Arie Hoekman,UNFPA Representative Strengthening Midwifery to save lives and promote health of women and newborn 3rd MCH Annual Conference Nanchang, November

Overview Facts and figures on maternal mortality Effects of skilled attendance in pregnancy and birth MOMs: Midwives and others with midwifery skills What midwives do 2011 the State of the World Midwifery Actions to Strengthen Midwifery Force and Services UNPFA assistance in strengthening midwifery in China

Facts and figures on maternal mortality and morbidity Every year approx 350,000 maternal deaths happen worldwide 75% of these deaths occur during childbirth and the post-partum period 80% of maternal deaths are due to 5 direct causes: hemorrhage, sepsis, unsafe abortion, obstructed labor and hypertensive disease of pregnancy 7 million women suffer injury, infection or disability from maternal causes

Facts and figures on maternal mortality More than 60% of all maternal deaths occur in 6 countries — India, Nigeria, Pakistan, Afghanistan, Ethiopia and DRC Only 23 countries are on track to achieve a 75% decrease in maternal mortality rates (MDG 5) by 2015 China is one of these 23 countries

Effects of skilled attendance in pregnancy and birth Up to 90% of maternal deaths could be prevented by universal access to adequate reproductive health services (MDG 5b), involving basic equipment, supplies and skilled healthcare workers A 10% increase in skilled health workers leads to a 5% reduction in maternal deaths Malaysia, Sri Lanka and Thailand managed to half their Maternal Mortality Rate within 10 years by increasing the number of midwives

MOMs: Midwives and others with midwifery skills UNFPA uses “midwives and others with midwifery skills” to mean “skilled birth attendant”. MOMs recognizes the unique skills, roles and responsibilities midwives bring to delivery care and of the central role they play in making motherhood safer. “Skilled birth attendant” encompasses the definition of a midwife, but is broader and more generic. It also includes nurses, physicians and others who have been trained in proficiency in midwifery skills.

What midwives do The basic services midwives routinely provide to protect the health of the mother and the baby include: 1.Caring for women during pregnancy, childbirth and the postnatal period 2.Treating complications due to miscarriages and/or unsafe abortions 3.Providing newborn care 4.Providing pre-pregnancy advice and health education

What midwives do 5. Recognizing and addressing problems in the woman and newborn before, during and after childbirth 6. Offering general health information, including reproductive health care and family planing 7. Assisting women to successfully breastfeed 8. Referring women and newborns for higher level care when complications arise during pregnancy and childbirth 9. Providing additional health services in communities such as immunizations and treatment of common diseases

2011 The State of the World’s Midwifery

2011 The State of the World’s Midwifery: Delivering Health, Saving Lives A total of 58 developing countries ( China is not one of them) were surveyed. Together they account for 91 % of the world’s maternal death Up to 3.6 million lives could be saved if additional 112,000 more health workers with midwifery skills were practicing in communities in these countries, backed up by a properly functioning health system The report states that midwifery is key to reducing maternal and infant deaths, and the only effective way to achieve MDG 4 & 5 However, midwives are in short supply in many developing countries and world demand at present calls for an additional 350,000 midwives The report calls therefore for action and gives recommendations

Recommendations to strengthen midwifery profession and services Every successful profession, has to have three strong pillars: education, association and regulation. Recognize midwifery as distinct profession and promote it as a career including positions at the national policy level Invest in human resource management to develop and maintain competencies, manage entries and exits, and improve data on the practicing midwifery workforce Establish criteria for entry into the profession, educational standards and practice competencies

Recommendations to strengthen midwifery force and services Accredit schools and education curricula in both public and private sectors, and Protect the prof. title ‘midwife’ and define its scope of practice License and relicense midwives, maintain codes of ethics and code of conduct, and manage sanctioning Promote the establishment of a Professional Midwifery Association: this can be a catalyst for change as it can raise midwives’ profile and status in the national policy arena and strengthen their input into health plans and policy development Ensure adequate availability and distribution of emergency obstetric and newborn care facilities, including midwife-led units of care

Observed situation in China China has made considerable achievement in reducing maternal mortality and morbidity Extremely strong focus on institutional delivery at tertiary level hospitals – impersonal, high C-section, accessibility problems especially in remote areas China has no distinct profession of midwives China has few medical education institutions providing postsecondary and undergraduate midwifery educations One programme is the 3 years of midwifery education after 9 compulsory years of school, which actually puts the social status of midwives at a low level and they are often seen as ‘second class’ health worker

UNPFA assistance in strengthening midwifery in China In collaboration with the MOH, the China MCH Association, Peking University and the Hunan Health Bureau, UNFPA is supporting the implementation of a project in Hunan called ‘strengthening midwifery and promoting natural delivery’. It aims to demonstrate how: an increased use of qualified midwives is one of the measures to reduce C-section without medical reasons and women’s access to delivery services as well as basic RH services in remote areas will improve by skilled community midwives.

UNPFA assistance in strengthening midwifery in China The project aims to achieve the following: -provide evidence-based policy recommendations for (re-)establishing) midwifery as a profession in the health system and (re-)establishing a formal educational system in midwifery -Update guidelines on provision of services and to improve service providers’ skills and awareness how to create an enabling environment for natural delivery

Thank you !