First Global Midwifery Survey Reveals Concerns Midwives Face Today

More organizations want to ensure the role of midwifery continues to help mothers and babies worldwide. Results from the first global Midwives’ Voices, Midwives’ Realities survey show more organizations recognize the challenges of midwifery, and want to work to ensure these vital roles continue to help mothers and babies around the world.

Midwives in many parts of the world say they face a myriad of stressors that make working conditions less than desirable, including low and inconsistent pay and disrespect from both patients and doctors, according to a global survey designed to look at the challenges midwives worldwide.

In 2014, the World Health Organization collaborated with the International Confederation of Midwives and White Ribbon Alliance, with support from USAID, and started its first global survey of midwives in order to discover and address issues midwives have today.

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The survey consisted of 2,470 midwives from 93 countries worldwide. More than a third of the midwives interviewed said they feared violent acts toward them, or experienced harassment. The results were published in Midwives’ Voices, Midwives’ Realities, and according to USAID Bureau for Global Health senior maternal health advisor, Mary-Ellen Stanton, 58% of those surveyed felt they were treated respectfully in their fields.

Stanton said that the report did not only outline problems, but midwives also offered solutions that should be carefully examined for implementation.

While many feel that midwives play a pivotal role when it comes to the health and welfare of mothers and babies, in many parts of the world, the challenges make midwifery difficult, resulting in poor quality of care for mothers and newborns.

Evidence confirms midwives help reduce maternal mortality rates in numerous ways, from prenatal conception counselling to labor and delivery, and community education. Frances Day-Stirk, president of the International Confederation of Midwives says that according to the UNFPA’s 2014 State of the World’s Midwifery Report, of 73 countries accounting for 96 percent of maternal deaths worldwide, only four have a potential midwifery workforce that can deliver necessary interventions.

The World Health Organization says that investing in midwifery and listening to their experience can result in tremendous return on investment with maternal and newborn care. Nancy Kamwendo, national coordinator for the White Ribbon Alliance says that a big problem is that there are simply not enough midwives to meet demand in some places.
In Malawi, for instance, the number of childbearing women to midwives could be more than 800 to 1. WHO recommends a ratio of 175 to 1 minimum.

More, Kamwendo says that midwives work on average more than 58 hours a week, and in some countries, go months without receiving compensation. When that is coupled with unsafe operating conditions that often require the midwives to travel long distances, it’s no wonder that having enough midwives to meet demand is a challenge.

The report also said that often midwifery work is considered, ‘women’s work,’ and not comparable in importance to the value of a medical practitioner.

Surveyed midwives felt that their work was not valued as highly as it should be because of the societal place of women in general, and that undermining opinion makes them weary. Fran McConville, technical officer of midwifery for WHO says that globally, midwives have very big jobs to do where they have to work around gender discrimination, politics, money and power, and that weighs on the midwives who are the sources of health and wellbeing of mothers and newborns.

Related: An Inspiring Interview With Midwife and Author Patricia Harman

Day-Stirk says that one of the major goals of the survey was to give voice to midwives and empower their voices by addressing issues like physical and sexual assault, inconsistent and poor wages and disrespect by senior medical staff, which midwives feel is a significant issue.

She says that listening to midwives and hearing their realities is the first step in ensuring their quality of job satisfaction increases, which would only benefit mothers and babies worldwide.

McConville says that getting more midwives into decision-making positions will ultimately help with the demands of midwifery, as well as create a culture of better education and training, which would attract talented people to the field.

She believes that communication networks between midwives would also help them feel connected, and young midwives would be able to take concerns to senior midwives, knowing there’d be action.

Stanton hopes that because of surveys and discussions like these, the profession of midwifery will receive the respect it deserves, and that respect will be commensurate with the amazing benefits they are providing for women and their families. She believes that raising the attention to the professionalism of midwifery will result in better appreciation from women, their communities, their employers and policy makers.


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