The International Day of the Midwife on 5 May celebrates the work of midwives across the globe in a world of increasing risk and crisis. In 2025, the theme for this celebration is "midwives: critical in every crisis." This theme highlighting the role of midwifery and its crucial contribution to maternal health during crisis is very relevant to Nepal.

In the past two years, Nepal has witnessed the severe impacts of earthquakes and river flooding in different parts of the country. Record-breaking extreme heatwaves have hit large parts of the country in the past years, and new challenges of building climate-resilient communities are becoming increasingly important. These events have an enormous impact on people, communities, and public services.

Women are disproportionately impacted by these events because of the profound inequalities they face in their lives. It goes without saying pregnant women, new mothers and their newborns are particularly vulnerable during these crises. Pregnancy and births do not pause when there is a flood or an earthquake, and the need for services that support healthy births that midwives can provide is not diminished during a crisis. They become even more critical.

As we salute midwives here in Nepal and around the world, it is an opportunity to recognise not only the incredible work midwives do but also the potential of realising a vision of a strong and professional cadre of midwives that are an integral part of the health sector.

As Nepal invests in building a more resilient health service, resources such as midwives should be at the centre of thinking about the future. The midwifery model of care that has evolved across the world offers a simple, affordable and sustainable solution to high maternal mortality levels that produces good outcomes for mothers and newborns time and time again.

The benefits of a strong midwifery cadre also go beyond the positive outcomes of their direct work with mothers and babies; there are also significant economic cost-benefit returns for the wider health sector and population on investments in midwifery, according to academic studies.

Nepal's remarkable journey

According to the maternal mortality report released last month, Nepal has an estimated maternal mortality ratio of 142 deaths per 100,000 live births. This is a significant reduction from the ratio of 239 deaths per 100,000 live births in 2016.

This progress is a result of significant political commitment and investments in maternal healthcare and family planning with positive outcomes in antenatal care, the availability of skilled birth attendants, and safe delivery facilities. This level of progress is still, however, behind the SDG target of 70 deaths per 100,000 live births by 2030, reducing the neonatal mortality rate to less than 12 deaths per 1,000 live births, and reducing the stillbirth rate to below 12.5 per 1,000 live births.

Maternal deaths in Nepal are also preventable. The 2021 Nepal maternal mortality survey concluded more than half of these deaths occurred at health facilities due to delays in receiving health care, while 26 percent of mothers died at home. The remaining 17 percent of deaths occur whilst travelling to health facilities or during referrals between facilities. The most common reasons for delays at health facilities are linked to lack of emergency obstetric and neonatal care readiness and poor referral networks.

A clear policy environment

To meet the SDG targets on maternal mortality, there needs to be acceleration of efforts with strengthened midwifery models contributing to obtaining key outcomes. The Ministry of Health and Population's policies recognise this crucial need and are committed to increasing the number of midwives within a clear policy framework that creates a conducive environment for the future.

This comprehensive policy framework includes the National Nursing and Midwifery Strategy (2021–2030) and the Human Resources for Health Strategy (2021–2030), which have prioritised midwifery as essential for achieving national health targets. The government has also recently developed a National Midwifery Roadmap for 2024-2030 which outlines a clear strategic pathway, with policy objectives and interventions, to build a sustainable midwifery workforce and enhance quality of care.

An important step towards meeting this need is this ministry's targets to train and deploy 3,900 certificate-level midwives by the end of 2025, increasing to 6,000 by 2030. It also aims to educate and deploy 250 midwifery officers supported by 30 midwifery administrators by the end of this year. The National Midwifery Roadmap outlines short- and longer-term goals that include plans for conducting organisational and management surveys to assess and guide the supply and deployment of midwifery human resources. It also covers standards in midwifery education so that they meet international standards of clinical practice. A key pillar is also that it provides the essential resources required and identifies the structures for posts required to support midwifery service delivery.

Translating policy goals into actions

This strong policy commitment now needs to be matched by acceleration in implementation. Closing the midwifery gap is crucial. Well-trained and supported midwives are critical to ensuring universal health coverage. They are able to deliver 90 percent of all essential sexual, reproductive, maternal and newborn health services in an affordable, efficient and sustainable way and are a key part of the solution to driving down maternal mortality.

If the government targets are to be met, it is crucial that Nepal urgently expands investments, including in education and deployment of midwives, promoting midwifery models of care in a conducive environment. Ensuring that there is a professional network of skilled midwives to reach the most affected communities will be central to the reduction of maternal mortality over the next five years to ensure the government's impressive track record continues to transform the health sector.

Young Hong is the UNFPA Country Representative for Nepal