Invest in midwives to save women's lives

Maternal mortality remains a major problem around the world. Approximately 40 million women a year give birth to children without access to trained staff. By scaling up the Swedish model with well-trained midwives who have the main responsibility for childbirth, maternal mortality can be drastically reduced, write Ingela Wiklund and Anna Nordfjell from the Swedish Midwifery Association and Anders Molin from Sida.

Today June 3 is launched State of the World's Midwifery 2014. It takes place at the International Confederation of Midwives (ICM) 30th Triennial Congress in Prague where the world's midwives gathered for an international conference. This is the second report on maternal and child mortality in the world's poorest countries produced through a collaboration between UNFPA, UN s Population Fund, ICM, the World Health Organization (WHO), Svenska Sida and several other global partners.

The purpose of the report is to mobilize world leaders to act for continued work against maternal and child mortality, focusing on the 73 countries that account for more than 95 percent of this mortality in the world. The report also provides recommendations on how countries should act to reduce the high maternal and child mortality rates. Access to qualified care of a trained midwife during childbirth for all women is one of the most important measures.

In 2000, world leaders agreed on Millennium Development Goal 5 (MDG 5), to reduce global maternal mortality by 75 percent. The efforts made so far have led to a halving of the death toll in 30 years, from about 600 to about 000 per year, but in the poorest countries in the world, mortality due to pregnancy and childbirth is still appallingly high.

How Sweden organizes care for women during pregnancy and childbirth with the help of well-trained midwives has become a model for many countries in the world. As early as the 1700th century, Sweden began to train midwives, which led to a marked reduction in maternal and child mortality in our country, mainly during the latter part of the 1800th century. The fact that all women in Sweden are offered care during pregnancy and childbirth by a midwife is a major success factor. The Swedish experience has been a strong contributor to the fact that today there is agreement on two issues that were previously controversial. It is partly about the fact that qualified maternity care must be offered to all women, life-threatening complications can affect everyone. On the one hand, it is known that maternity care requires qualified staff, trained midwives according to international standards.

Midwives in our country not only contribute with care during childbirth, they also work with maternal health care, contraceptive and sexual counseling, youth care, gynecological care, abortion care, gynecological cell sampling and health information etc. This experience is also relevant in low- and middle-income countries where there is often an intense debate about which staff category should have the right to perform which tasks and where the medical profession often sees with great skepticism about task shifting tasks to other healthcare categories. . The Swedish model for maternity care is also a clear example that the midwife can not only handle normal births but is the most suitable category of staff to do this. This gives a special weight in the context of development assistance to argue for the midwife's important role for women's and children's health, by doing so in Sweden. Not because it's the cheapest, but because it's the best.

The Swedish government has been clear that the issue of women's health and especially reduced maternal mortality and safe abortions as well as access to midwives is a priority. In the new development assistance policy platform from March 2014, the government writes:

"Swedish development assistance must focus on increasing access to trained staff, especially midwives, and adequate maternity care in connection with pregnancy and childbirth, as well as improving women's access to contraception and safe and legal abortions."

The Swedish Midwifery Association, with the support of Sida together with Swedish universities, has participated in several international projects with the aim of strengthening midwifery education in different countries.

Since the millennium goal five was formulated, an increasing proportion of women in the world have had access to a trained midwife in connection with pregnancy and childbirth, and it is estimated that two out of three women have access to competent healthcare staff in connection with childbirth. To further improve the situation of women during pregnancy and childbirth, efforts need to be made to train more midwives in the world, the estimated need is approximately 300.

Access to good health care is a human right, but despite this, today almost 40 million women give birth without the help of trained staff. In addition, midwives work in many parts of the world under very difficult circumstances and with limited resources.

The UN report highlights in particular Bangladesh as a positive example as one of the world's poorest and most densely populated countries has succeeded in reversing the trend and reducing the previously very high maternal mortality rate. Bangladesh is one of the countries that has now decided to train professional midwives based on the standard developed by ICM, and in 2013 the first 500 students began their education. It has been estimated that during their working lives, these 500 midwives will help reduce maternal mortality in Bangladesh by 80 percent and save the lives of 36 women.

Sweden has been a strong contributing factor to this development. Partly through support for the national health plan but also by for several years through Swedish support to UNFPA made it possible for Swedish midwives to be able to work strategically for a modern and regulated midwifery education. Another important success factor in Bangladesh is that with Swedish support, among other things, women are given access to safe abortions, which has led to a sharp reduction in mortality in unsafe abortions.

Women have the right to evidence-based care with competent midwives no matter where they live in the world.

In Sweden, we believe that the right to decide over one's own sexuality and reproduction is a fundamental right for all people. Sexual and reproductive health and related rights (so-called SRHR issues) include everyone's equal opportunities, rights and conditions to have a safe and satisfying sexual life, and to be able to decide over their own body and childbirth without coercion, violence or discrimination. In large parts of the world and also here in Europe, there is discrimination and oppression regarding sexual and reproductive rights. Abuse of women is increasing, especially in conflict, post-conflict and crisis situations. Professional professional organizations and other organizations in our country, together with the Swedish government, can do much to improve the situation for the world's poor and vulnerable people.

Ingela Wiklund, chairman of the Swedish Midwifery Association

Anna Nordfjell, international secretary of the Swedish Midwifery Association

Anders Molin, Works Representative, Health, Page

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