Imagine if midwives’ voices were heard, they were fairly compensated, had safe working conditions, and could perform their full scope of practice.

A 2021 comprehensive review found that skilled birth attendants and midwives in low- and middle-income countries face low salary and inconsistent payments; poor supervision; lack of supplies, equipment, electricity, and water; and lack of safety; leading to low morale, poor retention of trained staff, acute staff shortages, and a heavy workload for remaining staff.

Lack of respect and recognition for frontline health workers lies at the heart of many workforce-related challenges that impede progress toward eliminating preventable maternal and child deaths, reaching universal health coverage, and even ending the COVID-19 pandemic. So we sat down with 26 experts, including frontline health workers like Olajumoke Adebayo to identify effective strategies and recommendations to change that.

Ola is a nurse-midwife and advocate in Nigeria, and one of the International Confederation of Midwives’ Young Midwife Leaders. She shares key challenges she and other midwives face and what she thinks will help.

Read: Strengthening Respect and Recognition for Health Workers: Strategies and Recommendations, our new report for more promising approaches to increasing respect and recognition for health workers.

Q: What challenges do national policymakers need to address to increase respect and recognition for nurses and midwives?

To be honest, not a lot of respect is given to nurses and midwives. You get to work, you get insulted after working really, really hard. You get insults from employers, patients, everybody. At the end of the day, the self esteem of the nurses and midwives are usually pretty weak. A young nurse or midwife comes in very enthusiastic about helping people and changing the world, but two or three years down the line they’re already tired of the job because there is no fulfillment and nobody listens to you.

Q: What interventions do you think would be effective?

I identify more as a midwife. In Nigeria, I see a lot of policies that midwives have to implement, but midwives were not involved in making them. So most of the time when health leaders bring policies down to the local level, the implementation is very difficult and unrealistic. At the national level, there needs to be a rule that says if there’s a policy that will be implemented at the lower levels of the health system, especially by nurses or midwives, there has to be a nurse or a midwife at the decision-making table.

For compensation, nurse-midwives are usually afterthoughts. It’s really, really difficult to get just one good paying job as a midwife in Nigeria. You have to do your main job and then do other jobs to make ends meet, especially with current inflation levels. This is why a lot of young people do not want to be nurses or midwives anymore. They’re going to good paying jobs in tech or finance, where the entry level pay is so much better than even for a very qualified nurse or midwife. So countries need to pay nurses and midwives fairly.

The working environment is not really safe. Especially for women, especially as midwives—they’re scared of being raped at work, being sexually assaulted, or being killed. I’ve had situations where I thought a male patient was going to harm me, and I got threats, and then I had to use my people skills to find a way to talk to the patient and try to calm him down. If I don’t feel safe at work, I don’t think I will be able to provide proper care to the patients. So there’s a need to create policies that don’t just make the health worker responsible, but hold the patients responsible.

Q: What actions at a global level do you think would be useful?

The global community can put pressure on governments to address issues around respect and recognition and they can bring awareness to key reports like the State of the World’s Midwifery (SoWMy) 2021 report, which shows the benefits of investing in midwifery.

The SoWMy report shows that if midwives were supported and invested in by governments around the world, 4.3 million lives would be saved every year. Governments need to clearly see that if you invest in midwives, they’ll be able to get these returns.

National leaders need to provide more leadership opportunities for midwives and include us in policymaking.

Q: What mechanisms do you think can help strengthen respect and recognition of health workers?

The International Confederation of Midwives (ICM) is a really strong network and doing a really good job highlighting the impact of midwives and putting us at the forefront.

A lot of midwives in Africa identify positively with the ICM. They amplify our thoughts and our voices a lot. For me, if the global space can try to always consult with international associations like ICM, I think it would go a long way to identify what needs to be done.

Social media can also be really effective. I’m very active on Twitter (@Thejummyadebayo), but most midwives I know are on LinkedIn, Facebook, and WhatsApp. ICM uses these social platforms and their newsletters are very effective in communicating what they’ve been up to, what’s currently happening, and new opportunities to improve advocacy.

Q: What types of policy recommendations would you recommend to the World Health Organization?

The World Health Organization should develop a basis of what a midwife is supposed to do and what a nurse is supposed to do to give a basic picture of their role. The ICM has some frameworks on what a midwife is supposed to do and the World Health Organization could decide to adopt them.

In Nigeria, midwives’ work has been dictated by doctors and in some hospitals, midwives are not allowed to perform certain roles they’ve been trained to do. I can say that if midwives were allowed to do certain jobs, a lot of deaths would have been prevented. And quality of life for certain patients would have improved drastically because time is very important in health. Every little time delay affects the outcome of the patient. Let governments know that by not letting a certain cadre of health workers perform their full role, you are shortchanging yourself in improving the health outcomes of people in your country.

Q: What gender transformative actions do you think are needed?

When it comes to leadership, there are not a lot of women who can help make decisions for us. It’s usually men at the top making decisions. It’s like they are creating maternal and child health policies without asking the midwives—the main people doing deliveries at the local level—to help shape them. The person at the front line knows so much better. So national leaders need to provide more leadership opportunities for midwives and include us in policymaking.

There also needs to be a lot more investment in educating nurses and midwives. We can’t always afford the education we want, based on our pay and time away from work. It’s not easy as a woman juggling jobs, children, a family, and housework. So I see a lot of nurses not furthering their education and reaching their full potential.

The Strengthening Respect and Recognition for Health Workers: Strategies and Recommendations report was funded by the Johnson & Johnson Foundation. Thanks to Helen Cornman, an IntraHealth consultant, for conducting or co-conducting many of the interviews for the report.