May 5th is dedicated to celebrating the International Day of the Midwife, focusing this year on the theme “One Million More Midwives.” For Bangladesh, this serves as a reminder to fulfill a journey that commenced with great promise. The nation has been acknowledged globally as a “Champion Country” for its significant strides in reducing maternal mortality rates and establishing a professional midwifery cadre to provide top-tier sexual and reproductive health services, including safe and respectful maternity care. Over the past 15 years, the UNFPA has been a key partner in this endeavor, collaborating with the Government of Bangladesh to develop high-standard curricula, faculty, and regulatory frameworks essential for this crucial profession. Presently, more than 11,000 midwives in Bangladesh have completed their training and are licensed to practice.
Despite the substantial groundwork laid, the pace of deploying these professionals remains slow. Maternal and newborn mortality rates continue to be high, with around 4,000 women losing their lives annually during childbirth in 2023. The commitments towards advancing midwifery in Bangladesh have not yet translated into a sufficient number of professionals available to safeguard lives. To regain momentum, it is crucial to understand that investing in midwives is not merely a health expenditure but a strategic investment in women’s lives, representing a cost-effective approach to building a healthy, resilient, and prosperous nation. Experts refer to this as the “triple impact” of midwifery.
The Influence on Health: Prioritizing Quality over Medicalization
By ensuring that midwives are trained to meet international standards, the UNFPA guarantees that they can deliver 90% of essential sexual and reproductive health services. When midwives take the lead, there is a notable decrease in unnecessary medical interventions. The trend of excessive medicalization in childbirth facilities is on the rise. To counter this, it is imperative to have midwives who can advocate for safe and natural deliveries. By reducing the dependency on avoidable Caesarean sections and other surgical procedures, midwives not only enhance the health outcomes for mothers and newborns but also shield families from exorbitant out-of-pocket medical costs.
The Impact on the Economy: A Significant Return on Investment
The economic rationale for investing in midwifery is undeniable. Midwives offer a cost-efficient means to reach the most underserved communities, ensuring that high-quality care is accessible at the primary level, closer to where women reside, rather than in overburdened facilities catering to critically ill patients. Global evidence highlights that in nations like Bangladesh, every dollar invested in midwifery can yield a return of up to 16 times the initial investment. By averting long-term disabilities in newborns and maintaining the health and productivity of mothers, midwives play a direct role in boosting the human capital of Bangladesh.
The Impact on Resilience: Addressing Climate and Crisis Challenges
As one of the world’s most climate-vulnerable countries, Bangladesh constantly faces threats from cyclones, floods, and rising sea levels. In times of disasters when hospitals become inaccessible, midwives stand unwaveringly with women and adolescents in their communities. Through collaborative efforts with the Government of Bangladesh, the UNFPA ensures that midwives are at the forefront of responding to natural calamities and climate change, safeguarding a woman’s right to a safe childbirth even amidst climate-related crises. Whether in remote coastal villages or the congested refugee camps of Cox’s Bazar, midwives provide consistent care that saves lives.
To fully realize these benefits, midwives require professional training and supportive workplaces. This involves education at accredited institutions, licensing, fair remuneration, and the authority to practice their full range of skills. An enabling environment equipped with essential resources such as water, sanitation, electricity, communication tools, and medical supplies is crucial for midwives to carry out their life-saving work effectively. Continuous availability of crucial maternal medications and contraceptives without interruptions is also essential.
By 2030, an estimated 25,000 midwifery positions are needed in primary health centers across the country. The systematic establishment of midwifery roles and the swift deployment of these professionals to primary health facilities represent the pivotal next phase of this success story. Accelerating this process is not merely a health priority but a critical step toward bolstering national resilience. Until every woman in Bangladesh, regardless of her socioeconomic status or location, has access to high-quality midwifery care, the nation risks falling short of its ambitious development objectives.
Investing in midwives translates to investing in the rights, dignity, and equity of every woman in Bangladesh. More midwives in positions, health facilities, and communities are urgently needed. By stationing three midwives in each of the 3,500 union-level health facilities nationwide, a 24/7 support system for mothers can be established. Leveraging existing facilities and infrastructure, bringing midwives to these local hubs can bridge the gap in delivering life
