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The state of the world's midwifery 2011: Delivering health, saving lives

Profile image of Petra ten Hoope-BenderPetra ten Hoope-Bender

2011, International Journal of Gynecology & Obstetrics

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The State of the World's Midwifery 2011 report assesses the midwifery workforce across 58 countries, highlighting the need for increased action to improve maternal and newborn health. It identifies challenges and opportunities for enhancing midwifery services amid global health initiatives aimed at preventing maternal and child deaths. The report underscores the urgency of addressing midwifery workforce shortages to meet international health goals.

Figures (408)

Learning to record foetal heartbeat is one of the simplest and most common techniques. When part of a midwife’s competencies, it is a life-saving aid. (Sven Torfinn; Sudan)
Learning to record foetal heartbeat is one of the simplest and most common techniques. When part of a midwife’s competencies, it is a life-saving aid. (Sven Torfinn; Sudan)
Birth is always an intense moment, both for women and for the maternal health team. It is our collective responsibility to ensure that the quality of care available protects and saves lives. (Lynsey Addario; Afghanistan)
Birth is always an intense moment, both for women and for the maternal health team. It is our collective responsibility to ensure that the quality of care available protects and saves lives. (Lynsey Addario; Afghanistan)
Ensuring midwives are in the right place at the right time with the necessary infra- structure, drugs and equipment is a central pillar of the Global Strategy for Women’s and Children’s Health. (WHO/Marie-Agnes Heine; Senegal) A proficient, motivated and supported midwifery workforce is a major key to success in tackling this heavy toll of death and disability. The evidence is unanimous and clear: midwives and other health workers with midwifery competencies are essential to saving the lives of women and newborns 11, 12, 13, 14,15 A proficient, motivated and supported midwifery is unanimous and clear: midwives and other
Ensuring midwives are in the right place at the right time with the necessary infra- structure, drugs and equipment is a central pillar of the Global Strategy for Women’s and Children’s Health. (WHO/Marie-Agnes Heine; Senegal) A proficient, motivated and supported midwifery workforce is a major key to success in tackling this heavy toll of death and disability. The evidence is unanimous and clear: midwives and other health workers with midwifery competencies are essential to saving the lives of women and newborns 11, 12, 13, 14,15 A proficient, motivated and supported midwifery is unanimous and clear: midwives and other
Source: The Global Strategy for Women’s and Children’s Health (adapted from the Global Consensus for Maternal, Newborn and Child Health —- September 2009) The State of the World’s Midwifery 2011: Deliver- ing Health, Saving Lives results from the work of multiple agencies, organizations and individuals. The report has been coordinated by the United Nations Population Fund (UNFPA) in line with the agreement between UN agencies to acceler- ate implementation of the maternal and newborn continuum of care.” It is devoted to document- ing the current practice of midwifery and setting out what needs to be done to improve midwifery services. A similar undertaking was completed 45 Recognizing the central role of midwifery services in the successful implementation of the Global
Source: The Global Strategy for Women’s and Children’s Health (adapted from the Global Consensus for Maternal, Newborn and Child Health —- September 2009) The State of the World’s Midwifery 2011: Deliver- ing Health, Saving Lives results from the work of multiple agencies, organizations and individuals. The report has been coordinated by the United Nations Population Fund (UNFPA) in line with the agreement between UN agencies to acceler- ate implementation of the maternal and newborn continuum of care.” It is devoted to document- ing the current practice of midwifery and setting out what needs to be done to improve midwifery services. A similar undertaking was completed 45 Recognizing the central role of midwifery services in the successful implementation of the Global
Source: Adapted from WHO and The Lancet's Stillbirths Series.” Proportion of births attended by a skilled health worker and the burden of maternal, foetal and newborn deaths in 58 selected countries
Source: Adapted from WHO and The Lancet's Stillbirths Series.” Proportion of births attended by a skilled health worker and the burden of maternal, foetal and newborn deaths in 58 selected countries
not authorized to provide. for a caesarean section or other care that they are In the event of a more serious complication or
not authorized to provide. for a caesarean section or other care that they are In the event of a more serious complication or
High-quality antenatal care can maximize health during pregnancy and includes early detection and treatment or referral of selected complications. (Ellen Krijgh; Viet Nam)
High-quality antenatal care can maximize health during pregnancy and includes early detection and treatment or referral of selected complications. (Ellen Krijgh; Viet Nam)
Source: Adapted from WHO (2010) recommended ‘Packages of Interventions for Family Planning, Safe Abortion Care, Maternal, Newborn and Child Health’ and ICM (2010) Essential competencies for basic midwifery practice. WHO's essential care packages and the role of midwifery competencies across the continuum of care
Source: Adapted from WHO (2010) recommended ‘Packages of Interventions for Family Planning, Safe Abortion Care, Maternal, Newborn and Child Health’ and ICM (2010) Essential competencies for basic midwifery practice. WHO's essential care packages and the role of midwifery competencies across the continuum of care
Learning with models enables student midwives to attain proficiency in the essential competencies. (Liba Taylor for ICM; India) * In addition to the health system design and opera- tion, midwifery education programmes, regulatory frameworks and association development are three critical pillars for creating a high-quality midwifery workforce. They should be regarded as a package (education, regulation and association) as well as a continuum for midwifery workforce development. implementation of evidence-based interventions,
Learning with models enables student midwives to attain proficiency in the essential competencies. (Liba Taylor for ICM; India) * In addition to the health system design and opera- tion, midwifery education programmes, regulatory frameworks and association development are three critical pillars for creating a high-quality midwifery workforce. They should be regarded as a package (education, regulation and association) as well as a continuum for midwifery workforce development. implementation of evidence-based interventions,
Not all women are able to access a midwife while pregnant or during labour and birth. For some it entails a lonc and arduous journey by whatever means possible. (Claire Escoffier; Somalia) Such a multidisciplinary, collaborative approach is at the heart of WHO’s recently published list of the competencies required for the effective provision of high-quality sexual and reproductive health services at the primary health care level.” These 13 competencies relate to essential sexual and reproductive health services, not to specific professions. Individual cadres need to be clear about what they are expected to provide and to know the internal referral mechanisms within the team. In order to ensure that people receive comprehensive and continuous care, all primary health care staff should be aware of the competencies available at the next referral level, and vice versa, and know how to use the referral system.
