According to the report, adequately trained midwives can address approximately 90% of the demand for essential sexual, reproductive, maternal, newborn and adolescent health interventions. Across the 17 participating EECA countries, only 8% of these interventions are led by professional midwives, with only 5.5 midwives per 10,000 population. The midwife density varies greatly between countries, with the highest, at 16.2 per 10,000 population in Belarus, and the lowest, at 1.4/10,000 population in Georgia. Only 54% of EECA countries legally recognise midwifery as distinct from nursing, compared with 95% in Western Europe.

Around 70% of EECA countries have policies that recommend midwife-led care for pregnancy, childbirth and the postnatal period. However, the data shows that, although these policies may exist in practice, they are not always implemented, according to Andrea Nove, technical director of UK-based research and knowledge management consultancy, Novametrics. Six countries have a regulatory system that is specific to midwives, but none has a separate regulatory body for them. There is also poor representation of midwives in leadership roles: only Tajikistan reported any midwife leaders at all. In comparison to the worldwide average, EECA countries and territories also place unusually stringent restrictions on midwives' scope of practice with regards to basic emergency obstetrics and newborn care.

Midwives have the potential to contribute to broader activities, such as promoting primary healthcare and universal health coverage, responding to violence against women, and addressing sexual and reproductive rights. With their proximity to communities, midwives can also act as agents of change for promoting women's empowerment and behaviour change, including family planning and addressing harmful social and gender norms. Additionally, they can serve as a point of contact in the community for sexual and reproductive health services and support self-care interventions, such as self-monitoring of blood pressure during pregnancy.

However, women in the EECA still face barriers to career progression due to gender discrimination and patriarchal attitudes towards the roles of women and men. Also, decreased public investment in social care increases the burden of unpaid labour on women. The COVID-19 pandemic has exacerbated these issues, making it difficult for women with children to participate in paid work. Midwives, who are mostly women, require gender-transformative policies and practices to empower and enable them.

The universal coverage of midwife-delivered interventions could save over 20,000 lives per year by 2035, according to an analysis of data from Azerbaijan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan.

“Midwives should be seen as a vital investment within a country's health system. This report encourages advocates to use the evidence in this report to change perception. Midwives are an investment that yields not only health benefits but also socioeconomic returns,” said Nove.

The report recommends investment in four key areas to help midwives achieve their potential:

Health workforce planning, management and regulation of the work environment
High-quality education and training of midwives
Midwife-led improvements to service delivery
Improving representation in leadership and governance roles

These investments should be considered at country and regional levels by governments, policymakers, regulators, education institutions, professional associations, international organizations, civil society organizations and researchers.

Midwives could address 90% of demand for essential interventions

November Challenge

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