References

Alkema L, Chou D, Hogan D Global, regional, and national levels and trends in maternal mortality between 1990 and 2015, with scenario-based projections to 2030: a systematic analysis by the UN Maternal Mortality Estimation Inter-Agency Group. Lancet. 2016; 387:(10017)462-74 https://doi.org/10.1016/S0140-6736(15)00838-7

Amouzou A, Ziqi M, Carvajal-Aguirre L, Quinley J. Skilled attendant at birth and newborn survival in Sub-Saharan Africa. J Glob Health. 2017; 7:(2) https://doi.org/10.7189/jogh.07.020504

Perry HB, Zulliger R, Rogers MM. Community health workers in low-, middle-, and high-income countries: an overview of their history, recent evolution, and current effectiveness. Annu Rev Public Health. 2014; 35:399-421 https://doi.org/10.1146/annurev-publhealth-032013-182354

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Why midwives alone are not enough

02 July 2019
5 min read
Volume 27 · Issue 7

Abstract

Despite the reductions in maternal mortality and morbidity across the world, there is far to go. Indie McDowell explores why increasing the numbers of trained midwives alone is not the answer

Talking to midwives from across Ethiopia and Kenya about the challenges and triumphs of being a clinician, the conversation often turned to where to go next (Box 1). Although there have been considerable steps taken over the recent decades to reduce maternal, neonatal and child mortality and morbidity (Alkema et al, 2016), there is still some way to go. Across eastern Africa, many programmes of risk and harm reduction have centred on the training of healthcare professionals, both increasing the skills of those already practising and introducing new positions, such as the community health extension workers (Say et al, 2014). There are proven benefits to such approaches, with research demonstrating a general raised awareness of common health problems, vaccinations, and the importance of public health education (regarding, for example, access to clean water, improved hygiene practices, and adherence to medicine schedules) in the prevention of certain disease outbreaks (Perry et al, 2014). In addition, research has also shown a decreased burden on larger medical facilities, with basic treatment outsourced to community-based health posts (Perry et al, 2014). These are commendable improvements that work. But in the realm of maternal health, the problems run deeper (Say et al, 2014). As midwives have said:

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