Andrea Nove1, Ingrid K Friberg2, Luc de Bernis3, Fran McConville4, Allisyn C Moran4, Maria Najjemba5, Petra Ten Hoope-Bender6, Sally Tracy7, Caroline S E Homer8. 1. Novametrics, Duffield, UK. Electronic address: andrea@novametrics.org. 2. Tacoma, WA, USA. 3. Bias, France. 4. Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland. 5. Uganda Country Office, United Nations Population Fund, Kampala, Uganda. 6. United Nations Population Fund Office of Geneva, Geneva, Switzerland. 7. Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia. 8. Maternal, Child and Adolescent Health, Burnet Institute, Melbourne, VIC, Australia.
Abstract
BACKGROUND: Strengthening the capacity of midwives to deliver high-quality maternal and newborn health services has been highlighted as a priority by global health organisations. To support low-income and middle-income countries (LMICs) in their decisions about investments in health, we aimed to estimate the potential impact of midwives on reducing maternal and neonatal deaths and stillbirths under several intervention coverage scenarios. METHODS: For this modelling study, we used the Lives Saved Tool to estimate the number of deaths that would be averted by 2035, if coverage of health interventions that can be delivered by professional midwives were scaled up in 88 countries that account for the vast majority of the world's maternal and neonatal deaths and stillbirths. We used four scenarios to assess the effects of increasing the coverage of midwife-delivered interventions by a modest amount (10% every 5 years), a substantial amount (25% every 5 years), and the amount needed to reach universal coverage of these interventions (ie, to 95%); and the effects of coverage attrition (a 2% decrease every 5 years). We grouped countries in three equal-sized groups according to their Human Development Index. Group A included the 30 countries with the lowest HDI, group B included 29 low-to-medium HDI countries, and group C included 29 medium-to-high HDI countries. FINDINGS: We estimated that, relative to current coverage, a substantial increase in coverage of midwife-delivered interventions could avert 41% of maternal deaths, 39% of neonatal deaths, and 26% of stillbirths, equating to 2·2 million deaths averted per year by 2035. Even a modest increase in coverage of midwife-delivered interventions could avert 22% of maternal deaths, 23% of neonatal deaths, and 14% of stillbirths, equating to 1·3 million deaths averted per year by 2035. Relative to current coverage, universal coverage of midwife-delivered interventions would avert 67% of maternal deaths, 64% of neonatal deaths, and 65% of stillbirths, allowing 4·3 million lives to be saved annually by 2035. These deaths averted would be particularly concentrated in the group B countries, which currently account for a large proportion of the world's population and have high mortality rates compared with group C. INTERPRETATION: Midwives can help to substantially reduce maternal and neonatal mortality and stillbirths in LMICs. However, to realise this potential, midwives need to have skills and competencies in line with recommendations from the International Confederation of Midwives, to be part of a team of sufficient size and skill, and to work in an enabling environment. Our study highlights the potential of midwives but there are many challenges to the achievement of this potential. If increased coverage of midwife-delivered interventions can be achieved, health systems will be better able to provide effective coverage of essential sexual, reproductive, maternal, newborn, and adolescent health interventions. FUNDING: New Venture Fund.
BACKGROUND: Strengthening the capacity of midwives to deliver high-quality maternal and newborn health services has been highlighted as a priority by global health organisations. To support low-income and middle-income countries (LMICs) in their decisions about investments in health, we aimed to estimate the potential impact of midwives on reducing maternal and neonatal deaths and stillbirths under several intervention coverage scenarios. METHODS: For this modelling study, we used the Lives Saved Tool to estimate the number of deaths that would be averted by 2035, if coverage of health interventions that can be delivered by professional midwives were scaled up in 88 countries that account for the vast majority of the world's maternal and neonatal deaths and stillbirths. We used four scenarios to assess the effects of increasing the coverage of midwife-delivered interventions by a modest amount (10% every 5 years), a substantial amount (25% every 5 years), and the amount needed to reach universal coverage of these interventions (ie, to 95%); and the effects of coverage attrition (a 2% decrease every 5 years). We grouped countries in three equal-sized groups according to their Human Development Index. Group A included the 30 countries with the lowest HDI, group B included 29 low-to-medium HDI countries, and group C included 29 medium-to-high HDI countries. FINDINGS: We estimated that, relative to current coverage, a substantial increase in coverage of midwife-delivered interventions could avert 41% of maternal deaths, 39% of neonatal deaths, and 26% of stillbirths, equating to 2·2 million deaths averted per year by 2035. Even a modest increase in coverage of midwife-delivered interventions could avert 22% of maternal deaths, 23% of neonatal deaths, and 14% of stillbirths, equating to 1·3 million deaths averted per year by 2035. Relative to current coverage, universal coverage of midwife-delivered interventions would avert 67% of maternal deaths, 64% of neonatal deaths, and 65% of stillbirths, allowing 4·3 million lives to be saved annually by 2035. These deaths averted would be particularly concentrated in the group B countries, which currently account for a large proportion of the world's population and have high mortality rates compared with group C. INTERPRETATION: Midwives can help to substantially reduce maternal and neonatal mortality and stillbirths in LMICs. However, to realise this potential, midwives need to have skills and competencies in line with recommendations from the International Confederation of Midwives, to be part of a team of sufficient size and skill, and to work in an enabling environment. Our study highlights the potential of midwives but there are many challenges to the achievement of this potential. If increased coverage of midwife-delivered interventions can be achieved, health systems will be better able to provide effective coverage of essential sexual, reproductive, maternal, newborn, and adolescent health interventions. FUNDING: New Venture Fund.
Authors: William E Rosa; Howard Catton; Patricia M Davidson; Catherine J Hannaway; Elizabeth Iro; Hester C Klopper; Elizabeth A Madigan; Frances E McConville; Barbara Stilwell; Ann E Kurth Journal: J Nurs Scholarsh Date: 2021-05-31 Impact factor: 3.928
Authors: Joseph Akuze; Kristi Sidney Annerstedt; Claudia Hanson; Lenka Benova; Effie Chipeta; Jean-Paul Dossou; Mechthild M Gross; Hussein Kidanto; Bruno Marchal; Helle Mölsted Alvesson; Andrea B Pembe; Wim van Damme; Peter Waiswa Journal: BMC Health Serv Res Date: 2021-12-11 Impact factor: 2.655
Authors: Ana Paula Cavalcante de Oliveira; Carla Aparecida Arena Ventura; Mariana Lopes Galante; Mónica Padilla; Anna Cunha; Isabel Amelia Costa Mendes; Kleyde Ventura de Souza; Manoel Carlos Neri da Silva; Mayra Isabel Correia Pinheiro; Nádia Mattos Ramalho; Sonia Acioli; Vinícius Nunes Azevedo Journal: Rev Lat Am Enfermagem Date: 2021-11-19
Authors: Caroline Se Homer; Sabera Turkmani; Alyce N Wilson; Joshua P Vogel; Mehr Gul Shah; Helga Fogstad; Etienne V Langlois Journal: BMJ Glob Health Date: 2022-01