Amref Health Africa calls for greater focus on this important health worker cadre to reduce maternal deaths on the continent
International Day of the Midwife, May 5 2015
Although global progress continues to be made towards the fifth Millennium Development Goal – to reduce maternal mortality by 75% by 2015 – progress in Africa remains slow and insufficient. According to the World Bank, although maternal mortality has declined worldwide, the share of maternal deaths is increasingly concentrated in sub-Saharan Africa. The latest joint World Bank statistics indicate in 2013, 62 per cent of maternal deaths worldwide (178,000 out of 262,000) occurred in sub-Saharan Africa, compared to 42 per cent in 1990.
Sub-Saharan Africa is the only region where the proportion of maternal deaths has increased this much, indicating a slower reduction of maternal mortality than other parts of the world. The countries in this region are characterized by high fertility rates, a high unmet need for family planning and low uptake of the recommended four ante-natal care visits during pregnancy, which fuel the high maternal mortality rates. These countries are further characterized by early marriages and high prevalence of teenage pregnancies.
Most maternal deaths can be averted by implementing programmes and policies that support women’s access to affordable and high-quality family planning, antenatal, delivery and postnatal care. The main causes of maternal mortality are bleeding, hypertension and infection.
Maternal deaths are also closely linked to infant deaths. However, slow progress has been achieved in reducing newborn mortality in sub-Saharan Africa. Two-thirds of infant deaths in the region occur in the first 28 days of life (neonatal period), with the time immediately after delivery being the most risky period. In fact, the percentage of child deaths in the neonatal period in Africa has increased in the last decade.
According to the Countdown 2014 Report (UNICEF/WHO), approximately 18,000 children globally still die every day, the vast majority living in disadvantaged populations. The leading causes of post-neonatal child deaths remain preventable infectious diseases such as pneumonia, diarrhoea and malaria.
Available evidence indicates that countries with a high proportion of births assisted by skilled attendants who are trained, qualified and accredited have low maternal mortality rates. It is noteworthy that a midwife can provide a broad spectrum of reproductive and maternal services to 500 women in a year.
In light of this, Amref Health Africa, through its Stand Up for African Mothers campaign, has prioritized training of midwives as one of the key strategies to reduce deaths of mothers and their newborns in the countries with the highest maternal deaths in Africa. Unfortunately Africa has a shortage of midwives, both in numbers and competencies. The majority of midwives serving on the continent have only received basic training and require upgrading or further training in order to meet global standards for midwifery.
African countries have developed a road map for scaling up human resources for health for improved health service delivery in the African region 2012-2025 which prioritizes the following areas: strengthening health workforce leadership and governance capacity; strengthening human resources for health regulatory capacity; scaling up education and training of health workers; optimizing the use, retention and performance of the active health workforce; improving health workforce information and generation of evidence for decision-making and strengthening health workforce dialogue and partnership
These strategies have been embedded in the development of the Sustainable Development Goals (SDGs) under the Proposed Goal 3, which seeks to "increase substantially health financing and the recruitment, development and training and retention of the health workforce in developing countries”.
On the occasion of the International Day of the Midwife 2015, Amref Health Africa calls for Governments in Africa and foreign aid departments of developed countries to increase investment in scaling up education and training of midwives to increase access to quality health services and reduce needless deaths of mothers and their newborn children.
Amref Health Africa further urges African Governments to:
- Prioritize the strategy to strengthen human resources for health during the ongoing SDG Intergovernmental negotiations (September 2014 - August 2015).
- Reinforce the need to prioritize midwifery in human resources for health development under SDG 3.
- Champion breaking down of indicators for SDG3 and strategy 3C by cadre to ensure that midwifery is allocated the resources required by Governments and development partners.
Amref Health Africa also requests Ministries of Health in Africa to:
- Scale up education and training of midwives by increasing physical space and adoption of eLearning.
- Increase regional and national budgets for recruitment, deployment and retention of midwives in rural areas.
- Strengthen midwifery regulatory bodies and associations to ensure that issues affecting this important cadre are addressed and their continuous professional development is institutionalized.