Tanzania: Midwifery Investment Can Save More Lives

INVESTMENT in midwives is considered a cost-effective approach to improving health outcomes for mothers and babies while reducing maternal and neonatal mortality and stillbirths.

Data indicates that universal coverage of midwifedelivered interventions could avert 67 percent of maternal deaths, 64 percent of neonatal deaths and 65 percent of stillbirths, allowing 4.3 million lives around the globe to be saved annually by 2035.

Entirely, it's not only about saving lives; midwives are the key to achieving Tanzania's Vision 2025 and the ambitious sustainable development goals, as emphasized by the President of Tanzania Midwives Association (TAMA), Mr Feddy Mwanga. "Midwives not only improve the chance of a safe pregnancy and delivery, but also provide the full continuum of care throughout women and adolescents' lives.

By doing so, they play a key role in the empowerment of women and building equitable, inclusive and sustainable societies," said Mr Mwanga.

According to the State of the World's Midwifery Report of 2021, investing in midwives can facilitate positive birth experiences and safe, improved health outcomes, augments labour supply, and favours inclusive and equitable growth which in turn facilitates economic stabilization, and can have a positive macroeconomic impact.

Each year on May 5, the world marks the International Day of the Midwife to honour the extraordinary contribution of midwives to humanity. The theme for this year's commemorations focused on the mounting data and evidence for more investment in midwifery as an essential element of health care.

In Tanzania, efforts to strengthen health systems and improve sexual and reproductive health and rights of women and girls, including a reduction in the number of preventable maternal, infant and child deaths are gaining momentum although much needs to be done.

The midwifery report has taken note on how Covid-19 pandemic has shone a light on the importance of investing in primary health care for meeting population health needs.

Midwives are essential providers of primary health care and can play a major role in this area as well as other levels of the health system: in addition to maternity care, they provide a wide range of clinical interventions and contribute to broader health goals, such as addressing sexual and reproductive rights, promoting self-care interventions and empowering women and adolescent girls.

For midwives to achieve their potential, greater investment for key areas have been underscored in the report, including education and training; health workforce planning, management and regulation and the work environment; leadership and governance; and service delivery.

These investments should be considered at country, regional and global levels by governments, policy-makers, regulatory authorities, education institutions, professional associations, international organizations, global partnerships, donor agencies, civil society organizations and researchers.

The need to invest in the production and deployment of Sexual, Reproductive, Maternal, Newborn and Adolescent Health (SRMNAH) workers is not confined to countries with a needs-based shortage. Many countries, including some high-income countries, are forecast to have insufficient SRMNAH workers to meet demand by 2030.

The report also addresses among such factors preventing the SRMNAH workforce from meeting all of the needs, including insufficient numbers, inefficient skill mix, inequitable distribution, varying levels and quality of education and training programmes, limited qualified educators (including for supervision and mentoring) and limited effective regulation.

"Even where workforce data is available, they are rarely fully disaggregated by important characteristics, such as gender, occupation group and geographical location, making it difficult to identify and address gaps in service provision. "Some population groups risk their access to SRMNAH workers being restricted due to characteristics, including age, poverty, geographical location, disability, ethnicity, conflict, sexual orientation, gender identity and religion," states the report.

As such, the voices of service users are essential for understanding the factors that influence their care-seeking behaviour. "Left behind" groups require special attention to ensure that they can access care from qualified practitioners. "Investment in midwives needs to include not just investment in their numbers, but investments in their education, ongoing training, regulation, and working environment," said Pamela O'Donnell, High Commissioner of Canada in Tanzania.

"If these investments are made, they will be able to achieve their full life-saving, healthimproving, system-strengthening potential." UNFPA as a lead UN agency in partnership with TAMA supports the efforts of the government to build a competent, well-trained and well-supported midwifery workforce.

In her statement to mark this year's International Midwifery Day, UNFPA Executive Director, Dr Natalia Kanem observed that midwives deserve greater investment in their capabilities and workplaces that empower them and fully acknowledge their skills and contributions.

The latest edition of the State of the World's Midwifery report launched last week by UNFPA, the World Health Organization and the International Confederation of midwives affirms that if the number of midwives increase the quality of care they provide, an estimated 4.3 million lives would be saved a year by 2035.

"Midwives often work under extraordinary circumstances. They may walk miles to reach women or open space in their own homes to help them safely give birth. They have faced increasing pressure during the Covid-19 pandemic, and heightened inequalities in their workplaces.

Often short on protective gear, and with less access to vaccines than other healthcare workers, midwives have put their own lives at risk serving others," said Dr Kanem. According to her, such dedication is an invaluable resource, yet too many health systems depend on it without commensurate backing of midwifery as a profession.

That will short-circuit ambitions to reach the goal of zero preventable maternal deaths by 2030. "We have the evidence and know what must be done. Health systems everywhere need to take note - and take action - because investing in empowered midwives is one of the surest ways to safeguard life and protect the health and well-being of all," emphasized the UNFPA Executive Director.

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