Professionals with delivery skills: backbone of the health system and key to reaching the maternal health Millennium Development Goal.

The attainment of the fifth Millennium Development Goal requires adequate national reserves of skilled birth attendants. Nurses, midwives, and their equivalents form the frontline of the formal health system are a critical element of global efforts to reduce ill-health and poverty in the poorest areas of the world. Planning and policies supporting these cadres of workers must be placed high on the development agenda and championed by key international and national players. This article first sets forth an argument for the equity and efficiency of nurses, midwives, and their equivalents as the cadre largely responsible for maternal health. Second, it traces the root causes of neglect of this critical cadre, including a vacuum in political will in the context of poverty, lack of protections for frontline workers, the historical political position of the field of midwifery, lack of a pipeline of secondary school graduates, and gender inequity. Investment in the largely female cadre that cares for the majority of the world's poorer women has simply not been a high enough priority. Five key policy recommendations include harnessing political will and adequate metrics, protection of frontline workers' safety and livelihoods, ensuring an adequate pipeline with a focus on girls' education, donor support for training and professional organizations, and a rapid scale-up of a robust cadre of delivery care professionals. Finally, a call for unified international support of rapid scale-up of cadres of delivery care workers is put forth.