Perinatal health care is an important aspect of primary health care. According to an estimation by World Health Organization, a woman dies of pregnancy-related causes every two minutes most of which are preventable with the right care at the right time.

For instance, in 2020, there were maternal 287, 000 deaths which were noted to be largely concentrated in the poorest parts of the world and in countries affected by conflict, while in 2021, 2.3 million children died in the first month of life globally, which on average is 6,400 neonatal deaths every day.

Midwives are listed as among the maternal and newborn health (MNH) professionals alongside nurses, obstetricians, pediatricians, and anesthetists because they all support

the health and well-being of women and newborns by performing the primary functions of emergency maternal and newborn care. However, midwives are unique in that they

are able to provide women and newborns with most of the essential services in even the most difficult humanitarian, fragile, and conflict-affected settings.

Midwifery- which the WHO defines as skilled, knowledgeable, and compassionate care for childbearing women, newborn infants, and families across the continuum from pre-pregnancy, pregnancy, birth, postpartum, and the early weeks of life- plays a central role in perinatal health care. From prenatal counseling, antenatal care, childbirth, and postnatal care, midwives are depended on in various capacities to provide reproductive healthcare throughout pregnancy and childbirth.

However, despite the vital role they play, midwives are still barely recognized and appreciated in most regions across the globes.

2021 State of the World Midwifery

Despite being able to provide about 90% of the Sexual Reproductive Maternal Newborn and Adolescent Health (SRMNAH) care needed, midwives account for less than 10% of the global SRMNAH workforce. The 2021 State of the World Midwifery Report (SowMY2021) approximated that the world needs 900,000 more midwives especially in low-income countries and in Africa.

Other than preventing maternal and newborn deaths, quality midwifery renders diverse services by improving other health-related outcomes across the perinatal continuum.

What Women Want: Midwives’ Voices, Midwives’ Demands

In 2021, White Ribbon Alliance Kenya commissioned a listening exercise with midwives to document their challenges, aspirations, and recommendations for the delivery of quality, equitable, and dignified Reproductive, Maternal, and Newborn Health (RMNH) care which then was compiled into a report titled

‘What Women Want: Midwives’ Voices, Midwives’ Demands Kenya Report 2021’.

The report which presented the lived experiences, challenges and self-expressed priorities made by midwives working in various sectors in Kenya, highlighted the biggest challenges midwives face including weak health systems, lack of adequate space, beds, ambulances, weak referral systems, coupled with understaffing and shortage of trained midwives to render services. Career problems included midwives’ quest to develop their professional careers appeared to be disillusioned by non-responsive recruitment, promotion, and remuneration policies.

Midwives have spoken; its now time to deliver forthem.

71.9% of midwives in Kenya cite the heavy workload and shortage of midwives as a great impediment to the provision of quality and dignified care to women, girls, and newborns. Often, when midwives’ voices are missing from global health leadership, decisions and policies don’t always reflect the diverse concerns and needs of women. The lack of women’s leadership in the global health workforce has led to the deprioritisation of women’s health issues.

The State of the World’s Midwifery 2021 estimates a global shortage of 900,000 midwives, projected to fall to 750,000 by 2030 if all countries continue on their current trajectory. The Lancet estimates that expanding midwifery care by 25% over 5 years would result in a 41% reduction in maternal deaths and a 39% reduction in infant mortality. This equates to 170,000 women’s lives saved and 1.2 million infants per year, by 2035.

Therefore, there’s an urgent need to strengthen the midwifery funding mechanisms to improve midwifery pay and conditions. Investing in improving the working conditions of midwives will be critical to improving the well-being of mothers and their newborns during the critical times of pregnancy and childbirth. There is need to address harassment in the workplace and improve workplace safety thus ensuring they deliver quality care to pregnant women and their newborns. Further, the scope of practice needs to be expanded to strengthen midwifery education and training at all levels. Addressing the gender pay gap in midwifery will be key thus ensuring there is equal pay for work done. These will not be possible without working to strengthen leadership within midwifery to ensure that midwives remain key in decision making tables for mothers, their newborns, and the midwifery profession at large. The data is available, midwives have voiced their realities, and mothers, and newborns have voiced their realities too, too many lives are at stake. What is lacking is the will and action of every actor responsible. The talk needs to stop! It is time to Act for good!

The time is now!