Millions of lives of women and newborns are lost, and millions more experience ill health or injury because the needs of pregnant women and the skills of midwives are not recognised or prioritised.

The world is currently facing a shortage of 900,000 midwives, which represents a third of the required global midwifery workforce.

The COVID-19 crisis has only exacerbated the problems, with the health needs of women and newborns being overshadowed, midwifery services being disrupted and midwives being deployed to other health services.

These are some key takeaways from the 2021 State of World's Midwifery report launched today by UNFPA, World Health Organisation and International Confederation of Midwives and partners, which evaluates the midwifery workforce and related health resources in 194 countries, including Nepal.

According to the report, acute shortage of midwives is exacting a terrible global toll in the form of preventable deaths. Fully resourcing midwife-delivered care by 2035 could avert 67 per cent of maternal deaths, 64 per cent of newborn deaths and 65 per cent of stillbirths. It could save an estimated 4.3 million lives per year. Despite alarms raised in the last State of the World's Midwifery report in 2014, which also provided a roadmap regarding the ways to remedy this deficit, progress over the past eight years has been too slow. The analysis in this year's report shows that the situation will have improved only slightly at current rates of progress by 2030.

Midwives do not just attend births. They also provide antenatal and postnatal care and a range of sexual and reproductive health services, including family planning, detecting and treating sexually transmitted infections, and sexual and reproductive health services for adolescents, while also ensuring respectful care and upholding women's rights. As the number of midwives increase, and they are able to provide care in an enabling environment, the health of women and newborns improves as a whole, thereby benefiting every section of the society.

As per the report, greater investment is needed to ensure education and training for midwives to achieve their life-saving and life-changing potential, midwife-led service delivery, and midwifery leadership.

Governments must prioritise funding and support for midwifery and take concrete steps to include midwives in relation to determining health policies.

Dr Franka Cadée, president of the International Confederation of Midwives says, "As autonomous, primary care providers and midwives are continually overlooked and ignored, it's high time that the governments acknowledge the evidence surrounding the life-promoting and life-saving impact of midwife-led care.

ICM is committed to leveraging the strength of our global midwife community to extend these powerful findings and inspire country-level change."

According to Dr Natalia Kanem, UNFPA executive director, the State of the World's Midwifery report sounds the alarm that the world urgently needs 1.1 million more essential health workers in the current scenario to deliver sexual, reproductive, maternal, newborn and adolescent health care while 80 per cent of these missing essential health workers are midwives. A capable, well-trained midwife can have an enormous impact on childbearing women and their families – an impact often passed on from one generation to the next."

"Midwives play a vital role in reducing the risks of childbirth for women all over the world, but majority of them have been exposed to risk during the COVID-19 pandemic.

We must learn the lessons from the pandemic by implementing policies and making investments in a bid to deliver better support and protection for midwives and other health workers," says WHO Director-General, Dr Tedros Adhanom Ghebreyesus.

A version of this article appears in the print on May 6, 2021, of The Himalayan Times.