This month, more than 4000 midwives from over 100 countries will descend on Toronto for 5 days to attend the 31st International Confederation of Midwives (ICM) Triennial Congress. The theme of this year's Congress is particularly apt: ‘Midwives—Making a Difference in the World’. Although there has been a remarkable reduction in the number of women and newborns dying over the last 25 years, there is still an unacceptably high number of mothers and babies who die each year as a result of pregnancy and childbirth. In 2013 alone, it was estimated that, of the 139 million births worldwide, 289 000 women died from childbirth complications and around 3 million newborn babies died in the first month of life. A further 2.6 million babies were stillborn (United Nations Population Fund (UNFPA), 2014).
The UN's 2030 Agenda for Sustainable Development (UN, 2015) sets out 17 goals towards which member states have committed to work. Goal 3—‘Ensure healthy lives and promote wellbeing for all at all ages'—identifies multiple targets related to improved global health by 2030, including reducing maternal mortality and ending preventable deaths of newborns and children under 5. One strong and consistent message which has emerged from a number of reports in recent years, is that midwives can, and do, make a difference in saving the lives of women and newborns and promoting good health—but there are not enough of them to go round. It has been estimated that 1 in 3 women globally gives birth without the help of anyone trained to do so; 2 million have given birth alone (Save the Children, 2014).
Recognising the importance of midwifery in global efforts to reduce maternal and neonatal mortality, the UNFPA coordinated a series of ‘State of the World's Midwifery’ reports. The second, A Universal Pathway: A Woman's Right to Health, (UNFPA, 2014), examined the state of midwifery in 73 low and middle-income countries in Africa, Asia and Latin America. The countries reviewed account for more than 92% of all maternal and newborn deaths and stillbirths globally, and yet only 42% of the world's trained health professionals. Only 22% of the countries have enough adequately educated midwives to meet the basic needs of women and newborns and 78% of the countries face serious shortages of midwives (UNFPA, 2014).
The report discusses four key factors, which must be addressed to ensure that all women have access to sexual, reproductive, maternal and newborn services as a basic human right: availability, accessibility, acceptability and quality of midwifery. It also highlighted that midwives who are educated and regulated to international standards can provide 87% of the essential care required before and after childbirth; and if this happened then around two thirds of all maternal and newborn deaths would be prevented, saving millions of lives every year (UNFPA, 2014).
Disparities in the number of maternal and newborn deaths between the wealthy and poor countries of the world must be addressed. It is estimated that if all pregnant women and their newborns received care at the standards recommended by the World Health Organization, maternal deaths would drop by around 67% and newborn deaths by 77%. Investment in quality midwifery could help bridge this gap and was one of the key messages from the important Lancet series on midwifery (Lancet, 2014).
The Congress will provide opportunities for midwives from across the globe to share knowledge and skills for better quality care and the strategies required to continue the fight to reduce maternal and neonatal mortality. It also provides a forum to develop relationships and partnerships with other midwives internationally; if we can work together globally, our voices will be more likely to be heard at international and national policy making levels.
Saturday 17 June—the day before the ICM Congress starts—will see the March for More Midwives, when thousands of midwives take to the streets of Toronto to highlight the need for more funding for midwives and midwifery education. March with them on the day or if you can't be there, share the word and show your support on social media for this important cause.
Canada itself has only around 1300 midwives, who attend 10% of births, so there is much that needs to be done to promote the value and advantages of midwifery here, too. It feels right that the world's biggest ever midwifery gathering will take place in this great city, and I look forward to meeting many of you here!