Investing in Midwives to Reduce Maternal Mortality
Lessons from Rwanda
We are all a daughter or son, partner, sibling, or friend of a mother; whether we realize it or not, our lives have been impacted by the unique and powerful role of mothers. Mothers positively affect the lives of their children and family, but also the lives of their broader communities.
And yet, despite the essential role that mothers play in societies around the world, our interest, focus, and investment in their health, their pregnancies, and their lives have fallen short. We consistently prioritize other critical health issues, ranging from HIV to cancer, over maternal health. While the emphasis on improving maternal health has grown over the last few decades, much more attention needs to be given to this critical issue.
While maternal mortality is often misconceived as a developing world issue, data on the issue in the U.S. reveals some startling statistics: Not only does the U.S. have the highest maternal mortality rate (MMR) in the developed world, it is also the only country where the MMR has increased in recent years (from 12 to 14 per 100,000 live births, between 2000 and 2015 respectively). Tennis Ace Serena William’s recent delivery struggles raised the profile of the issue, highlighting that it affects American women of all socioeconomic groups but especially black women.
To address this crisis, the first step is to acknowledge its existence. Next, we must identify innovative, cost-effective means of addressing our shortcomings. We need to explore and embrace different approaches to maternal healthcare, practicing humility as we learn from how other nations around the world are addressing this challenge.
Midwives can, and should, be considered as an essential part of the solution. Increasingly perceived as an alternative, “hippie” birth option in the U.S., midwives are central players in the safe delivery of mothers and babies in the majority of the world, from Europe to Africa to Asia. According to the State of the World’s Midwifery: 2014, midwives could avert roughly two-thirds of all maternal and newborn deaths and provide 87% of essential care for women and newborns.
In Rwanda, the outlook for pregnant and expectant mothers has improved greatly over the last two decades. The country was one of only nine countries to achieve Millennium Development Goal 5A — achieving at least a 75% point-estimate reduction in maternal mortality — with an estimated 78% reduction in maternal mortality rate. While this is commendable progress, there is still considerable room for improvement, as there are still 290 maternal deaths for every 100,000 live births.
Midwifery, which is among the few dedicated maternal health professions, is one of the reasons for this incredible progress. In Rwanda, midwives provide a full spectrum of services, from family planning to postnatal visits. Overall, they still represent an under-tapped opportunity for reducing maternal mortality in the nation, as Rwanda faces a shortage of midwives in the thousands, leaving nurses to fill in the gap and dedicate the majority of their time to maternal health services despite limited specific training.
Acknowledging these shortcomings, the Rwandan Ministry of Health has placed increasing emphasis on improving maternal health in Vision 2020, with investing in midwives an important component of their strategy for doing so. The Rwandan Association of Midwives was established in 2011 to meet the professional needs of midwives, and the University of Rwanda enrolled students in its first Master’s in Midwifery program in late 2018. As these developments continue, we should strive to provide advanced trainings, invest in midwifery education, and encourage young Rwandans — men and women — to pursue midwifery as a career.
We continue to work toward the day when all women can safely deliver children without fear of losing their lives. We are on track to achieve this, but as we work to close the gap in the U.S. and abroad, we need to learn from what’s working and leverage every resource we have, starting with midwives.
Katie Suarez was a 2017–2018 Global Health Corps fellow in Rwanda.
Global Health Corps (GHC) is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. To learn more, visit our website and connect with us on Twitter/Instagram/Facebook.
