In summary:
- About two-thirds of maternal deaths, newborn deaths and stillbirths could be prevented by 2035 if the current level of professional midwife healthcare was scaled up to facilitate support for interventions such as family planning, diabetes management, assisted delivery and breastfeeding worldwide
- Even a modest increase in the provision of care by midwives of 10 percent every five years would avert around a fifth of maternal and neonatal deaths and 14 percent of stillbirths globally by 2035, according to this new modelling study
- Greater use of midwives, particularly in low-to-middle income countries, could improve the survival of mothers and babies but, to realise this potential, midwives need sufficient training, to be part of a supportive and skilled team, and work in an environment with adequate water, sanitation and medical supplies.
A new modelling study supported by Burnet Institute estimates that scaling up the provision of midwife-led care across the world could reduce maternal deaths by 67 percent, newborn deaths by 64 percent, and stillbirths by 65 percent if midwives were enabled to provide a range of interventions from family planning to post-natal care.
This could equate to saving 4.3 million lives per year by 2035.
Improving the health of mothers and newborn babies remains an important priority on the international agenda and there has been an increasing awareness around the role of midwives in addressing this need.
Published in The Lancet Global Health, the study provides evidence for the potential impact of scaling up midwife delivered healthcare and calls for greater investment in the profession, not only to increase the numbers of midwives but to improve their education, training, regulation and working environment.
Supervising author, Professor Caroline Homer AO, said the paper further cements the importance of midwives.
“Midwives who are educated, regulated, professionally supported will save lives of mothers and babies,” Professor Homer, Burnet Institute Co-Program Director, Maternal, Child and Adolescent Health, said.
“Investments in midwifery are urgently needed in all countries. Not investing will cost lives, and in a world disrupted by COVID-19 we cannot afford to wait.”
Lead author Dr Andrea Nove from Novametrics Ltd., UK, said it’s possible to achieve a substantial increase in the level of provision of essential interventions delivered by midwives if they are supported by appropriate professional education, regulation and improved working environments.
“This could save millions of lives, however, there are numerous barriers to fulfilling this level of scale-up, particularly in low- to middle-income countries,” Dr Nove said.
“These include insufficient numbers of qualified midwives, poor transport links, lack of supplies and equipment and, in some countries, a lack of trust from the public. There is need for greater recognition of the importance of supporting and enabling this service to reach its potential.”
The new study follows a past report on midwifery in The Lancet and uses the Lives Saved Tool (LiST) which models variations in deaths based on the uptake, effectiveness and impact of a range of interventions.
Using an updated version of LiST, the current study aimed to provide a more accurate estimate of the impact of increasing the provision of midwife healthcare around the world.
The study used the LiST to model effects on mortality at a country level of about 30 midwife delivered interventions.
These were treatments, responses and procedures that can be provided before conception, in antenatal care, during labour and birth and after birth, such as family planning, hypertension screening, induction of labour and use of antibiotics for newborn sepsis.
Four scenarios were used to demonstrate the effects of changes in the level of provision of midwife healthcare around the world:
- a modest increase of 10 percent every five years in the coverage of interventions,
- a substantial increase by 25 percent every five years,
- an increase that would reach 95 percent of coverage by 2035 (universal coverage), and
- a decrease in coverage by two percent every five years.
The study modelled the effect of changes in the level of provision of healthcare interventions delivered by midwives for 88 countries and amalgamated the results. This was also done for three groups of countries that were categorised according to their level of development.
In these 88 countries there are currently over three million stillbirths per year, three million newborn deaths per year and over 400,000 maternal deaths per year.
Substantial Increase
Researchers estimated that relative to this current provision of healthcare by midwives, a substantial increase (25 percent increase every five years) in the 88 countries would result in 41 percent fewer deaths of mothers, 26 percent fewer stillbirths and 39 percent fewer deaths of newborn babies. In absolute numbers this would mean averting 170,000 maternal deaths, 852,000 stillbirths and 1.22 million newborn deaths per year by 2035. The reduction in deaths was estimated to be greater in the least developed countries.
Modest Increase
A modest scale-up in interventions (10 percent every five years) delivered by midwives would result in 22 percent fewer maternal deaths, 14 percent fewer stillbirths and 23 percent fewer deaths of newborn babies. It is estimated this would avert 93,000 maternal deaths, 448,000 stillbirths and 718,000 newborn deaths per year by 2035.
Universal Coverage
Scaling up midwife delivered interventions to ensure universal coverage (95 percent coverage) by 2035 could result in a 67 percent reduction in maternal deaths, a 65 percent reduction in stillbirths and a 64 percent reduction in deaths of newborn babies, according to the study. Similar to the scenario of a substantial increase in coverage, these reductions would be greatest in the least developed countries. Overall, this universal scale-up could potentially save 280,000 maternal deaths, 2.09 million stillbirths and 1.97 million neonatal deaths annually by 2035.
Small Decrease
In comparison, a small decrease (of two percent) in the provision of midwife delivered healthcare would result in 34,000 more maternal deaths, 222,000 more stillbirths and 295,000 more newborn deaths per year by 2035.
In the universal coverage scenario, the authors estimate that family planning could avert the most stillbirths and deaths of newborn babies in the least developed countries.
In countries with medium-to-high development, interventions during pregnancy, such as management of hypertension, might make the greatest contribution towards reducing stillbirths, while interventions during and after childbirth such as assisted vaginal delivery and management of newborn sepsis, might make the greatest contribution to reducing newborn deaths.