Not all women are able to access a midwife while pregnant or during labour and birth. For some it entails a lonc and arduous journey by whatever means possible. (Claire Escoffier; Somalia) Such a multidisciplinary, collaborative approach is at the heart of WHO’s recently published list of the competencies required for the effective provision of high-quality sexual and reproductive health services at the primary health care level.” These 13 competencies relate to essential sexual and reproductive health services, not to specific professions. Individual cadres need to be clear about what they are expected to provide and to know the internal referral mechanisms within the team. In order to ensure that people receive comprehensive and continuous care, all primary health care staff should be aware of the competencies available at the next referral level, and vice versa, and know how to use the referral system.
Midwives are able to provide health education and services to all in the community, promoting planned pregnancies and positive parenting. (Ahmed Al-Adboei; Yemen) Given the realities at country level, community midwifery services need to be aware of prevailing supply and demand characteristics and consider interim and longer-term strategies to address the quality of care* and humanization of childbirth. Many of the countries that are the focus of this report have invested in CHWs to provide some of the primary care services. Often trained in a period of months, CHWs do have a role to play in strengthening maternal and newborn services by performing some of the essential outreach tasks in the continuum of care. They can, among other things, keep records, promote family planning, urge pregnant women to give birth in a health facility, encourage exclusive breastfeeding and newborn care during home visits, and encourage birth registration. Where outreach services in the community are supervised by and connected to the primary health care centre there is evidence of increased referrals to health facilities and reduced 46, 47 illness and deaths in newborns. Given the realities at country level, community
Midwives are able to provide health education and services to all in the community, promoting planned pregnancies and positive parenting. (Ahmed Al-Adboei; Yemen) Given the realities at country level, community midwifery services need to be aware of prevailing supply and demand characteristics and consider interim and longer-term strategies to address the quality of care* and humanization of childbirth. Many of the countries that are the focus of this report have invested in CHWs to provide some of the primary care services. Often trained in a period of months, CHWs do have a role to play in strengthening maternal and newborn services by performing some of the essential outreach tasks in the continuum of care. They can, among other things, keep records, promote family planning, urge pregnant women to give birth in a health facility, encourage exclusive breastfeeding and newborn care during home visits, and encourage birth registration. Where outreach services in the community are supervised by and connected to the primary health care centre there is evidence of increased referrals to health facilities and reduced 46, 47 illness and deaths in newborns. Given the realities at country level, community
(WHOLE COUNTRY AND RURAL AREAS) 2010 EXPECTED OBSTETRIC AND NEWBORN COMPLICATIONS PER DAY
(WHOLE COUNTRY AND RURAL AREAS) 2010 EXPECTED OBSTETRIC AND NEWBORN COMPLICATIONS PER DAY
The professionalization of birthing care: percentage of births assisted by professional and other carers in selected areas, 2000 and 2005 with projections to 2015 Source: Adapted from WHO (2005)" Despite the overall growth in the use of midwifery services at birth, there are still large proportions of women who cannot, or do not, access care. In some settings midwifery services are non-existent because there are no facilities nor professional cadres available; in other cases services are poor because midwifery staff does not have access to the necessary drugs, equipment, supplies and commodities. In some countries, basic life-saving drugs for women and children are not on the national essential drugs list, are not available at the right place at the right time, or are not available due to stock outs. But ensuring an adequate supply of midwifery services does not guarantee their use by women. Even where services do exist, women often find them hard to access, culturally inappropriate or they encounter financial barriers in the form of user-fees and or services is inextricably linked to poverty, Studies show that women with strong decision- making power are more than twice as likely to give birth at a facility compared with women with little decision-making power.” In all countries, poverty is strongly associated with less access and use of health care, including less use of skilled midwifery care at birth.” Poor demand for services is inextricably linked to poverty,
The professionalization of birthing care: percentage of births assisted by professional and other carers in selected areas, 2000 and 2005 with projections to 2015 Source: Adapted from WHO (2005)" Despite the overall growth in the use of midwifery services at birth, there are still large proportions of women who cannot, or do not, access care. In some settings midwifery services are non-existent because there are no facilities nor professional cadres available; in other cases services are poor because midwifery staff does not have access to the necessary drugs, equipment, supplies and commodities. In some countries, basic life-saving drugs for women and children are not on the national essential drugs list, are not available at the right place at the right time, or are not available due to stock outs. But ensuring an adequate supply of midwifery services does not guarantee their use by women. Even where services do exist, women often find them hard to access, culturally inappropriate or they encounter financial barriers in the form of user-fees and or services is inextricably linked to poverty, Studies show that women with strong decision- making power are more than twice as likely to give birth at a facility compared with women with little decision-making power.” In all countries, poverty is strongly associated with less access and use of health care, including less use of skilled midwifery care at birth.” Poor demand for services is inextricably linked to poverty,
especially in the presence of geographical barriers (transportation costs), socio-economic barriers and oender discrimination. Cochrane review” concluded that women who especially in the presence of geographical barriers Cochrane review” concluded that women who had continuous support in childbirth were likely to have a slightly shorter labour, were more likely to have a spontaneous vaginal birth and less likely to report dissatisfaction with their childbirth experiences. In Latin America, several projects have recorded positive results in the reduction of dissatisfaction both from women giving birth and providers, an increase in institutional deliveries and a reduction in maternal death.” The main facilitators for these results include women’s own cultural values and beliefs in a natural birth as well as institutional strategies designed to prevent unnecessary medical interventions. Midwives provide high-quality, culturally sensitive care during labour as one of their core competencies. (William Daniel; Tajikistan) Barriers that stop women from accessing care,
especially in the presence of geographical barriers (transportation costs), socio-economic barriers and oender discrimination. Cochrane review” concluded that women who especially in the presence of geographical barriers Cochrane review” concluded that women who had continuous support in childbirth were likely to have a slightly shorter labour, were more likely to have a spontaneous vaginal birth and less likely to report dissatisfaction with their childbirth experiences. In Latin America, several projects have recorded positive results in the reduction of dissatisfaction both from women giving birth and providers, an increase in institutional deliveries and a reduction in maternal death.” The main facilitators for these results include women’s own cultural values and beliefs in a natural birth as well as institutional strategies designed to prevent unnecessary medical interventions. Midwives provide high-quality, culturally sensitive care during labour as one of their core competencies. (William Daniel; Tajikistan) Barriers that stop women from accessing care,
Source: Estimates based on national data from WHO's Global Atlas of the Health Workforce and SoWMy Survey in 58 countries. births in one year. While this level of service provi-
Source: Estimates based on national data from WHO's Global Atlas of the Health Workforce and SoWMy Survey in 58 countries. births in one year. While this level of service provi-
Regional distribution of the midwifery workforce Source: Estimates based on national data from WHO's Global Atlas of the Health Workforce and SoWMy Survey in 58 countries.
