwives, told reporters on a conference call.
Midwives, who are trained to deliver babies and provide medical care before and after pregnancy, can provide most of the services needed for women and newborns, experts said. That is critical to relieve pressure on doctors, especially in areas where medical resources are scarce or difficult to access.
In 2013, there were an estimated 2.6 million stillbirths, 3 million newborn deaths and 289,000 maternal deaths. More than 92 percent of those deaths occurred in the countries reviewed, the groups said in their “State of the World’s Midwifery” report.
Many lack the infrastructure necessary to allow for quality care from midwives, and often don’t have regulatory systems in place to adequately train them, according to the report. Collecting necessary data is also a problem.
“Women and girls’ right to maternal and reproductive health are essential,” Babatunde Osotimehin, a physician and executive director of the UN’s Populations Fund, told reporters. They “need and deserve respectful, compassionate care before, during and after pregnancy and birth … This is not the case in many countries. This needs to change.”
The crisis is also an economic one, experts said. For example, boosting midwifery services can reduce costly cesarean births, saving up to $128.5 million over three decades, Day-Stirk said.
One country that has shown some gains is Bangladesh, where the government in 2010 launched an effort to train 3,000 midwives, helping reach key health goals even though birth-related mortality remains high, experts highlighted.
The report, funded by the UN along with the U.S. and Canadian governments, the Bill and Melinda Gates Foundation and other groups, and Johnson & Johnson, is part of the UN and WHO’s larger effort to boost access to midwives by 2030.
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