Maternal mortality cannot be reduced without midwives and others with midwifery skills
Up to 3.6million deaths could be avoided each year in 58 developing countries if midwifery services are upgraded by 2015, according to the first ever State of the World’s Midwifery 2011 report to be published.
The report focused on 58 countries with high maternal and newborn rates, and a crisis in human resources for health. Put together these countries which include Zimbabwe, Zambia, Uganda, Rwanda, Sudan, Botswana, and Vietnam account for 60% of all births and 91% of all maternal deaths.
“The report points to the urgent need to train more health workers with midwifery skills and ensure equitable access to their life-saving services in communities to improve the health of women and children”, said Dr. Babatunde Osotimehin, the UNFPA Executive Director during launch in Durban, South Africa. Far too many women and newborns, mostly the poor and marginalized in both urban and rural settings are dying because they have no access to functioning health facilities or to qualified health professionals, notably those with midwifery skills.
From findings of the report 358 000 women die every year while pregnant or giving birth which is almost 1000 a day, some 2 million newborns die within the first 24 hours and there are 2.6 million stillbirths, all because of inadequate or insufficient health care. If adequate facilities were accessible to deal with complications on their onset, and midwives are in place and they can refer severe complications to specialized care many of these deaths could be averted. 61% or nearly two thirds of all maternal deaths, 49 percent or almost half of stillbirths and 60 percent or 3 in 5 newborn deaths could be avoided. The report noted that a health system that relies on midwives or other cadres who are less than competent to provide care throughout their professional careers is dangerous to women, newborns, families and communities.
Maternal mortality in Zimbabwe has more than doubled since 1990, and more than half of all maternal deaths are linked to HIV. In 1994 according to the Zimbabwe Demographic Health Survey (ZDHS) maternal mortality was 283 deaths per 100 000 live births and in 2005/6 (ZDHS) it was estimated at 555 deaths per 100 000 live births and in 2010/11 it was estimated at 960 deaths per 100 000 live births. This is unacceptably high and Zimbabwe needs to intensify its interventions towards reducing maternal mortality. Implementation of campaigns such as CARMMA also need to be accelerates.
The report pointed to the critical need of addressing the issue of staff shortages and retention in Zimbabwe. On paper there is a total of about 8 244 midwives including nurse – midwives in the country. However, the number of those practicing is not known as the health sector has been hard hit by brain drain. The non-existence of a live registry of licensed midwives and the fact that midwives are not recognized as an autonomous profession in the country makes it even difficult to take stock of the number of practicing midwives in the country.
Other key challenges highlighted for Zimbabwe in the report are in midwifery training and practice. These include understaffing in midwifery schools which is affecting the quality of support and supervision available to students; limited resources and basic equipment; and low salaries and poor working conditions which have contributed to brain drain.