Regional distribution of the midwifery workforce Source: Estimates based on national data from WHO's Global Atlas of the Health Workforce and SoWMy Survey in 58 countries.
Note: Excludes countries where data on the proportion of nurse-midwives who regularly attend births are unavailable. Source: Estimates based on national data from WHO's Global Atlas of the Health Workforce and SoWMy Survey against birth estimates from United Nations, Department of Economic and Social Affairs, Population Division (2009). their babies, country respondents emphasized inadequate numbers of staff over quality of care. Only a handful of countries explicitly men- tioned ‘quality’ as an issue to address. These few countries mentioned the lack of partogram use, deficient skills in monitoring and recording, and the need for supervision and support as well as a lack of clearly articulated standards of care to follow. In countries where policies aimed at
Note: Excludes countries where data on the proportion of nurse-midwives who regularly attend births are unavailable. Source: Estimates based on national data from WHO's Global Atlas of the Health Workforce and SoWMy Survey against birth estimates from United Nations, Department of Economic and Social Affairs, Population Division (2009). their babies, country respondents emphasized inadequate numbers of staff over quality of care. Only a handful of countries explicitly men- tioned ‘quality’ as an issue to address. These few countries mentioned the lack of partogram use, deficient skills in monitoring and recording, and the need for supervision and support as well as a lack of clearly articulated standards of care to follow. In countries where policies aimed at
Note: Includes basic and comprehensive EmONC Source: SoWMy Survey. Percentage of maternity facilities providing Emergency Obstetric and Newborn Care Note: Includes basic and comprehensive EmONC A story of diversity: Midwifery education around the world
Note: Includes basic and comprehensive EmONC Source: SoWMy Survey. Percentage of maternity facilities providing Emergency Obstetric and Newborn Care Note: Includes basic and comprehensive EmONC A story of diversity: Midwifery education around the world
Public and private pathways in midwifery education Note: Based on all 58 countries with the exception of number of schools, which includes data from 57 countries. Source: SoWMy Survey.
Public and private pathways in midwifery education Note: Based on all 58 countries with the exception of number of schools, which includes data from 57 countries. Source: SoWMy Survey.
VARIATION IN MIDWIFERY SCHOOL SIZE AND CAPACITY Notes: (1) Based on responses from 58 countries; (2) Based on 55 out of the 91 pathways; (3) Average of 111% across 36 pathways where complete data for capacity and stock were reported. for curricula revision linked to the ICM essential competencies or the inclusion of WHO sexual and reproductive health competencies. Some coun- try respondents refer to EmONC and Integrated Management of Childhood Illnesses (IMCI) ele- ments rather than to standardized midwifery competencies.
VARIATION IN MIDWIFERY SCHOOL SIZE AND CAPACITY Notes: (1) Based on responses from 58 countries; (2) Based on 55 out of the 91 pathways; (3) Average of 111% across 36 pathways where complete data for capacity and stock were reported. for curricula revision linked to the ICM essential competencies or the inclusion of WHO sexual and reproductive health competencies. Some coun- try respondents refer to EmONC and Integrated Management of Childhood Illnesses (IMCI) ele- ments rather than to standardized midwifery competencies.
Note: Data for the public sector are used where there are differences between public/ private education. Source: SoWMy Survey.
Note: Data for the public sector are used where there are differences between public/ private education. Source: SoWMy Survey.
Note: For selected countries with available data (grouped by <500 and >500 enrolment per year). Enrolments and graduations in the same year are not comparable. Source: SoWMy Survey.
Note: For selected countries with available data (grouped by <500 and >500 enrolment per year). Enrolments and graduations in the same year are not comparable. Source: SoWMy Survey.
Source: Friedman H et al. Background paper for The State of the World’s Midwifery report. Unpublished. April 2011
Source: Friedman H et al. Background paper for The State of the World’s Midwifery report. Unpublished. April 2011
Note: Based on responses from 53-58 countries depending on the indicator. Electronic register for licensing is counted as ‘Yes' if the register is updated at least once per year. Source: SoWMy Survey. example, permission for private practice is often
Note: Based on responses from 53-58 countries depending on the indicator. Electronic register for licensing is counted as ‘Yes' if the register is updated at least once per year. Source: SoWMy Survey. example, permission for private practice is often
sometimes in the context of all primary health countries mentioned a cost-recovery mechanism,
sometimes in the context of all primary health countries mentioned a cost-recovery mechanism,
Note: Based on responses from 49-54 countries depending on the indicator. Source: SoWMy Survey.
Note: Based on responses from 49-54 countries depending on the indicator. Source: SoWMy Survey.
Note: Based on responses from 32 countries with human resource for health plans that specifically address maternal and newborn health services. Source: SoWMy Survey. Note: Based on responses from 52-57 countries depending on the indicator. Source: SoWMy Survey.
Note: Based on responses from 32 countries with human resource for health plans that specifically address maternal and newborn health services. Source: SoWMy Survey. Note: Based on responses from 52-57 countries depending on the indicator. Source: SoWMy Survey.
Part 3 sets out a number of recommendations
Part 3 sets out a number of recommendations
Once aligned, plans and strategies must be cost- health strategies, and maternal and newborn
Once aligned, plans and strategies must be cost- health strategies, and maternal and newborn
be subject to change.
be subject to change.
Afghanistan's health status is among the poorest in the world. Maternal mortality continues to be among the highest. Cultural and geographic factors continue to pose barriers for women to access health services. A National Reproductive Health Commodity Security Action Plan is now in place, and a National Human Resource Development Plan for Reproductive Health with a focus on the Safe Motherhood Initiative for 2008-2020 has been launched. A major pre-servict midwifery education initiative has been launched by the Ministry of Public Health to train and graduate new midwives. This includes strengthening existing programmes for the placement of graduates in provincial, regional and national hospitals, and establishing Community Midwifery Education programmes for community-based providers. Substantial increases in the number of practising midwives across urban and rural areas, coupled with increases in skilled attendance at birth, attest to the success of these programmes. A new Demographic and Health Survey is due to report in 2011.
