The State of the World’s Midwifery 2014 launched in China to call for greater investment in midwifery to save lives of women and newborns
BEIJING, 4 November 2014 - The National Health and Family Planning Commission (NHFPC), United Nations Population Fund (UNFPA) China and World Health Organization (WHO) China organized a national launch of the State of Midwifery 2014 titled A Universal Pathway, a Woman’s Right to Health in Beijing. The report revealed that major deficits in the midwifery workforce occur in 73 countries where these services are most desperately needed. This national launch aims to highlight the implications of the report’s findings to China and possible strategies to respond to these. Following the launch, a workshop on the development of midwifery workforce was convened among policy makers from health, human resources, education sectors and representatives from medical universities.
The 73 African, Asian and Latin American countries represented in the 2014 State of the World’s Midwifery report suffer 96 per cent of the global burden of maternal deaths, 91 per cent of stillbirths and 93 per cent of newborn deaths, but have only 42 per cent of the world’s midwives, nurses and doctors. The report urges countries to invest in midwifery education and training to contribute to closing the glaring gaps that exist.
“Midwives deliver – and not only babies. Midwives make enormous contributions to the health of mothers and newborns and the well-being of entire communities. Access to quality health care is a basic human right. Greater investment in midwifery is key to making this right a reality for women everywhere,” said Mr. Arie Hoekman, UNFPA Representative to China.
Midwives have a crucial role to play in the achievement of the Millennium Development Goals (MDGs) 4 (decrease child death) and 5 (increase maternal health). When educated to international standards and within a fully functional health system, they can provide about 90 per cent of the essential care to women and newborns and can potentially reduce maternal and newborn deaths by two thirds. Despite a steady decline in maternal deaths in 73 countries in the report—dropping yearly by 3 per cent since 1990—and newborn deaths---decreasing by 1.9 per cent per year since 1990---there is more that these countries need to do to address the severe shortage of midwifery care.
The report highlighted progress made on availability, accessibility, acceptability and quality of midwifery services. A number of countries have effectively strengthened midwifery and improved access. Nearly half (45 per cent) of the 73 countries have implemented measures to retain midwives in remote areas and 28 per cent are increasing the recruitment and deployment of midwives, while 20 per cent have implemented new codes of practice and 71 per cent have improved information collection enabling countries to address shortages and education standards.
Despite progress, inequities such as lack of access to services and poverty have increased within and among countries. There are still not enough adequately educated midwives to support the health of women and newborns, and this contributes to hundreds of thousands of preventable deaths annually. Today, only 22 per cent of countries have potentially enough midwives to provide life-saving interventions to meet the needs of women and newborns, which leaves over three-fourths (78 per cent) of the countries with severe shortages in proper care. As the population grows, so does the gap in critical resources and infrastructure, unless urgent action is taken.
China has made remarkable achievement in reducing maternal mortality in the past 20 years. “The Government of China has attached great importance to achieve the MDG goals on maternal health in the past decades. Measures such as promoting hospital delivery have been proven very effective in advancing maternal health in China, and we value international experiences and good practices being brought in to address the remaining gaps,” said Deputy Director General Ms. Zhang Yang from National Health and Family Planning Commission.
“Midwifery is vital for preventing the remaining avoidable maternal and neonatal deaths in China,” said Dr. Bernhard Schwartländer, Representative of WHO China.
The shortage of qualified midwives and the lack of health education on natural delivery among mothers-to-be and their families have led to unnecessary obstetric intervention such as high caesarean section rate. Evident challenges also remain in addressing regional disparities, with maternal mortality ratio in western regions 2.5 times higher than that of the eastern region. In poor and remote areas, community-based midwifery services to reach out to the women in need should be built up to supplement efforts to increase hospital delivery rate.
With support from National Health and Family Planning Commission, UNFPA China and the Chinese Maternal and Child Health Association have launched a pilot programme in Hunan province advocating for improved resource allocation and formal inclusion of midwifery curriculum and certification in medical education systems. At the same time, the programme will promote natural delivery in selected hospitals by working with health providers and clients.
The policy workshop on development of midwifery in China provided insights from international experiences, reviewed the situation in China and led to proposed collaborative strategies to enhance advocacy and programme support in midwifery development in China.
The full report and executive summary of “The State of Midwifery 2014 titled A Universal Pathway, a Woman’s Right to Health” Chinese version can be downloaded from the website of UNFPA China: http://unfpa.cn and website of WHO: http://www.wpro.who.int/china
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