Today, the world is facing an unprecedented number of crises. From natural disasters and conflict to the ongoing impacts of climate change, these emergencies are placing immense strain on health systems and disproportionately affecting women girls and newborns exposing them to heightened risks, such as pregnancy complications and sexual violence while limiting their access to essential health services. In humanitarian settings, women face a risk of dying in childbirth that is twice as high as in non-crisis situations.
When bombs fall or floods wash away roads and homes, where services are severed and infrastructure has collapsed, midwives are often the first responders and the last line of defense. They often travel across even the most remote and dangerous terrain to ensure essential services that save lives and safeguard health and human rights. Deploying midwives as part of a humanitarian and national disaster response is a life-saving and cost-effective way to reduce preventable maternal deaths.
Midwives often put themselves at enormous risk when they venture out to provide care to women and girls in hard to reach communities in crisis settings. They step up to mitigate health-related effects, deliver lifesaving care and ensure continuity of quality services in crisis-induced complications like pregnancy loss and sexually transmitted infections, more often with minimal resources. Yet, midwifery is still not always recognized as the vital health profession it is. Chronic underinvestment in midwifery has translated to inadequate training, a lack of infrastructure and supplies and low salaries; barriers that are present in times of stability and only grow worse in times of crisis. Recent severe funding cuts to humanitarian assistance threaten to widen these gaps, with tragic impacts on women and girls in some of the world’s most challenging places.
Zambia has made commendable progress in reducing maternal and neonatal mortality, strengthening the midwifery workforce, and expanding access to essential services. In the three decades since the International Conference on Population and Development (ICPD), maternal mortality rates have dropped by 75%: from 752 per 100,000 live births in 1994 to 187 per 100,000 in 2024. A key driver of this achievement has been the increased availability of skilled midwifery personnel. The proportion of births assisted by a skilled attendant more than doubled, rising from 42% in 2002 to 84% in 2024.
However, despite these significant strides, Zambia has not yet reached its goal of reducing maternal mortality to 100 per 100,000 live births by 2021. The journey toward ending preventable maternal deaths is far from over. Too many expectant mothers and newborns still lose their lives due to conditions that are both preventable and treatable with timely and quality care.
UNFPA and its partners are accelerating efforts to integrate care provided by midwives into health systems around the world through the introduction of the Midwifery Model of Care. The Midwifery Model of Care focuses on providing skilled, respectful and evidence-based care while ensuring timely referral to medical services when necessary.
The State of the World's Midwifery report demonstrates that universal coverage of care provided by midwives could reduce maternal and newborn deaths, including stillbirths, by two-thirds, and every dollar invested in midwifery has the potential of yielding up to a 16-fold return in health and economic benefits. Midwifery models of care are highly effective, cost-efficient and woman-centered and deliver better outcomes for women and babies - and do so more efficiently.
Actualizing the Midwifery models of care and implementing the midwifery accelerators is critical to sustaining the gains that Zambia has made, and also to enhance ongoing efforts to meet the WHO recommended threshold of 4.2 midwives per 1,000 population and the Sustainable Development Goal (SDG) 3.1 target to reduce the global maternal mortality ratio to less than 70 per 100,000 live births by 2030.
There is a critical need for stronger multi-stakeholder collaboration to support the Government in ensuring that midwifery educators and tutors are well-equipped with the necessary knowledge and skills, and that they work within a framework of comprehensive and supportive workplace policies. More so, efforts must be made to strengthen midwifery leadership and governance by actively involving midwives in health policy development and planning at all levels of the health system.
On this International Day of the Midwife, we call on governments and partners to join UNFPA in the Midwifery Accelerator initiative, which aims to increase financial and programmatic investments in midwives – and the systems that support them – before more lives are lost. Let us work together to end the global shortage of nearly one (1) million midwives and to ensure that we can end preventable maternal deaths once and for all.