Afghanistan's health status is among the poorest in the world. Maternal mortality continues to be among the highest. Cultural and geographic factors continue to pose barriers for women to access health services. A National Reproductive Health Commodity Security Action Plan is now in place, and a National Human Resource Development Plan for Reproductive Health with a focus on the Safe Motherhood Initiative for 2008-2020 has been launched. A major pre-servict midwifery education initiative has been launched by the Ministry of Public Health to train and graduate new midwives. This includes strengthening existing programmes for the placement of graduates in provincial, regional and national hospitals, and establishing Community Midwifery Education programmes for community-based providers. Substantial increases in the number of practising midwives across urban and rural areas, coupled with increases in skilled attendance at birth, attest to the success of these programmes. A new Demographic and Health Survey is due to report in 2011.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
A national maternal and newborn health plan exists that includes the midwifery workforce
A national maternal and newborn health plan exists that includes the midwifery workforce
The largest and most densely populated of the least developed countries, one third of the Bangladesh population is below age 15. The increase in female education and the deployment of family planning services have brought advance. in women’s health. Maternal mortality has been reduced by 61 percent since 1990. Cultural and socio-economic factor: remain barriers to births in facilities, compounded by quality of care, particularly in rural areas. The Poverty Reduction Strategy Paper and the Health, Nutrition and Population Sector Program have set MDGs 5 and 4 as priorities. The government has committed to increase the proportion of institutional deliveries to 50 percent and to graduate an additional 3,000 midwives, for which the Minister of Health has recently approved a three-year direct-entry education programme. This will include particular focus on candidates from rural areas.
The largest and most densely populated of the least developed countries, one third of the Bangladesh population is below age 15. The increase in female education and the deployment of family planning services have brought advance. in women’s health. Maternal mortality has been reduced by 61 percent since 1990. Cultural and socio-economic factor: remain barriers to births in facilities, compounded by quality of care, particularly in rural areas. The Poverty Reduction Strategy Paper and the Health, Nutrition and Population Sector Program have set MDGs 5 and 4 as priorities. The government has committed to increase the proportion of institutional deliveries to 50 percent and to graduate an additional 3,000 midwives, for which the Minister of Health has recently approved a three-year direct-entry education programme. This will include particular focus on candidates from rural areas.
> MIDWIFERY WORKFORCE
> MIDWIFERY WORKFORCE
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
A national maternal and newborn health plan exists that includes the midwifery workforce
A national maternal and newborn health plan exists that includes the midwifery workforce
With an increasing population size, Benin registers high fertility and adolescent birth rates. Policies to encourage g| education are in place. Maternal mortality has been reduced by 50 percent since 1990, but standards and coverage reproductive health services remain low. The Government has launched the National Strategy for Reducing Materr and Neonatal Mortality (2006-2015), which addresses human resources. A policy of free maternal health services i: in place (including caesarean sections), and the capacity of midwives and maternity nurses to deliver a package of sexual and reproductive health interventions (including clean and safe delivery, family planning and post-abortion cé has been strengthened. A three-year, direct-entry midwifery programme has recently been re-activated. Initiatives currently underway to improve the quality of education and professional standards. They include the revision of the curriculum according to the essential ICM competencies, hence contributing to addressing the quality and availabil of the midwifery workforce.
With an increasing population size, Benin registers high fertility and adolescent birth rates. Policies to encourage g| education are in place. Maternal mortality has been reduced by 50 percent since 1990, but standards and coverage reproductive health services remain low. The Government has launched the National Strategy for Reducing Materr and Neonatal Mortality (2006-2015), which addresses human resources. A policy of free maternal health services i: in place (including caesarean sections), and the capacity of midwives and maternity nurses to deliver a package of sexual and reproductive health interventions (including clean and safe delivery, family planning and post-abortion cé has been strengthened. A three-year, direct-entry midwifery programme has recently been re-activated. Initiatives currently underway to improve the quality of education and professional standards. They include the revision of the curriculum according to the essential ICM competencies, hence contributing to addressing the quality and availabil of the midwifery workforce.
>» SERVICES
>» SERVICES
Bhutan has made progress in the past decades to develop its health sector. Reductions in population growth and improved HIV prevention have contributed to improving health status. Maternal mortality has been significantly reduced. A policy is in place to provide free maternal healthcare and a human resources for health master plan has been developed. Midwives receive free education under a nationally accredited scheme, and are offered employment upon graduation. The curriculum has been updated recently. Despite an increase in midwifery enrolment there is only one modern educational institution in the country. Lack of specialist care (anaesthetists and obstetricians) to manage complications affects the efficiency of the available services. Nurses are being trained to provide anaesthesia and ‘task shifting’ is promoted to give educated midwives the capacity and autonomy to manage emergencies rather than resorting to non-specialist doctors.
Bhutan has made progress in the past decades to develop its health sector. Reductions in population growth and improved HIV prevention have contributed to improving health status. Maternal mortality has been significantly reduced. A policy is in place to provide free maternal healthcare and a human resources for health master plan has been developed. Midwives receive free education under a nationally accredited scheme, and are offered employment upon graduation. The curriculum has been updated recently. Despite an increase in midwifery enrolment there is only one modern educational institution in the country. Lack of specialist care (anaesthetists and obstetricians) to manage complications affects the efficiency of the available services. Nurses are being trained to provide anaesthesia and ‘task shifting’ is promoted to give educated midwives the capacity and autonomy to manage emergencies rather than resorting to non-specialist doctors.
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
One of the poorest countries in South America, Bolivia is experiencing heavy rural to urban migration, and indigenou and rural women are less likely to access health services. Free health care is offered to pregnant women and childre under the age of five. A 2008 conditional cash transfer programme aims at increasing antenatal care and reducing malnutrition. There is a shortage of qualified human resources for maternal health, particularly in rural areas and among indigenous populations. A new initiative to develop capacity and graduate a new cadre of obstetric nurses was implemented in 2008 in three universities. New faculty have been trained, student enrolment from rural areas encouraged, and a first intake of students commenced in 2010. Official recognition and the incorporation of the new cadre of obstetric nurses into the national health system is the key next step. Continuing education and adequate supply of commodities and equipment will be essential to allow midwives to operate in an enabling environment.
One of the poorest countries in South America, Bolivia is experiencing heavy rural to urban migration, and indigenou and rural women are less likely to access health services. Free health care is offered to pregnant women and childre under the age of five. A 2008 conditional cash transfer programme aims at increasing antenatal care and reducing malnutrition. There is a shortage of qualified human resources for maternal health, particularly in rural areas and among indigenous populations. A new initiative to develop capacity and graduate a new cadre of obstetric nurses was implemented in 2008 in three universities. New faculty have been trained, student enrolment from rural areas encouraged, and a first intake of students commenced in 2010. Official recognition and the incorporation of the new cadre of obstetric nurses into the national health system is the key next step. Continuing education and adequate supply of commodities and equipment will be essential to allow midwives to operate in an enabling environment.
