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Posted: April 29th, 2018
The state of the midwifery profession in industrialised and developing nations
The state of the midwifery profession in industrialised and developing nations
Midwifery is a vital profession for improving the health and well-being of women, newborns, and adolescents around the world. However, the state of the midwifery profession varies widely across different regions and income levels, reflecting the diverse challenges and opportunities that midwives face in different contexts. This paper aims to provide an overview of the current situation of midwifery in industrialised and developing nations, based on the latest evidence and reports.
According to the third global State of the World’s Midwifery report (SoWMy 2021), there is a global shortage of 900,000 midwives, which is particularly acute in low-income countries (LICs) and in Africa [1]. The shortage is projected to improve only slightly by 2030 unless additional investments are made. The evidence suggests that these investments would yield important returns, including: more positive birth experiences, improved health outcomes, and inclusive and equitable economic growth [1]. Most high-income countries (HICs) have sufficient SRMNAH workers to meet the need for essential interventions, and their education and regulatory environments tend to be strong [1]. Upper-middle-income countries also tend to have strong policy environments [1]. LICs and lower-middle-income countries tend to have a broader scope of practice for midwives, and many also have midwives in leadership positions within national government [1].
Some of the key regional variations include: major midwife shortages in Africa and South-East Asia but more promising signs of growth in South-East Asia than in Africa; a strong focus in Africa on professional midwives (rather than associate professionals: the norm in many South-East Asian countries); heavy reliance on medical doctors rather than midwives in the Americas and Eastern Mediterranean regions and parts of the Western Pacific; and a strong educational and regulatory environment in Europe but a lack of midwife leaders at national level [1].
A scoping review of midwifery in Middle Eastern and North African (MENA) countries found that there was significant variation across the region in midwifery education, practice, and regulation, and scope of practice was limited in most countries [2]. Education programs lacked standards defined by the International Confederation of Midwives (ICM). There was no specific regulatory body for midwives in many of these nations and midwifery was not legally classified as an autonomous profession in many [2].
A qualitative study of midwives’ challenges and factors that motivate them to remain in their workplace in the Democratic Republic of Congo (DRC) revealed that midwives faced an unsupportive organisational system, inadequate pre-conditions in the work environment, and low professional status [3]. However, they also expressed a strong sense of calling, professional pride, and satisfaction from saving lives and building relationships with the women and the community [3].
A recent report by WHO/Europe highlighted some of the efforts to advance nursing and midwifery professions in the WHO European Region, such as strengthening education and regulation, enhancing leadership and governance, improving working conditions and retention, promoting interprofessional collaboration, and increasing public recognition [4].
A book chapter on the contribution of midwifery to global health and development argued that midwives have expertise and potential to improve population health and that with effective policies and workforce planning, regulatory frameworks, educational standards and supportive managerial practices, as part of an interdisciplinary team, midwives provide safe, high-quality and person-centred care, improve the coverage and integration of health services and reduce the costs of healthcare organisations and health systems [5].
In conclusion, this paper has provided a brief overview of the state of the midwifery profession in industrialised and developing nations, based on some recent sources. It has shown that there are significant gaps and disparities in the availability, accessibility, quality, and recognition of midwifery services across different regions and income levels. It has also highlighted some of the challenges and opportunities that midwives face in different contexts. It is hoped that this paper will stimulate further research, policy dialogue, and action to strengthen the midwifery profession globally.
References
[1] Nove A., ten Hoope-Bender P., Boyce M., et al. The State of the World’s Midwifery 2021 report: findings to drive global policy
and practice. Human Resources for Health. 2021;19:146. https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-021-00694-w
[2] Safari K., McKenna L., Davis J. Midwifery in Middle Eastern and North African countries: A scoping review. Women
and Birth. 2020; https://www.womenandbirth.org/article/S1871-5192%2820%2930375-9/pdf
[3] Engeset M., Luhanga M.R., Sundby J., et al. Midwives’ challenges and factors that motivate them to remain in their
workplace in the Democratic Republic of Congo. Human Resources for Health. 2020;18:80. https://human-resources-health.biomedcentral.com/articles/10.1186/s12960-020-00510-x
[4] WHO/Europe. New country examples highlight efforts to advance nursing and midwifery professions in the WHO European Region. 2022; https://www.who.int/europe/news/item/12-05-2022-new-country-examples-highlight-efforts-to-advance-nursing-and-midwifery-professions-in-the-who-european-region
[5] Homer C.S.E., Nove A., ten Hoope-Bender P., et al. The Contribution of Midwifery to Global Health and Development. In: Filippi V., Chou D., Ronsmans C., et al., editors. Maternal and Perinatal Health in Developing Countries. Cham: Springer International Publishing; 2021. p. 41–56. https://link.springer.com/chapter/10.1007/978-3-030-46765-4_3
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