Global Call to Action - Protecting Midwives to Sustain Care for Women, Newborns and their Families in the COVID-19 Pandemic - UNFPA
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Global Call to Action Protecting Midwives to Sustain Care for Women, Newborns and their Families in the COVID-19 Pandemic Release Date: 5 May 2020 (International Day of the Midwife)
Protecting Midwives to Sustain Care
for Women, Newborns and their Families in
the COVID-19 Pandemic
We are facing a global health crisis: health systems are being misinformation, all culminating in growing distress among women and
tested, as shortages of both staff and resources place midwives. These findings are echoed by WHO staff in country offices
intense pressure on services. As the world struggles to globally.
get COVID-19 under control, our global health workforce
It’s crucial that governments, health institutions, donors, NGOS and
is under increasing strain – and woman-centred, the global health community come together and ensure essential,
midwifery-led care is more at risk than ever. evidence-based midwifery services are maintained as far as possible
throughout this global health emergency. If we fail to protect mid-
Midwives are central to the health and protection of women and newborns
wife-led services, there is a high risk of poor maternal health outcomes
during pregnancy, childbirth and in those critical early days and months
and the avoidable harm of midwives through transmission of COVID-19.
once a baby is born. Midwives also play an important role in enabling access
by women to contraception and other reproductive health services. The Today is the International Day of the Midwife, a day when we come
World Health Organisation (WHO) estimates that 83% of all maternal together as a global health community to celebrate midwives, and
deaths, stillbirths and newborn deaths could be averted with the full the commitment of the midwifery profession globally to saving lives
package of midwifery care. However, in the battle to manage COVID-19, and upholding the rights of women to a safe and positive birth. This
essential maternal and newborn health services have become less of a year, ICM, in partnership with UNFPA, is uniting in solidarity with
priority in some countries. The International Confederation of Midwives our global midwifery workforce to launch a series of calls to action
(ICM) has listened to its Member Associations in all regions, and accounts for governments, decision makers, donors and health institutions to
from the midwives working on the frontlines during this pandemic are ensure the protection of midwives, women and newborns during the
harrowing, unveiling an increase in gender discrimination, domestic violence, COVID-19 pandemic. We are supported by many partner organisations
human rights abuses, the over-medicalisation of birth and fear and listed below.
The following actions will ensure the continuation of midwife-led
care, and the protection of maternal health and rights:
1. Ensure equitable availability of Personal Protective Equipment 2. Include midwives in policy, decision-making, planning and re-
(PPE) for midwives, regardless of their work environment, sponse to COVID-19
supported by additional training on correct and appropriate
usage of PPE
The Problem: The Solution: The Problem: The Solution:
There is an acute shortage of personal We ask governments, donors, NGOs In many countries, midwives have not We ask governments, donors, NGOs
protective equipment (PPE). The pur- and health institutions to: been included in the initial planning and and health institutions to:
pose of PPE is two-fold: to protect response taskforces, which has led to
the midwife and her family, and to • Ensure equitable availability of PPE an oversight or misinterpretation of the • Ensure midwife involvement and lead-
protect the woman and her new- for midwives, regardless of their work need to protect midwives, childbearing ership in determining health policy
born. Due to the intimate nature environment, complemented with women and their newborns in this crisis. and effective COVID-19 response.
of childbirth, midwives and women face additional training on correct and The result has been the redeployment of Such measures will ensure appropriate
fear and anxiety regarding potential appropriate usage of PPE. midwives, closure of maternity units, and regulation for the provision of mid-
cross-infection. PPE shortages. In some countries, the wifery services at all levels of the
• Make available critically important lack of attention for midwives and the health system.
Governments around the world are re- WASH resources, such as hand sani- needs of childbearing women and new-
sponsible for the provision of personal tiser, to ensure midwives and birthing borns has negatively impacted the right • Recognise that midwives are the most
protective equipment (PPE) for their centres are properly equipped to deliver of women to respectful and quality ma- appropriate professionals to inform
health care professionals, but midwives in quality care for pregnant women and ternity care. the government about effective or-
some countries are reporting that gov- newborns. ganisation of midwifery services, and
ernments are neglecting to account for The pandemic has also led to an of their own needs and those of the
midwives in their orders. This signals • Prioritise testing for COVID-19 for increased demand for homebirths and women and newborns they care for.
that midwives are not valued despite the all pregnant women, as well as the community-based antenatal and postnatal
essential care they provide to mothers midwives who care for them. This will care. These changes imply a need for a
and newborns. ensure a reduction in infection along- swift and appropriate regulatory response
side the adequate provision of PPE. to facilitate midwives to provide care
within a regulatory framework that pro-
tects both the midwife and the public.