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
> POLICIES
> POLICIES
HIV is associated with almost 80 percent of maternal deaths and a decreased life expectancy at birth, and it remains
HIV is associated with almost 80 percent of maternal deaths and a decreased life expectancy at birth, and it remains
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
Burundi has faced considerable turmoil in the past decades, with population displacement and refugees. More than three quarters of its population lives in poverty. HIV continues to be a priority concern. Contraceptive use is low and maternal mortality remains very high. A 2005 road map aims at increasing the availability and accessibility of maternal health services and to increase skilled attendance at birth. A four-year direct-entry midwifery education programme w, revived in 2007 and the curriculum has been updated. Midwives are granted a post upon graduation. A lack of faculty compromises the quality of the programme. A midwives association has recently been established and is working closely with the Ministry of Health. The number of graduate midwives is growing annually but attention needs to be given to increasing the number of admissions while improving the quality of education programmes. Deployment, continuing education and retention of the midwifery workforce in the public health system are key policy areas.
Burundi has faced considerable turmoil in the past decades, with population displacement and refugees. More than three quarters of its population lives in poverty. HIV continues to be a priority concern. Contraceptive use is low and maternal mortality remains very high. A 2005 road map aims at increasing the availability and accessibility of maternal health services and to increase skilled attendance at birth. A four-year direct-entry midwifery education programme w, revived in 2007 and the curriculum has been updated. Midwives are granted a post upon graduation. A lack of faculty compromises the quality of the programme. A midwives association has recently been established and is working closely with the Ministry of Health. The number of graduate midwives is growing annually but attention needs to be given to increasing the number of admissions while improving the quality of education programmes. Deployment, continuing education and retention of the midwifery workforce in the public health system are key policy areas.
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
> POLICIES
> POLICIES
With 80 percent of its population living in rural areas, Cambodia has made remarkable progress in reducing poverty anc improving people's health in the past decades. Maternal mortality has decreased 58 percent since 1990, but sociocultu and economic factors still prevent women from accessing public health services. A policy of free access to care for lov income groups is being tested and progressively extended. The 2008 Health Strategic Plan prioritized maternal health. The country has an acute shortage of health professionals and not enough cadres are being graduated. A Midwifery Council was established in 2006. A three-year direct-entry midwifery programme was introduced in 2008, and the curriculum for a four-year bachelor’s degree is being developed. While these initiatives are underway, several in-service training programmes have been implemented. Strengthening the competencies and numbers of midwifery faculty, anc the educational materials, equipment and infrastructure is important to address the current shortage of midwives.
With 80 percent of its population living in rural areas, Cambodia has made remarkable progress in reducing poverty anc improving people's health in the past decades. Maternal mortality has decreased 58 percent since 1990, but sociocultu and economic factors still prevent women from accessing public health services. A policy of free access to care for lov income groups is being tested and progressively extended. The 2008 Health Strategic Plan prioritized maternal health. The country has an acute shortage of health professionals and not enough cadres are being graduated. A Midwifery Council was established in 2006. A three-year direct-entry midwifery programme was introduced in 2008, and the curriculum for a four-year bachelor’s degree is being developed. While these initiatives are underway, several in-service training programmes have been implemented. Strengthening the competencies and numbers of midwifery faculty, anc the educational materials, equipment and infrastructure is important to address the current shortage of midwives.
>» SERVICES
>» SERVICES
More than half of the population in Cameroon lives in urban areas, and the country has received large numbers of displaced people. Maternal mortality remains very high, and has not significantly decreased since 1990. Measures to reduce financial barriers to maternal care have started to be implemented. A plan is being developed to strengthen human resources development and management, with a special focus on midwifery training, including incentive packages for rural retention, educating general practitioners on comprehensive emergency obstetric care, and training nurse-anaesthetists. Midwifery education is available as a post-nursing programme and entry criteria includes at least two years experience as a nurse. Assessment of the curriculum with regard to essential ICM competencies is yet to be completed. The country has no direct-entry programme for midwifery, but plans are underway to revise midwifery education and scale up numbers. To that end, a midwifery school affiliated with the Faculty of Medicine and Biomedic Sciences will be established.
More than half of the population in Cameroon lives in urban areas, and the country has received large numbers of displaced people. Maternal mortality remains very high, and has not significantly decreased since 1990. Measures to reduce financial barriers to maternal care have started to be implemented. A plan is being developed to strengthen human resources development and management, with a special focus on midwifery training, including incentive packages for rural retention, educating general practitioners on comprehensive emergency obstetric care, and training nurse-anaesthetists. Midwifery education is available as a post-nursing programme and entry criteria includes at least two years experience as a nurse. Assessment of the curriculum with regard to essential ICM competencies is yet to be completed. The country has no direct-entry programme for midwifery, but plans are underway to revise midwifery education and scale up numbers. To that end, a midwifery school affiliated with the Faculty of Medicine and Biomedic Sciences will be established.
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
The Central African Republic is ethnically diverse and has a low population density. The country is emerging from instability due to internal armed conflicts, which aggravated the already weak economic situation and the limited access to basic social services, including health care. Total fertility, and the adolescent birth rate in particular, are high, and contraceptive use remains low. Maternal mortality remains very high, and has not decreased since 199( partly due to a high prevalence of HIV. Maternal and child health are a priority in the national health plan. A direct entry programme for midwifery education is in place, but graduates may not always secure employment in the public sector. Regulation and licensing procedures for midwifery have yet to be developed. Continuing education programmes are in place, but are mostly concentrated in urban areas. The national association of midwives and nurse-midwives is an active advocate for professional development. nurse-midwives is an active advocate for professional development.
The Central African Republic is ethnically diverse and has a low population density. The country is emerging from instability due to internal armed conflicts, which aggravated the already weak economic situation and the limited access to basic social services, including health care. Total fertility, and the adolescent birth rate in particular, are high, and contraceptive use remains low. Maternal mortality remains very high, and has not decreased since 199( partly due to a high prevalence of HIV. Maternal and child health are a priority in the national health plan. A direct entry programme for midwifery education is in place, but graduates may not always secure employment in the public sector. Regulation and licensing procedures for midwifery have yet to be developed. Continuing education programmes are in place, but are mostly concentrated in urban areas. The national association of midwives and nurse-midwives is an active advocate for professional development. nurse-midwives is an active advocate for professional development.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
> MIDWIFERY WORKFORCE'
> MIDWIFERY WORKFORCE'
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Number of facilities providing essential childbirth care Unavailable
Number of facilities providing essential childbirth care Unavailable
Health indicators and infrastructure have deteriorated in Céte d'Ivoire as a result of years of instability and conflict. Fertility remains high and contraceptive use is low. Maternal mortality has been moderately reduced since 1990, but remains high partially due to the significant HIV prevalence. Transition to free maternal and newborn care in 2010 has boosted demand for services but is exerting additional pressure on the fragile health system. The Human Resources Plan has estimated the number of midwifery professionals needed, and defined the roles of different cadres. A three year direct-entry programme for midwifery education has been in place since 2007, and the curriculum includes ICM essential competencies. Overall, education programmes lack a regulatory framework and career plans. Deployment | midwives to rural areas is problematic. Improving the recruitment and working conditions of faculty and reducing the number of students per cohort have been identified as key strategies to improve the quality of education.
