Last week, the United Nations Population Fund (UNFPA) and partner agencies released The State of the World’s Midwifery 2011 report, which shows the world is short 350,000 midwives—nearly the same number of women who die each year from complications of pregnancy or childbirth: 358,000. Using data from 58 developing countries where 91% of maternal deaths occur, the report stresses that making high-quality midwifery services more widely available is an essential step to improving women and children’s health.

The report examines specific challenges in the field of midwifery such as the number and distribution of skilled birth attendants worldwide; emerging concerns related to education, professional associations, and national regulation and policies of practice; and personnel and gender considerations for the largely female midwifery workforce. The report calls for accelerating investments in midwifery services, scaling up training and incentives, and “skilling up” qualified providers.

The report also includes several background papers on IntraHealth’s work in India, Mali, Rwanda, and Uganda:

• Strengthening pre-service education for midwives and nurses in Rwanda and Mali by Boniface Sebikali and Catherine Murphy
• Training auxiliary nurse midwives in Jharkhand State, India by Barbara Stilwell and Sharon Arscott-Mills
• Auxiliary midwives use active management of third stage labour to improve safe delivery in Mali by Laura Hurley
• Data show high level of attrition in Uganda by Julie C. Spero and Pamela A. McQuide.

These papers describe some of the work IntraHealth is doing in collaboration with governments and partners to train more midwives and better support working providers. For example, in Rwanda and Mali, IntraHealth has worked with the ministries of health and local schools to improve national nursing and midwifery curricula, training health workers on “know-how” rather than “know-all.” Mali has also successfully expanded access to skilled maternal care for hundreds of thousands of women living in the country’s rural north by training a group of auxiliary midwives called matrones to perform lifesaving protocols at birth. Similarly, in two states in India, auxiliary nurse midwives have been trained as skilled birth attendants and can effectively prevent maternal deaths. And in Uganda, an electronic database is tracking all people who entered midwifery training programs from 1970-2006 to inform data-driven decisions about gaps in the Ugandan health worker training system, including low rates of training completion, registration, and licensure.