DAKAR, 5 May 2009 (IRIN) - The number of midwives worldwide would have to more than double to meet Millennium Development Goals of reducing maternal and infant deaths by 2015, according to the International Confederation of Midwives (ICM) and World Health Organization on International Midwife Day.

Maternal mortality is the "highest health inequity in the world with more than 99 percent of deaths [in pregnancy and childbirth] occurring in the developing world," World Health Organization (WHO), World Bank, UN Children's Fund (UNICEF) and UN Population Fund (UNFPA) said in a joint statement. In 2008 the agencies pledged to work with governments to fill the "urgent need for skilled health workers, particularly midwives", the statement says.

WHO estimates that for the annual 160 million births worldwide it would take an additional 350,000 midwives to ensure that at least 95 percent of births were attended by trained health workers, thereby helping meet MDGs.

ICM estimates that there are 250,000 licensed midwives worldwide, with 13,000 in sub-Saharan Africa. The region had more than half of the world's maternal deaths during pregnancy and childbirth in 2005, according to WHO's latest compiled statistics.

Monir Islam, director of WHO's Making Pregnancies Safer Programme, said governments' failure to focus on midwifery has been deadly. "Starting in 1987 in an effort to make motherhood safer, countries invested in traditional birthing attendants, which has not reduced maternal and infant mortality."

He said: "Traditional birthing attendants have their role in ensuring safe motherhood. They have community standing and can promote nutrition, can prepare a woman for childbirth, but at the moment of birthing [they] should bring the woman to a trained health worker."

He said countries that invested in midwifery and emergency obstetric care, including Thailand and Malaysia, have been able to cut their maternal and infant deaths.

But he noted that midwifery training is still not enough to ensure safe childbirths. "It is also about employment, deployment, retention and giving midwives supplies. What good is a midwife who comes to the clinic every day with no supplies? No gloves? Or those used to do tasks that auxiliary nurses could do?"

A health worker is considered a midwife only after completing a certified midwifery education programme to provide care during pregnancy, labour and the postpartum period, according to ICM.

WHO's Islam told IRIN that while Malawi has adequate training facilities, the majority of midwives are concentrated in cities while rural areas lack trained health workers.

He added that Botswana, Namibia, South Africa and Swaziland have good midwife coverage, whereas Francophone Africa countries are lagging. WHO is working with governments to develop midwifery curriculums.

"This will not happen overnight," said Islam. "But we need to take action."

pt/np

Relevant links:

MDG http://www.un.org/millenniumgoals/

Interational midwife day http://www.internationalmidwives.org/CongressesWorkshops/InternationalDayoftheMidwife/tabid/327/Default.aspx

WHO Making Pregnancies Safer http://www.who.int/making_pregnancy_safer/en/

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