Statement
calendar_today05 May 2025
Empowering midwives is the single most effective way to protect mothers and newborns
By Lydia Zigomo, UNFPA Regional Director, East and Southern Africa
In the flooded plains of Hanang, Tanzania, a midwife named Theodora braved the rising waters to rescue a mother bleeding during childbirth, cradled her through hours of wading, and helped her deliver a baby girl who wasn’t breathing—until she was. [Story here]
For me, stories like this are not just inspiring, they are deeply personal. They remind me of my mother and countless of her generation who were midwives and nurses, providing care to many of my generation when we went through the then bewildering but rewarding experience of childbearing as young mothers in countries like Zimbabwe. Midwifery, is an honourable though often overlooked and undervalued profession. It is a calling. Many midwives work in the most difficult of conditions in overcrowded and often under resourced health facilities, sometimes in remote rural communities, across difficult terrain. Yet midwifery is the quiet, resolute, relentless heartbeat of care that has carried our women across generations, and these women shaped who I am. And every time I meet a midwife in the Democratic Republic of Congo (DRC), Ethiopia, or Malawi, I connect with them as I recognize that same spirit, that same fierce, quiet power.
A crisis of access, a crisis of survival
That same life force lives in thousands of midwives across East and Southern Africa. In DRC, women like Esther Okunia offer maternal health services in the middle of conflict zones and displacement camps, where even the basics like clean water, sterile equipment are luxuries. In Ethiopia’s Tigray region, midwives like Sister Kahsa have established safe spaces for survivors of sexual violence in conflict zones, providing not only medical attention but dignity, comfort, and protection. In South Sudan, midwives escorted women through rivers to reach emergency obstetric care. In Uganda, they cut across rural landscapes on motorbikes to reach expectant mothers. These are not just acts of heroism – these are evidence of system failure, where midwives are forced to do everything with far too little.
While most of us sing their praises and proclaim them as the unsung heroes, we continue to undervalue them and their skills. Indeed, their stories inspire, but the statistics demand urgency. The region still records an estimated 58,000 maternal deaths a year; roughly 159 women dying every single day from complications we know how to prevent. Nearly a quarter of global maternal deaths and stillbirths happen in East and Southern Africa. The same countries that bear the highest burden, DRC, Ethiopia, Tanzania, Uganda, also face chronic shortages of skilled midwives. Stillbirths and newborn deaths remain unacceptably high, and adolescent girls face some of the highest maternal mortality risks globally.
Midwives, skilled in providing integrated care, addressing the needs of each individual woman and newborn, within functional and enabling health systems, equipped with necessary resources and streamlined consultation and referral processes, can deliver 90 per cent of essential sexual and reproductive health services, if trained to proficiency and supported. Achieving universal coverage through midwifery models of care could prevent more than 60 per cent of maternal and newborn deaths and stillbirths by 2035. That’s 4.3 million lives saved every year; with more than a million in this region alone.
Many midwives lack the training, tools and protections to offer their full scope of care. In crisis settings, their own safety is at risk. Humanitarian funding cuts and global shifts in development assistance are threatening not just services, but the lives of women and babies who depend on them.
Glimmers of hope
Despite the bleak prognosis, we see signs of progress. Zambia, Uganda and Malawi have made bold moves to expand midwifery education and elevate the profession. DRC is piloting scholarships to train more midwives in underserved regions. These efforts work; however, they must be scaled.
The case for the midwifery models of care is clear. It saves lives and generates significant value for health systems and economies alike. Every dollar spent on the midwifery models of care returns up to 16-fold in health and social gains.
We need to expand education and training, strengthen regulatory systems, protect midwives in crises, and elevate their leadership in health decision-making. Midwifery is not an afterthought; it is the backbone of resilient, equitable health systems and with them, we will see a world where no woman dies giving life, and no newborn starts life without a chance.
Theodora’s story in Tanzania, the safe house built by Sister Kahsa in Ethiopia, the displaced mothers in DRC, all remind us of one simple truth – midwives are not just essential in every crisis – they are the life line. They hold it and they embody it, and they need us behind them.