Reducing global maternal and newborn mortality

The research, from Professors Mary Renfrew and Alison McFadden and team in the Mother and Infant Research Unit, was published in the Lancet Series on Midwifery and transformed professional, academic and public understanding of midwifery. It has changed global and national policy and standards of service provision, regulation, education and workforce. It enabled NGOs and governments to advocate and implement changes which help achieve the UN Sustainable Development Goals by addressing unacceptably high levels of maternal and newborn mortality and morbidity rates in low, middle and high-income countries across the globe.

Research supported by the Bill and Melinda Gates Foundation, NORAD and WHO, provided evidence of the value of midwifery, a definition and framework for quality maternal and newborn care. Analysis showed that quality midwifery provided by midwives who are educated and trained to international standards and integrated into the health system achieved reductions in a plethora of complications and improved outcomes for both mother and child. These included maternal and newborn mortality and stillbirth, pre-term birth, interventions in childbirth, maternal morbidity, pain, and anxiety and depression, and an increase in breastfeeding, immunisation, contraceptive use, improved mother-baby interaction and women’s experiences, and achieved health service resource efficiencies.

These findings launched a global call to action to implement midwifery at scale, defined in the Lancet Series Improvement of maternal and newborn health through midwifery. The impact was swift and extensive across all the fields necessary for large-scale, sustainable change: policy, guidance, advocacy, funding, education, practice and regulation.

Informed WHO and ICM guidance and standards

“It’s so influential, it’s really had a top to bottom change” “Globally, it has changed the language that we use in talking about midwifery... it has become embedded into many major global structures as well as right down to country level” (Fran McConville, Midwifery Advisor, WHO Geneva)

Supported advocacy globally and nationally

“It has been extremely influential in informing advocacy, funding and implementation efforts around the world. As a result, the Government of Malawi increased the midwifery workforce by more than 50% and established the position of Chief Midwifery Officer.” (Ms Ateva, Advocacy Manager, White Ribbon Alliance)

Increased funding for midwifery

“The Canadian government announced $6m in funding for indigenous midwifery and the Canadian Association of Midwives has been funded to support midwifery association strengthening and continuing education in Benin, DRC, Ethiopia, Haiti, Mali, South Sudan and Tanzania. It supported prioritizing $50,000,000 CAD from Global Affairs Canada and the Swedish International Development Corporation for South Sudan” (Ms Bacon, President, Canadian Midwives Association)

Strengthened regional and national policies and standards

Governments in every continent acted on the finding by implementing regional and national policy, introducing standards, guidance and achieving a strengthened midwifery workforce and quality of care. For example, the Indian government launched a programme of work for the education and regulation of professional midwives in December 2018 so that all women in India could have access to midwifery services for the first time:

“(There was) an extremely direct impact at a national level of a regional superpower with a population of 1.3bn” (Ministry of Health and Family Welfare, Government of India, Guidelines on Midwifery Services in India, New Delhi, 2018)

In Eastern Europe, a highly medicalised model of care with very high levels of maternal and newborn mortality is strengthening midwifery.

And in the UK, the Scottish Government’s strategy The best Start: A Five-Year Forward Plan for Maternity and Neonatal Care in Scotland, 2017, which is being implemented by all Health Boards, draws on this evidence and the QMNC framework to shape its recommendations.

Strengthened midwifery education and professional regulation

The research has strengthened midwifery education in countries worldwide by providing the core evidence for a WHO-UNFPA-ICM-UNICEF Framework for Action which is being used by universities globally:

“The PAHO Maternal Health Training Project is aiming to increase the number of healthcare workers trained competently in maternal and child health in eight Latin American countries. Quality of care was a fundamental focus... starting with the QMNC framework as a baseline. Currently, there are 4080 trained in Maternal Health.” (Prof Binfa, Head of WHO Collaborating Centre for Midwifery Development, University of Chile)

The research is being used by many countries to introduce and strengthen professional regulation:

“This research has been used to guide the revision (of the Required Competences for Registered Midwives (2018)) in Sweden” (Prof Klingberg and Dr Erlandsson, Dalarna University, Sweden)