3. Stop the re-deployment of midwives and ensure the quality of 4. Protect pregnant women and their newborns and uphold their right
midwifery care to a positive birthing experience
The Problem The Solution The Problem The Solution
While we understand that there are We ask governments, donors, NGOs Restrictions implemented by some health We ask governments, donors, NGOs
shortages of health staff in many coun- and health institutions to: authorities to combat COVID-19 are mis- and health institutions to:
tries and challenges being posed by the informed and are hampering women’s ac-
large number of COVID-19 cases in sev- • Not redeploy midwives to areas out- cess to maternity services. These include • Ensure maternity services are main-
eral countries, some governments and side of their scope of practice, unless the closure of maternity facilities, not tained so that maternal and newborn
organisations are redeploying midwives absolutely imperative. Redeployment allowing a birth companion even where in- health outcomes are not negatively
outside of maternity services to public will leave childbearing women without fection prevention and control measures affected by COVID-19. Midwifery care
health services screening for COVID-19 a qualified midwifery workforce to are in place, separating mother and new- is the most appropriate model of care
and caring for patients with severe cases. provide respectful, competent maternity born after birth, not permitting breast- for childbearing women and their
These directives place the midwife out- care. feeding or contact between mother and newborns. Midwives provide safe,
side of her scope of practice and training newborn, and enforced medical interven- high-quality care that can be provid-
in caring for the general sick population. • Increase access to evidence-based tions such as unnecessary caesarean or ed outside of a hospital setting in an
Midwifery care is not interchangea- guidance, training and other COVID-19 induction of labour. These are all blatant enabling environment. Midwives are
ble with nursing care, even in instances resources for midwives. violations of women and newborn’s rights therefore crucial to reducing the bur-
where midwives hold nursing qualifications, during pregnancy and birth. They are also den of COVID-19 to health systems at
given that these skills need to be continually counter to the evidence on safe and ef- the hospital level.
renewed and updated in line with current fective care.
practice. Redeployment directly leads to • Increase access to accurate and ev-
shortages of midwives to care for women Further, the spread of misinformation and idence-based information regarding
who continue to become pregnant and give lack of guidance and translation of COVID-19 and pregnancy, birth and
birth. COVID-19 resources is an ongoing con- breastfeeding for women.
cern for midwives and women. This leads
to women avoiding care, and in some
cases, late detection of complications of
pregnancy, birth and newborn care.
5. Uphold women’s sexual and reproductive rights 6. Prioritise funding for maternal health services and basic
resources to midwives’ associations to support midwives
providing community-based care and working to reach the
most vulnerable
The Problem The Solution The Problem The Solution
In some countries, maternal health We ask governments, donors, NGOs and Many have been shocked by the lack of We ask governments, international
services, including access to essential health institutions to: basic resources and the inadequacy of donor agencies, NGOs and philanthropic
contraceptives, comprehensive post-abor- our health systems to deal with a global organisations to:
tion care and other services has been dis- • Ensure provision of family planning and pandemic. Yet, the symptoms of these is-
rupted or stopped. This is in part due to a safe post-abortion care to women, as sues should come as no surprise, includ- • Directly allocate funds to maintaining
shortage of health care workers, reduction an essential part of crisis and emer- ing overworked and underpaid health midwifery services, including commu-
in supply of pharmaceuticals, deplet- gency interventions. Midwives can workers, poor health systems, inadequate nity-based services that are crucial
ing health finances, decreased access to provide these services and should training opportunities, and restrictive pol- at a time when facility-based services
services (e.g. public transport), and the be supported to continue their work. icies. For the midwifery profession, the are decreasing and when women are
closure of some services altogether. The chronic problems currently manifesting increasingly opting for decentralised
potential fallout from this alone will like- • Ensure attention for the increased run especially deep. The midwifery profes- services. Disseminating funds directly
ly result in an additional 15 million unin- risk of sexual and gender-based vio- sion has struggled to gain access to fund- to the organisations that represent
tended pregnancies, an increase in unsafe lence, particularly domestic violence ing, resources, training and recognition as midwives as frontline maternal health-
abortions and an increase in maternal and that women and midwives face during an autonomous profession even prior to care providers is the best way to ensure
newborn deaths. Reports are emerging a crisis. Services for survivors should COVID-19. they have the resources and capacity
from countries around the world that sex- be made available. to provide community-based services
ual and gender-based violence (SGBV) is Compounding this situation is the high and enable midwife-led care to reach
increasing due to the crisis. Midwives, the numbers of women seeking care from the most vulnerable women in com-
majority of whom are women, and the midwives outside of facilities, including munities.
women and girls they care for, are at in- in countries where community-based
creased risk of becoming victims of SGBV. midwifery services are not part of usual
maternal and newborn services. Women
are fearful of birthing in hospitals where
they risk infection; Women are being
discharged within hours of giving birth,
including women who give birth by cae-
sarean section. Often no follow-up care
is arranged. Midwives are stepping up to
provide this care to women and their new-
born, but they are often not resourced for
this work.Leading Partners
Supporting Partners
International Confederation of Midwives
La Confédération internationale des sages-femmes
Confederación Interacional de Matronas
Koninginnegracht 60,
The Hague 2514 AE
The Netherlands
Telephone +31 70 3060 520
Fax +31 70 3555 651
Email info@internationalmidwives.org
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