This is a key moment for midwifery, both nationally and globally. On the international agenda, despite the gains in reducing maternal mortality in recent years, levels of mortality and morbidity for women and infants remain unacceptably high. At the same time there is increasing concern about the sustainability of over-medicalised health systems, increasing inequalities in provision of care, and increasing awareness of the disrespect and abuse that many childbearing women experience. These concerns, and new evidence about the positive contribution that midwifery can make to survival, health and well-being, are prompting action by international agencies to promote midwifery. We are therefore at a crucial point in the evolution of midwifery globally; thoughtful, positive planning and co-ordination are needed to use this opportunity to gain the recognition and resources needed to scale up high quality midwifery, and to make it accessible to all women and children globally.
This lecture will draw on recent evidence and debates to re-consider the place of midwifery in this broader context of maternal and newborn care and health systems. It will examine the reasons why it has been surprisingly difficult to evidence the impact of midwifery, including systemic barriers to its full implementation and a limited evidence base. It will draw on insights from public health and quality improvement perspectives, and from extensive debates arising from the Lancet Series on Midwifery to illuminate some of the contentious issues and to challenge the often dichotomised discourse.
This lecture will demonstrate that midwifery has a unique and irreplaceable role in promoting the survival, health and well-being of women and children, and in ensuring the sustainability of health systems. Wherever it is strong and embedded into the health system, midwifery seems to create a necessary balance in the system that works to protect women, infants and families, to strengthen women’s own capabilities, and to promote longer-term health and well-being. Health systems without strong midwifery have escalating rates of unnecessary interventions – a pattern of health system provision that is unsustainable, as well as harmful. Yet a WHO report has shown that midwifery is often weakened by professional territorialism, commercial interests, and disempowerment related to traditional gender roles. These barriers must be tackled.
The lecture will conclude with a challenge to strengthen midwifery globally and in the UK through multi-agency, multi-disciplinary, coordinated action. A new global strategy for Women’s Children’s and Adolescent’s Health is being finalised, and the SDGs offer a platform for concerted action. Can we use these opportunities to scale up high quality midwifery for every woman and every child?