May 5th annually is International Day of the Midwife and it is set aside to honour the work of midwives, and promote awareness of the crucial care that midwives provide to mothers and their newborns. Midwives are critical health personnel, providing care and support to mothers and their newborns. This year’s theme is “100 years of progress”, marking the 100th year of the establishment of the International Confederation of Midwives (ICM).
The 2021 State of the World’s Midwifery report puts the global midwives shortage at 900,000. To close the gap by 2030, 1.3 million more midwives posts are needed but with current estimates only 300,000 more will be created by 2030. This shortage is particularly acute in Africa where essential needs for maternal and reproductive health care are met by midwives only 43% of the time.
In Nigeria, not only is there a shortage of midwives but there is also a shortage of data on the availability of the professionals in the country. A World Bank data that shows the number of midwives per 1000 people in Nigeria between 2013 and 2019 is missing a cumulative 8 years of data, where no figures are recorded.
More alarmingly, the records that do exist show that in the 9 years where data exists, the number of midwives to 1000 people in Nigeria has never reached 2. Rather, there has been a decline in the number of midwives per 1000 people, going from 1.59 per 1000 people in 2003 to 1.03 in 2013, a 35% decline. Within that decade there was no data for 2004, 2009, 2010, 2011, and 2012.
There was no data for 2014 and 2015 but in 2016 there was a slight increase up to 1.76 per 1000 people before the numbers dropped precipitously to 0.93 in 2018 and then ending at 1.50 in 2019.
The implications of these are enormous for a country with a maternal mortality rate of 576 per 100,000 live births, contributing 10 percent of global deaths for pregnant mothers and the fourth highest on Earth. Each year approximately 262,000 babies die at birth, the world’s second highest national total. Infant mortality currently stands at 69 per 1,000 live births while for under-fives it rises to 128 per 1,000 live births.
The absence of data on the availability of midwives, who are the front-line caregivers and backbone of maternal and child health care, will make it difficult to design interventions to increase the numbers and spread of these professionals.
Harsh economic realities forcing healthcare professionals to leave the country for better opportunities and the state of insecurity are no doubt part of the drivers of shortage of midwives in Nigeria. The WHO Regional Director for Africa, Dr Matshidiso Moeti, in his comments commemorating the International Day of the Midwife said “Governments and partners need to substantially increase investment in the education, recruitment, deployment, retention and protection of midwives”.
According to Mrs Oluwaseun Bamidele, a senior midwife, some of the challenges midwives encounter in Nigeria are; lack of necessary instruments for delivery and child health, “another challenge we face is cultural involvement. Women go to traditional birth places to give birth but when there are complications they run back to the hospital” she said. Mrs Oluwaseun also talked about the lack of accessible roads to the hospital property and lack of antenatal care visits.
On a positive note, she said that midwifery as a practice is improving in Nigeria. According to her “the level of education of midwives has improved greatly and there has been reduction in maternal, neonatal and under 5 death rates”.
Midwives are critical to achieving SDG 3.1, reducing maternal and newborn deaths and so should be fully integrated into health systems. According to the State of Midwifery report, investing in universal access to quality midwifery care could save 4.3 million lives annually in the prevention of maternal and neonatal deaths and stillbirths.