WHAT would you tell the midwife who delivered you if you met her today?
It is indeed rare to meet the one who coaxed your mother to a safe delivery. For millions of people, theirs are the hands that kneaded and guided, their voices that cajoled but when needed, firmly issued timely directives which ensured safe passage.
There are numerous examples across the globe of midwives who walk for days risking their own lives to ensure the safe delivery of another child. Sadly, millions were born and thousands continue to be born without a skilled birth attendant.
About 15 per cent of pregnant women worldwide face potential life-threatening complications during pregnancy, delivery and afterwards. Despite this, 35 per cent of new mothers in developing countries will give birth either alone or without skilled care - one of the most dangerous times in a woman's life.
Professionally-trained midwives have been key to the success of countries which have achieved dramatic improvements in maternal mortality. Midwives, who are typically women, are those that assist women in childbirth. One would have to graduate first as a nurse before taking another course to qualify as a midwife.
These unsung heroes more often than not are of low status in their communities, receive poor pay and lack support they require to carry out the enormous responsibility they have but most do what they do because they have an innate passion for it. Like Jordon's Munira Sha'ban, who despite being in her late 60s, came out of retirement to work with Syrian refugees in the Za'atari camp.
Sha'ban, who was hired by the UNFPA Jordon country office shared her experience during the United Nations (UN) high-level event on the survival of women, newborn and children, hosted by the UN Secretary-General Ban Ki-moon in New York on September 25 emphasized how midwives not only deliver babies but are also counsellors to pregnant women and awareness-raising agents on reproductive health and rights.
While access to quality health care is a basic human right, about 40 million women continue to give birth without skilled care, increasing the risk of death and disability for both mother and newborn. About 290,000 maternal deaths and three million newborn deaths occur every year because of the lack of well-educated and regulated health workers and facilities; investing in midwives is key to significantly averting these deaths.
The State of the World's Midwifery 2014 report published by the United Nations Population Fund (UNFPA), working with the World Health Organization and the International Confederation of Midwives entitled "A universal pathway. A women's right to health" reveals that while the 73 countries included in the report accounted for 92 per cent of the global maternal and newborn deaths and stillbirths, they have only 42 per cent of the world's medical, midwifery and nursing personnel.
The report states that only four of the 73 countries assessed can provide the minimum guaranteed package which provides the entire 46 interventions essential in sexual, reproductive, maternal and newborn health (SRMNH) services.
Gaps in these essential interventions include the four leading causes of maternal mortality: Severe bleeding; Infections; High blood pressure during pregnancy; and Unsafe abortion. When midwives are educated and regulated to international standards, they have the competencies to deliver 87 per cent of this service need.
It goes without saying that humanity will not be able to reduce maternal mortality and morbidity, which has direct implications on how countries will do in meeting the Millennium Development Goal 5 (reducing maternal mortality), without midwives.
Of the 14 countries the UNFPA Pacific Sub-Regional Office works with (excluding Tokelau) in the Pacific region and Papua New Guinea which reviewed the implementation of the International Conference on Population Development (ICPD) Program of Action (PoA), 10 countries are on-track as far as progress on maternal health is concerned. In relation to ensuring skilled birth attendance, Cook Islands, Fiji, Niue and Palau have achieved 100 per cent.
One of the key messages from the 2014 State of World Midwifery is the absolute necessity of facilities and equipment to offer essential and appropriate services, including for emergencies, once a cohort of midwives, responsive to national need, has been established.
Apart from working with governments in the area of sexual and reproductive health and rights, the UNFPA supports training of health personnel in various aspects of maternal care including life-saving skills for emergency cases.
Supporting midwifery schools is part of the organisation's technical assistance for example the current review of the Kiribati midwifery curriculum by a UNFPA-funded expert - upon the request of the Kiribati Government.
"The level of skilled birth attendance in Kiribati is on track at 80 per cent and we want to maintain the momentum of this progress and so the current review of the nursing school's midwifery curriculum is to ensure that graduates are equipped with updated knowledge and skills, and they are of international standard," UNFPA Pacific director and representative Dr Laurent Zessler said.
"In the Solomon Islands, once the current malaria outbreak has been dealt with, we hope to resume our planned midwifery conference which we support biennially and the training in the area of emergency obstetric and neo-natal assessments."
The review of the ICPD PoA recommends as well that all primary health care facilities must be of quality, apart from ensuring that maternal health services are available at community level and that skilled health personnel are trained on maternal health issues including basic and comprehensive emergency obstetric care services.
The ball is in our court now as individuals, as leaders, as members of society to do what we can to contribute to the creation of an environment that will enable the experience of giving life a truly joyful one. Humanity now has in the 2014 State of World's Midwifery report an informed guide through the report recommendations.
We owe it to our mothers and newborns.
For more information, please contact: Ariela Zibiah Email: zibiah@unfpa.org Landline: +679 3230711 Mobile: +679 9991697