Health indicators and infrastructure have deteriorated in Céte d'Ivoire as a result of years of instability and conflict. Fertility remains high and contraceptive use is low. Maternal mortality has been moderately reduced since 1990, but remains high partially due to the significant HIV prevalence. Transition to free maternal and newborn care in 2010 has boosted demand for services but is exerting additional pressure on the fragile health system. The Human Resources Plan has estimated the number of midwifery professionals needed, and defined the roles of different cadres. A three year direct-entry programme for midwifery education has been in place since 2007, and the curriculum includes ICM essential competencies. Overall, education programmes lack a regulatory framework and career plans. Deployment | midwives to rural areas is problematic. Improving the recruitment and working conditions of faculty and reducing the number of students per cohort have been identified as key strategies to improve the quality of education.
> MIDWIFERY WORKFORCE!’
> MIDWIFERY WORKFORCE!’
The Democratic Republic of the Congo has endured years of conflict and instability that damaged and destroyed much of the country’s infrastructure. More than half of its large population live in poverty, and the total fertility rate remains high. Maternal mortality has been reduced since 1990, but remains very high. A road map to improve materr and newborn health has been developed and budgeted, but is not yet fully operational at district level. The human resources for health plan does not specifically address the midwifery workforce. A combined nursing and midwifery programme has been implemented in the six nursing schools. In response to the severe shortage of midwives, the country is planning to open more midwifery schools. However, there is a lack of midwifery faculty, and the available educators are concentrated in the capital. The Democratic Republic of the Congo has endured years of conflict and instability that damaged and destroyed
The Democratic Republic of the Congo has endured years of conflict and instability that damaged and destroyed much of the country’s infrastructure. More than half of its large population live in poverty, and the total fertility rate remains high. Maternal mortality has been reduced since 1990, but remains very high. A road map to improve materr and newborn health has been developed and budgeted, but is not yet fully operational at district level. The human resources for health plan does not specifically address the midwifery workforce. A combined nursing and midwifery programme has been implemented in the six nursing schools. In response to the severe shortage of midwives, the country is planning to open more midwifery schools. However, there is a lack of midwifery faculty, and the available educators are concentrated in the capital. The Democratic Republic of the Congo has endured years of conflict and instability that damaged and destroyed
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
In this small and culturally diverse country the majority of people live in urban areas. Djibouti faces the challenges of poverty and high fertility, low use of reproductive health services, along with a significant HIV prevalence. Maternal mortality has reduced slightly, but remains high, and female genital mutilation/cutting contributes to maternal mortality and morbidity. Since 2006, maternal and newborn care has been provided free of charge. The absence of a human resource information system impedes an accurate projection of staffing needs. Equipment and human resources are unevenly distributed, particularly in the interior areas of the country. A three-year direct-entry midwifery programme is in place, affiliated with the Higher Institute of Health Sciences. The curriculum includes the ICM essential competencies. Career opportunities are available for midwives with several years of professional experience. A six-month in-service internship is now required for graduate midwives, before being posted. A midwives association is currently being created.
In this small and culturally diverse country the majority of people live in urban areas. Djibouti faces the challenges of poverty and high fertility, low use of reproductive health services, along with a significant HIV prevalence. Maternal mortality has reduced slightly, but remains high, and female genital mutilation/cutting contributes to maternal mortality and morbidity. Since 2006, maternal and newborn care has been provided free of charge. The absence of a human resource information system impedes an accurate projection of staffing needs. Equipment and human resources are unevenly distributed, particularly in the interior areas of the country. A three-year direct-entry midwifery programme is in place, affiliated with the Higher Institute of Health Sciences. The curriculum includes the ICM essential competencies. Career opportunities are available for midwives with several years of professional experience. A six-month in-service internship is now required for graduate midwives, before being posted. A midwives association is currently being created.
More than 80 percent of Ethiopia’s population lives in rural areas. The country has one of the highest levels of unmet need for contraception in Africa and only 6 percent of births are attended by a skilled health worker. Maternal mortalit has been steadily declining since 1990, but remains high. The lack of functioning health care facilities is severe, particularly in rural and isolated communities. The 2006 national reproductive health strategy includes maternal health, and addressing acute shortages in the midwifery workforce is a top priority of the proposed human resource strategy. Plans to expand midwifery education are underway. A direct-entry midwifery programme is available in 25 schools. Accelerated midwifery programmes and additional obstetric training for nurses are also available. Graduates are guaranteed employment and placements in their own communities are offered. Strengthening the infrastructure of the health system is important to raise the capacity and motivation of the midwifery workforce.
More than 80 percent of Ethiopia’s population lives in rural areas. The country has one of the highest levels of unmet need for contraception in Africa and only 6 percent of births are attended by a skilled health worker. Maternal mortalit has been steadily declining since 1990, but remains high. The lack of functioning health care facilities is severe, particularly in rural and isolated communities. The 2006 national reproductive health strategy includes maternal health, and addressing acute shortages in the midwifery workforce is a top priority of the proposed human resource strategy. Plans to expand midwifery education are underway. A direct-entry midwifery programme is available in 25 schools. Accelerated midwifery programmes and additional obstetric training for nurses are also available. Graduates are guaranteed employment and placements in their own communities are offered. Strengthening the infrastructure of the health system is important to raise the capacity and motivation of the midwifery workforce.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
A national maternal and newborn health plan exists that includes the midwifery workforce
A national maternal and newborn health plan exists that includes the midwifery workforce
Half of Ghana’s fast growing population lives in urban areas. The government has adopted a multisectoral approach to control the HIV epidemic. Special attention is given to youth reproductive health and the minimum age for marriage has been raised to 18. Maternal mortality has been reduced by 44 percent since 1990, but remains high. National health insurance covers antenatal care and delivery, but gaps in access to care persist, due in large part to midwifery shortages. Human resource policies and strategies include increasing the number of midwives. A new direct-entry programme for a BSc in midwifery supports this priority scale-up with the first cohort of students commencing in 2011 Recruitment and retention of midwives to rural postings and the remote northern provinces, is identified as a key priority, and would require raising the status of midwives, improving working conditions and developing a standardized reimbursement system for services rendered.
