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The State of the Worlds Midwifery (SoWMy 2021) Report 2021

A call to action for continued professional education and our personal responsibility for change.

https://www.unfpa.org/sites/default/files/pub-pdf/21-038-UNFPA-SoWMy2021-Report-ENv4302.pdf

Kay King – Head of Growth & Development, All4Maternity

Reviewing the report

This month saw the timely and urgent publication of the combined UNFPA (United Nations Population Fund), ICM (International Confederation of Midwives) and WHO (World Health Organisation) report ‘The State of the Worlds Midwifery 2021’. The report makes for desperate reading;, shining a light on the impact of Covid 19 on global needs within sexual, reproductive, maternal, newborn and adolescent (SRMNAH) healthcare.

Whenever a social problem is brought to our attention in reports as stark as this, I return to my education in Systems Thinking. Taking a Systems Thinking approach to the current crisis in these areas, the report presents a very ‘messy’ state of global midwifery.1 There are multiple interconnected systems and complexities which influence the situation we are currently in and quite frankly, it is overwhelming to read. As advocates and midwives, we need to ensure that we do not close our eyes to the urgency with a feeling of overwhelm, nihilism or helplessness and remember that we each have a roll to play in ensuring that, whilst we might not be able to solve the problem, we can improve the situation. We are all players in the much-needed advocacy and awareness raising of the current state of our sectors workforce.

Celebrating your effort

In her opening statement within the report, Amina Mohammed: Deputy Secretary- General of the United Nations compassionately reminds us that:

“Midwives deserve to be celebrated for their courageous and often dangerous work during the crisis, which has helped to reduce the risk of virus transmission among pregnant women and their infants by enabling many births away from hospitals, either at home or in a midwifery unit or birth centre.”

It is important that we pause at this point and agree. What you achieved, what all midwives achieved during and through the on-going crisis of the Covid 19 pandemic is evidence of our calling to this work and to the resilience and care that we bring to women and birthing people across the globe.

Understanding the scale of the problem

However, we are in a state of global crisis within SRMNAH and the report highlights that many of the gains that we had begun to make in our advocacy and progress towards increased SRMNAH and women’s health resourcing have taken a substantial step backwards as a result of the pandemic.3

‘Based on the available data, SoWMy 2021 estimates that, with its current composition and distribution, the world’s SRMNAH workforce could meet 75% of the world’s need for essential SRMNAH care. However, in low-income countries, the workforce could meet only 41% of the need. At current rates, the SRMNAH workforce is projected to be capable of meeting 82% of the need by 2030: only a small improvement on the current 75%. The gap between low-income countries and high- and middle-income countries is projected to widen by 2030, increasing inequality. To close the gap by 2030, 1.3 million new DSE worker posts (mostly midwives and mostly in Africa) need to be created in the next 10 years ’.2

“SDGs 3 and 5 will not be met by 2030 without increased commitment to and investment in the education, recruitment, deployment, retention and management of midwives and other SRMNAH workers.”

We are being urged to ensure that our governments and relevant stakeholders use SoWMy 2021 to inform their efforts to build back better and fairer from the pandemic, ‘forging stronger primary health-care systems as a pathway to UHC and fostering a more equitable world for all’. 2,4

Reflecting on our role in change

As we build back from the impact of the global COVID pandemic we need to reflect on our own practice, our work as midwives, doulas, antenatal teachers and birthkeepers and readdress how we each contribute to the global picture presented in this report. Whilst as an individual practitioner you may not feel that you know how to contribute to the systemic needs of global midwifery, what is very clear is that we need to keep doing what we are doing, continue to improve, model excellence and opportunities, mentor others and encourage advocacy and lobbying for both funding and policy change that improves the situation. Knowing how to do this requires a commitment to developing your understanding of the problems, engagement in activity towards social justice and not being shy of the role you can play as a voice for women’s health.

All4Maternity provides a platform for your midwifery education to continue beyond your formal higher education setting. Once you have graduated as a midwife and are working in practice, it is vital that your education continues.

One of the key messages within the SoTWMy 2021 report highlights:

COVID-19 has prompted new ways of providing midwifery education and services. These need to be developed and used effectively, including innovative digital technologies and online learning opportunities. Their effectiveness also needs to be assessed during “normal” conditions.”

All4 – Join Us

The approach taken by All4Maternity, through our publications The Practising Midwife journal and The Student Midwife journal are offerings to this effect. They sit alongside access to over 50 eLearning modules, blogs, podcasts and news about midwifery in global contexts and are an opportunity for your learning, caring and sharing needs to be met as you continue to invest in your midwifery skill and knowledge.

All4Maternity provides a ‘One4One’ subscription offer, which means that for every subscription we receive in a high-income country, we give a full access online subscription to a person from a low or middle-income country. With much of the SOTWMy 2021 report highlighting the disparity of SRMNAH across the globe, particularly with lacking resource in African countries this offer is important.

“To meet all of the need by 2030, 1.3 million new DSE (Dedicated SRMNAH equivalent) midwife, nurse and SRMNAH doctor positions will need to be created (mostly in Africa) in addition to those currently in existence: 1 million DSE midwives/nursemidwives, 200,000 DSE nurses and 100,000 DSE doctors. At current rates, only 0.3 million of these posts are set to be created.”2

Recognising that education is a privilege afforded to us and is a leading contributor to global inequity can and should prompt our commitment to it. The world needs more midwives, that is a very clear message and where we have the privilege and access to affordable continued professional development, the leverage to influence policy changes and the skill to model respectful maternity care, we are being called now- more than ever- to respond, by ensuring we uphold our commitment to women and birthing people the world over.

References

  1. Systems Thinking for Social Change: A Practical Guide to Solving Complex Problems. David Peter Stroth. Chelsea Green Publishing 2015
  2. The State of the Worlds Midwifery Report 2021: WHO, ICM and UNFPA https://www.unfpa.org/sites/default/files/pub-pdf/21-038-UNFPA-SoWMy2021-Report-ENv4302.pdf. Published May 2021. Accessed May 2021
  3. The Impact of Covid 19 on Women. United Nations Policy Report. https://www.un.org/sexualviolenceinconflict/wp-content/uploads/2020/06/report/policy-brief-the-impact-of-covid-19-on-women/policy-brief-the-impact-of-covid-19-on-women-en-1.pdf Published April 2020. Accessed May 2021
  4. Call to action: COVID-19. Geneva: Partnership for Maternal, Newborn & Child Health; 2020 https://www.who. int/pmnch/media/news/2020/PMNCHCall-to-Action-C19.pdf?ua=1 Accessed 6 February 2021.

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