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More midwives could save millions of lives per year by 2035: Lancet study

Increasing the number of midwives and their level of care could save up to 4.3 million lives per year over the next 15 years, particularly in low and middle income countries, according to a study published in The Lancet Global Health journal.

This modelling study estimates that scaling up the provision of midwife-led care across the world could potentially reduce maternal deaths by 67 per cent, newborn deaths by 64 per cent and stillbirths by 65 per cent if midwives were enabled to provide a range of interventions from family planning to post-natal care.

This could equate to saving 4.3 million lives per year by 2035, the researchers noted.

“Supported by appropriate professional education, regulation and improved working environments, it is possible to achieve a substantial increase in the level of provision of essential interventions delivered by midwives. This could save millions of lives,” said study lead author Andrea Nove from Novametrics Ltd. UK.

“However, there are numerous barriers to fulfilling this level of scale-up, particularly in low to middle income countries,” Nove said.

These limitations, he explained, include inequitable distribution of qualified midwives, poor transport links, lack of supplies and equipment and, in some countries, a lack of trust from the public, adding there is need for greater recognition of the importance of supporting and enabling this service to reach its potential.

The new study follows a past report on midwifery in The Lancet journal and uses the Lives Saved Tool (LiST) which models the deaths that could be avoided, assuming a specific uptake, effectiveness and impact of a range of interventions.

Using an updated version of LiST, the current study aimed to provide a more accurate estimate of the impact of increasing the provision of midwife healthcare around the world.

The study used the LiST to model effects on mortality at a country level of about 30 essential interventions which can be delivered in their entirety by competent and enabled midwives, the researchers said.

These were treatments, responses and procedures that can be provided before conception, in antenatal care, during labour and birth and after birth, such as family planning, hypertension screening, induction of labour and the use of antibiotics for newborn sepsis, they said.

The study modelled the effect of changes in the level of provision of healthcare interventions delivered by midwives for 88 countries and amalgamated the results.

This was also done for three groups of countries that were categorised according to their level of development.

If current mortality rates persist, in these 88 countries there will be over three million stillbirths per year by 2035, three million newborn deaths per year by 2035 and over 400,000 maternal deaths per year by 2035, according to the researchers.

They estimated that relative to the current provision of healthcare by midwives, a 25 per cent increase every five years in the 88 countries would result in 41 per cent fewer deaths of mothers, 26 per cent fewer stillbirths and 39 per cent fewer deaths of newborn babies.

The researchers noted that this would mean averting 170,000 maternal deaths, 852,000 stillbirths and 1.2 million newborn deaths per year by 2035, adding the reduction in deaths was estimated to be greater in the least developed countries.

Even a modest scale-up in interventions — 10 per cent every five years — delivered by midwives would result in 22 per cent fewer maternal deaths, 14 per cent fewer stillbirths and 23 per cent fewer deaths of newborn babies, according to the researchers.

It is estimated this would avert 93,000 maternal deaths, 448,000 stillbirths and 718,000 newborn deaths per year by 2035, they said. Scaling up midwife delivered interventions to ensure universal coverage (95 per cent coverage) by 2035 could result in a 67 per cent reduction in maternal deaths, a 65 per cent reduction in stillbirths and a 64 per cent reduction in deaths of newborn babies, according to the study.

Similar to the scenario of a substantial increase in coverage, these reductions would be greatest in the least developed countries, the researchers said.

Overall, this universal scale-up could potentially avert 280,000 maternal deaths, 2.1 million stillbirths and 2 million neonatal deaths annually by 2035, they said.

The study found that, in comparison, a small decrease of 2 per cent in the provision of midwife delivered healthcare would result in 34,000 more maternal deaths, 222,000 more stillbirths and 295,000 more newborn deaths per year by 2035.

“These new findings build on and strengthen existing evidence on the impact of quality midwifery care in averting deaths and improving health and wellbeing outcomes,” said Professor Mary Renfrew, from the University of Dundee, UK.

“They should command the attention of the global community in the same way that a new drug or innovative technical intervention would. There is serious and longstanding under-investment in international-standard midwifery. Gender, social, professional, and economic disempowerment of midwives and the women they care for all contribute to this,” said Renfrew, who was not involved in the study.

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