Half of Ghana’s fast growing population lives in urban areas. The government has adopted a multisectoral approach to control the HIV epidemic. Special attention is given to youth reproductive health and the minimum age for marriage has been raised to 18. Maternal mortality has been reduced by 44 percent since 1990, but remains high. National health insurance covers antenatal care and delivery, but gaps in access to care persist, due in large part to midwifery shortages. Human resource policies and strategies include increasing the number of midwives. A new direct-entry programme for a BSc in midwifery supports this priority scale-up with the first cohort of students commencing in 2011 Recruitment and retention of midwives to rural postings and the remote northern provinces, is identified as a key priority, and would require raising the status of midwives, improving working conditions and developing a standardized reimbursement system for services rendered.
> MIDWIFERY WORKFORCE:
> MIDWIFERY WORKFORCE:
Number of facilities providing essential childbirth care Unavailable
Number of facilities providing essential childbirth care Unavailable
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
> POLICIES
> POLICIES
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
Guyana has a small and culturally diverse population, with 70 percent living in rural areas. The negative rate of population growth is mainly due to migration. With very high rates of communicable diseases, HIV is one of the leading causes of mortality. Maternal mortality declined in the 1990s, but it increased again in the 2000-2008 period High priority is given to addressing maternal health gaps and services are now free in public health facilities. The maternal and newborn health policy aims at strengthening the midwifery workforce, and has contributed to a better deployment of midwives in remote areas and to the integration of traditional birth attendants in community care. A two-year direct-entry programme focused on graduating midwives for rural areas is implemented in three public schools in Guyana. The vacancy rate for midwifery faculty is high. Improving the learning environment is key to strengthening the coverage and quality of midwifery services.
Guyana has a small and culturally diverse population, with 70 percent living in rural areas. The negative rate of population growth is mainly due to migration. With very high rates of communicable diseases, HIV is one of the leading causes of mortality. Maternal mortality declined in the 1990s, but it increased again in the 2000-2008 period High priority is given to addressing maternal health gaps and services are now free in public health facilities. The maternal and newborn health policy aims at strengthening the midwifery workforce, and has contributed to a better deployment of midwives in remote areas and to the integration of traditional birth attendants in community care. A two-year direct-entry programme focused on graduating midwives for rural areas is implemented in three public schools in Guyana. The vacancy rate for midwifery faculty is high. Improving the learning environment is key to strengthening the coverage and quality of midwifery services.
> MIDWIFERY WORKFORCE
> MIDWIFERY WORKFORCE
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
A national maternal and newborn health plan exists that includes the midwifery workforce
A national maternal and newborn health plan exists that includes the midwifery workforce
India's population, the second largest in the world, is 70 percent rural. The percentage of the population living in poverty has declined in recent decades, but differences persist between and within regions. The status of women is low and measures are in place to halt discriminating practices against girls. Maternal mortality has been reduced by 59 percent since 1990, with greater successes in some states. National and state governments are committed to expanding coverage of health services to excluded populations. A conditional cash transfer programme is promoting institutional delivery. India has a strong body of midwives. However, in some regions the majority of midwifery services are provideo by auxiliary nurse midwives, who lack the full set of ICM competencies. Ensuring availability of human resources for skilled attendance at birth in remote facilities remains a challenge.
India's population, the second largest in the world, is 70 percent rural. The percentage of the population living in poverty has declined in recent decades, but differences persist between and within regions. The status of women is low and measures are in place to halt discriminating practices against girls. Maternal mortality has been reduced by 59 percent since 1990, with greater successes in some states. National and state governments are committed to expanding coverage of health services to excluded populations. A conditional cash transfer programme is promoting institutional delivery. India has a strong body of midwives. However, in some regions the majority of midwifery services are provideo by auxiliary nurse midwives, who lack the full set of ICM competencies. Ensuring availability of human resources for skilled attendance at birth in remote facilities remains a challenge.
> MIDWIFERY WORKFORCE
> MIDWIFERY WORKFORCE
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
In recent years the number of people ilving In poverty in the worlas TOUrTA MOST POPUIOUS COUNTry Nas Deen significantly reduced. Indonesia has implemented successful family planning programmes, and fertility has steadily declined. The maternal mortality ratio has been reduced by 62 percent since 1990. Socio-economic and cultural issues affect access, availability and utilization of care. A maternal health policy has been in effect since 2009, making institutional delivery free of charge. Government interventions have focused on securing availability and distribution of skilled birth attendants particularly in underserved areas with a village midwife programme initiated 15 years ago. As of 2012, all midwifery schools will need to be accredited by the National Accreditation Board. Midwifery posts are offered in public rural facilities, but more attractive employment conditions are offered by private practice in urban areas. A three-year direct entry programme is in place. Education schemes focusing on the teaching and managerial competencies of midwives will strengthen the quantity and quality of the future midwifery workforce.
