Invest in midwifery training for sake of expectant women

The world celebrates the International Day of the Midwife today, taking stock of the work done by this valuable cadre of health workers in our maternity units and other service delivery points of maternal and newborn care. It has been a challenging season since Covid-19 struck. It is worth reiterating that pregnancies do not stop even with crises.

The workload and working environment pose a great challenge to those providing midwifery services. The theme of this year’s celebration, “Follow the data, invest in midwives,” is a call on governments and all key stakeholders to use the data on maternal and newborn health, put money where it counts and invest in midwives.

Kenya has witnessed an increase in access and utilisation of skilled birth attendants driven by initiatives such as the universal health coverage and Linda Mama programme that offers free maternity care to mothers. The Beyond Zero campaign, spearheaded by First Lady Margaret Kenyatta has also influenced investment in high impact activities to promote maternal and child health. However, deaths due to complications from pregnancy or childbirth remain high.

The most recently available data from the Kenya Demographic and Health Survey estimates that 362 maternal deaths occur per 100,000 live births. At the current estimated annual births, this translates to over 5,000 women and girls dying due to complications of pregnancy or birth. These deaths can be partly attributable to a shortage of professional midwives, denying women access to high-quality delivery care and emergency services. Over 85 per cent of the deaths can be prevented if we have well-trained, skilled, and motivated midwives.

Kenya is not the only country grappling with shortage of midwives. The State of the World Midwifery Report 2021 shows that there is a global needs-based shortage of 900,000 midwives. Increased investment in midwives could save up to 4.3 million lives every year by averting 67 per cent of maternal deaths, 64 per cent of neonatal deaths, and 65 per cent of stillbirths globally. Cognizant of the local human resource challenge, the Ministry of Health developed the 2017-2030 task sharing policy that expands the scope of the midwife to undertake life-saving measures on mothers and babies.

Investing in midwives is one of the most cost-effective strategies to achieving universal sexual and reproductive health coverage and realisation of reproductive rights for women. Midwives’ work is not limited to delivering babies. They provide essential antenatal and postnatal care, including family planning counselling, sexually transmitted infection detection and treatment and sexual and reproductive health services for young people.

In the ongoing Covid-19 pandemic, Kenyan midwives have put their own lives at risk to bring new life into the world, working in difficult hospital environments and sometimes venturing outside health facilities to provide much needed care to mothers and newborns. More support by policy makers and government in expanding Kenya’s midwifery workforce is therefore fundamental to improving the quality of maternal and newborn care, and ending preventable maternal and newborn deaths.

Investing in midwives however goes beyond increasing the workforce numbers. It also includes investing in the education, training, and proper regulation of the profession. The knowledge base of the midwife must be widened through additional education to allow complex decision-making skills and clinical competencies for expanded practice. Enhancing the capacity of midwives guarantees women’s access to high-quality delivery care, including access to emergency obstetric care in case of a complication.

Midwives must also be accorded a work environment that enables them to be effective, by providing the appropriate resources within our health facilities. In the backdrop of a pandemic that has seen an unprecedented strain on the country’s health system, the evidence is clear that the benefits of investment in a strong health workforce far outweigh the cost, and that investment in midwives has multiplier effects on communities, and the economy.

Midwives are central to the work of UNFPA, the United Nations sexual and reproductive health agency. The Ministry of Health also remains committed to promoting maternal and neonatal health, among other health issues, cognizant of the fact that many maternal and perinatal deaths could be averted if more women had access to skilled birth attendants. The risk of death during pregnancy and childbirth is greatest in resource limited settings. Ending preventable maternal mortality therefore requires critical investment in frontline maternity care providers. In Kenya and globally, we celebrate the lifesaving work of midwives today and everyday.

Dr Mwangangi is the Health Chief Administrative Secretary. Dr Olajide is UNFPA Representative.