Every year, May 5 is celebrated as the International Midwives’ Day to honour the work done by midwives, and to acknowledge their role in saving the lives of mothers and new-borns.
Midwives provide women-centric care throughout the process of pregnancy and birth, promoting better labour pain management, reducing excess reliance on unnecessary C-sections and medical interventions during childbirth, offering emotional strength to women, and empowering their choices and decisions. Midwives cement a relationship of respect, compassion, and trust with mothers and their families, and with the woman-centric care they offer, they are crucial to ensuring equitable health access even in the remotest of communities.
India has made significant strides in the past decade and a half to curb the rates of maternal deaths in the country. India has improved its maternal mortality ratio (MMR)—the number of deaths per 100,000 live births — to 97 deaths per lakh in 2018-2020 from 103 deaths per lakh in 2017-2019. This rapid decline is the result of multiple targeted interventions by the Government of India with the objective of addressing all aspects of maternal care.
The campaign called What Women Want asked over 3.5 lakh women in India about their most important aspiration when seeking maternal health care and the resounding response was respectful maternal care, as part of quality care, where their needs are met, their voices heard, and their choices upheld. There is global evidence that midwives are best placed to provide respectful maternity care.
Dr Aparajita Gogoi, executive director, C3, and national coordinator, WRAI shares, “Evidence shows that fully educated, licensed, and integrated midwives supported by interdisciplinary teams can deliver up-to 90% of the essential sexual, reproductive, maternal, and newborn health interventions across the life-course, and midwifery-led care is a proven pathway for the Universal Health Care, primary healthcare, and to ensure quality, equity and dignity in healthcare; making trained and skilled midwives a critical asset to the public health system as they extend the reach of essential health services even to low-resource, rural settings where there could be a shortage of qualified and skilled care.”
India would need to cater to 34.6 million pregnancies per annum by 2030 to be able to achieve universal access in maternal and new-born healthcarecountry-wide (BMGF Midwifery Desk Research Findings, 2019). This would involve not just the deliveries, but also pre-natal and post-natal check-ups, and the ability to respond to birth complications. While this puts a massive load on our healthcare system, evidence also shows that professionally-trained ,midwives – working in tandem with inter-disciplinary healthcare teams – can significantly reduce this load by taking on 90% of the essential interventions during the continuum of pregnancy and delivery.
As a result, specialists and surgeons are able to spend more time dealing with more complicated pregnancies, providing more dedicated care. In addition, midwives address pregnant women’s needs in a more personalized manner, while providing valuable support to doctors and nurses in high-case-load medical facilities by shouldering the responsibility of looking after low-risk normal deliveries.
The Ministry of Health and Welfare, recognizing the role midwives can play in our health system, introduced a specialist cadre of Nurse Practitioners in Midwifery (NPMs) as an integral part of the health workforce in India. These NPMs are being trained and educated to international standards in providing quality and woman-centric maternal and new-born health care, strengthening the country’s maternal care system in resource-efficient ways.
In a campaign conducted by the White Ribbon Alliance India (WRAI), midwives across the country came together to map out strategies that would enable midwives to deliver on their expected roles.
These include appropriate infrastructure, remuneration, respect and recognition from health systems, clear career pathways and decision-making powers, and the creation of an enabling environment.
India is at a critical juncture of the rollout of midwifery-led care in India. This new code of NPMs could be a big game changer in maternity care provision. As we celebrate this International Day of the Midwife 2023, it is imperative that we all join forces and support midwives and the model of midwifery led care which will enable a care continuum where women’s agency, autonomy and dignity are at the forefront.
