The projected effect of scaling up midwifery

Paper 2 of the Lancet Series on Midwifery models the life-saving impact of scaling up midwifery interventions on women and babies in 78 countries with the highest burden of maternal and child mortality. The authors find that scaling-up midwifery interventions to cover almost all women and babies would avoid 83% of all maternal, stillbirth and newborn deaths in countries with the lowest levels of human development. A large part of that impact comes from scaling up family planning services, which, alone, could avoid 57% of all deaths.Midwifery interventions, for the purpose of this article, are defined as all of the essential interventions for reproductive, maternal and newborn care up until, but not including, comprehensive emergency care and other specialist interventions.  Midwifery interventions include, for example: family planning, sexual health care, routine antenatal, intrapartum, post-partum and post-natal care, as well as most Basic Emergency Obstetric and Newborn interventions.The article assesses the additional impact of specialist care. At all levels of development, an additional 30% of maternal deaths could be prevented by specialist care, on top of the 30% already prevented by midwifery care. However midwifery care prevents a larger proportion of stillbirths and newborn deaths compared to specialist care.The authors also examine the different impact of low, medium and universal scale-up of midwifery care in the context of low, medium and higher levels of development. Impact is higher the higher the level of scale-up. In addition, lower-levels of scale-up have a higher impact in lower development settings compared to higher development settings. The opposite is true for universal levels of scale-up, where higher development settings see a higher impact compared to lower development settings.The article also highlights the limitations of current tools for assessing the impact of midwifery care. For example, the analysis models quality based on uniform assumptions about how quality of care (specifically, access to basic or comprehensive emergency care) changes depending on levels of coverage for facility delivery. Another issue is the fact that midwifery care is much more than a list of interventions: as shown by Paper 1, it also includes values and approaches in delivering or rather avoiding the need for those interventions, which at present cannot be modelled quantitatively. Finally, midwifery care has an effect on well-being, satisfaction, morbidity, and other areas which women and their families care about but which cannot be modelled using existing tools.To read this article, click here. Free registration is required.Homer, C.S.E.,  Friberg, I.K., Bastos Dias, M.A., ten Hoope-Bender, P. Sandall, J., Speciale, A.M., & Bartlett, L.A. (2014). The projected effect of scaling up midwifery, The Lancet (Early online publication).