Donna Bryson, AP
More and better trained midwives could help save millions of lives in many countries with high death rates among newborns and women giving birth, the United Nations said Monday. "We have now realized that there is a huge potential in the hands of the midwives that was not being exploited," stated Vincent Fauveau, a doctor who coordinated a U.N. study of 58 countries. "They can do much more than deliver babies. They can deliver health services."
Dozens of aid, development and educational institutions endorsed a U.N. Population Fund study that said governments, donors and others must invest in and respect midwives. The study and new recommendations for training and licensing midwives were released at an international midwives conference. USAID, Save the Children and Johns Hopkins Bloomberg School of Public Health were among the groups endorsing the study.
In Ethiopia, only six percent of births are attended by a doctor, nurse or midwife, the study said. In Niger, many women have more pregnancies than is safe. In Botswana, the AIDS virus is linked to almost 80 percent of maternal deaths. Midwives should be looked to in countries that need to increase the number of births attended by trained professionals if there is a shortage of doctors and nurses, Fauveau said. Midwives, often particularly trusted among women in their communities, can also offer birth control counseling and services, he said.
Fauveau said broad improvements are needed, including increases in other health professionals, but that the role of midwives should not be neglected. In the West African country of Liberia, midwives often have to handle 10 to 15 deliveries a day during the highest pregnancy case load from February to July, said Tobias Bowen, administrator of a government hospital. The load "puts a lot of strains on them," Bowen said. "They are doing a tremendous job."
Fauveau said the U.N. health agency recommends midwives handle only one or two births a day, to ensure that women and children get the right care, and that the midwives don't burn out. The U.N. surveyed health officials in 58 countries identified as "suffering from a crisis in human resources for health." Two-thirds of the surveyed countries are in Africa. The countries surveyed accounted for 58 percent of all the world's births in 2009 — but 80 percent of stillbirths around the world, 82 percent of newborn deaths and 91 percent of maternal deaths.
Johns Hopkins determined as many as 3.6 million maternal, fetal and newborn deaths a year could be prevented if health services in the 58 countries are upgraded by 2015 and if the women there delivered in or near a clinic or hospital and had a professional to monitor their health during pregnancy, birth and immediately after. Such conditions are the norm in the developed world.
In 2000, the U.N. set Millennium Development Goals that included reducing child mortality by two-thirds and maternal mortality by three quarters by 2015. Many poor countries are struggling to meet the targets. "Investing in midwifery saves lives," Monday's U.N. study concluded. Fauveau added other investments were needed, including building more clinics, particularly in rural Africa. War, poverty and hunger also threaten women and children. "The revolution will not take place in a few months or a few years," Fauveau said. "It's a long-term strategy."