In recent years the number of people ilving In poverty in the worlas TOUrTA MOST POPUIOUS COUNTry Nas Deen significantly reduced. Indonesia has implemented successful family planning programmes, and fertility has steadily declined. The maternal mortality ratio has been reduced by 62 percent since 1990. Socio-economic and cultural issues affect access, availability and utilization of care. A maternal health policy has been in effect since 2009, making institutional delivery free of charge. Government interventions have focused on securing availability and distribution of skilled birth attendants particularly in underserved areas with a village midwife programme initiated 15 years ago. As of 2012, all midwifery schools will need to be accredited by the National Accreditation Board. Midwifery posts are offered in public rural facilities, but more attractive employment conditions are offered by private practice in urban areas. A three-year direct entry programme is in place. Education schemes focusing on the teaching and managerial competencies of midwives will strengthen the quantity and quality of the future midwifery workforce.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
> POLICIES
> POLICIES
> MIDWIFERY WORKFORCE'
> MIDWIFERY WORKFORCE'
The majority of the population in the Lao People’s Democratic Republic lives in rural areas. Geography, cultural diversit low population density and high levels of poverty contribute to very limited access to healthcare services. Reductions total fertility rates and increases in contraceptive use have been achieved in the past five years. Maternal mortality has decreased by 51 percent since 1990 but remains very high. An assessment conducted in 2008 showed that 80 percer of health workers had limited competencies to assist women during pregnancy, labour and birth. The 2009 National Skilled Birth Attendance Plan was developed to recruit, educate and retrain staff, in order to build a more competent midwifery cadre. Graduated midwives are posted in health centres to provide services and do outreach work at the community level. A strengthened health system will contribute to enhancing the enabling environment in which the new cadre of midwives work. The majority of the population in the Lao People’s Democratic Republic lives in rural areas. Geography, cultural diversity,
The majority of the population in the Lao People’s Democratic Republic lives in rural areas. Geography, cultural diversit low population density and high levels of poverty contribute to very limited access to healthcare services. Reductions total fertility rates and increases in contraceptive use have been achieved in the past five years. Maternal mortality has decreased by 51 percent since 1990 but remains very high. An assessment conducted in 2008 showed that 80 percer of health workers had limited competencies to assist women during pregnancy, labour and birth. The 2009 National Skilled Birth Attendance Plan was developed to recruit, educate and retrain staff, in order to build a more competent midwifery cadre. Graduated midwives are posted in health centres to provide services and do outreach work at the community level. A strengthened health system will contribute to enhancing the enabling environment in which the new cadre of midwives work. The majority of the population in the Lao People’s Democratic Republic lives in rural areas. Geography, cultural diversity,
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
A national maternal and newborn health plan exists that includes the midwifery workforce
A national maternal and newborn health plan exists that includes the midwifery workforce
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
A national maternal and newborn health plan exists that includes the midwifery workforce
A national maternal and newborn health plan exists that includes the midwifery workforce
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
> POLICIES
> POLICIES
In Mali, a vast landlocked country in western Africa, two thirds of the 13.5 million population lives in rural areas. The fertility rate is high and contraceptive usage is low. Almost half of the rapidly growing population is under 15 years of age and there is a relatively high net migration rate, due to an active diaspora. The maternal mortality ratio is one of the highest in the world, although it has slowly decreased in the past 20 years. The MDG 5 target for 2015 is out of reach in the present conditions. Traditional practices and a high illiteracy rate among women are important barriers for seekin professional maternal care, in addition to the unavailability of maternal health services in many rural areas. There are no incentives to keep skilled midwives in remote and hard to reach areas and no career plans for them. A recent policy of free caesarean sections could lead to an increase in the number of institutional deliveries if it was implemented with sufficient resources to respond to needs (for example, adequate provision of caesarean kits).
In Mali, a vast landlocked country in western Africa, two thirds of the 13.5 million population lives in rural areas. The fertility rate is high and contraceptive usage is low. Almost half of the rapidly growing population is under 15 years of age and there is a relatively high net migration rate, due to an active diaspora. The maternal mortality ratio is one of the highest in the world, although it has slowly decreased in the past 20 years. The MDG 5 target for 2015 is out of reach in the present conditions. Traditional practices and a high illiteracy rate among women are important barriers for seekin professional maternal care, in addition to the unavailability of maternal health services in many rural areas. There are no incentives to keep skilled midwives in remote and hard to reach areas and no career plans for them. A recent policy of free caesarean sections could lead to an increase in the number of institutional deliveries if it was implemented with sufficient resources to respond to needs (for example, adequate provision of caesarean kits).
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
>» SERVICES
>» SERVICES
The Islamic Republic of Mauritania in north-western Africa is a vast, sparsely populated country. Three quarters of its land is desert or semi-desert. The population is young and growing, and the adolescent birth rate is high. Responding to unmet maternal and newborn health needs is challenging. Maternal mortality remains high, even if it has decreased by 30 percent in the past 20 years. Very few facilities provide basic emergency obstetric and newborn care. The national policy and strategic health plan, published in 2009, focuses on maternal and child health, and an observatory of human resources for health has recently been launched. The government has introduced a voluntary fixed-rate pre- paid scheme covering pregnancy and birth (le ‘forfait obstetrical’), which has now been extended to large parts of the country. There is a professional association of Mauritanian midwives and a union, but no council has been specifically assigned to regulate midwifery work.
The Islamic Republic of Mauritania in north-western Africa is a vast, sparsely populated country. Three quarters of its land is desert or semi-desert. The population is young and growing, and the adolescent birth rate is high. Responding to unmet maternal and newborn health needs is challenging. Maternal mortality remains high, even if it has decreased by 30 percent in the past 20 years. Very few facilities provide basic emergency obstetric and newborn care. The national policy and strategic health plan, published in 2009, focuses on maternal and child health, and an observatory of human resources for health has recently been launched. The government has introduced a voluntary fixed-rate pre- paid scheme covering pregnancy and birth (le ‘forfait obstetrical’), which has now been extended to large parts of the country. There is a professional association of Mauritanian midwives and a union, but no council has been specifically assigned to regulate midwifery work.
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Vlorocco has nearly completed the transition from high to low fertility. Contraceptive use has increased significantly. _arge differences exist between urban and rural access to health care and skilled birth attendants. Gender disparities ersist and efforts are in place to improve the status of women. A reduction in the maternal mortality ratio of an >stimated 60 percent has been achieved in the past 20 years. The 2008-2012 strategic plan focuses on reproductive vealth. The policy for maternal and newborn health makes facility-based birth free of charge (including caesareans). The policy aims at strengthening the referral system; improving provision of essential drugs, blood and equipment; anc mproving access in rural areas. Measures to strengthen the competencies of the midwifery workforce are underway. These include a review of the curriculum and an increase in the hours of classroom instruction in the current educatior yrogrammes. The Midwives Association can play an important role in advancing regulation to promote the autonomy c he midwifery workforce.
Vlorocco has nearly completed the transition from high to low fertility. Contraceptive use has increased significantly. _arge differences exist between urban and rural access to health care and skilled birth attendants. Gender disparities ersist and efforts are in place to improve the status of women. A reduction in the maternal mortality ratio of an >stimated 60 percent has been achieved in the past 20 years. The 2008-2012 strategic plan focuses on reproductive vealth. The policy for maternal and newborn health makes facility-based birth free of charge (including caesareans). The policy aims at strengthening the referral system; improving provision of essential drugs, blood and equipment; anc mproving access in rural areas. Measures to strengthen the competencies of the midwifery workforce are underway. These include a review of the curriculum and an increase in the hours of classroom instruction in the current educatior yrogrammes. The Midwives Association can play an important role in advancing regulation to promote the autonomy c he midwifery workforce.
> MIDWIFERY WORKFORCE
> MIDWIFERY WORKFORCE
>» SERVICES
>» SERVICES
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
One of Asia's poorest countries, Myanmar faces significant humanitarian needs. More than 70 percent of its population lives in rural areas. Public funding for health and education is low. Nonetheless, an improvement in the health status of the population has been observed, and maternal mortality has been reduced by 43 percent in the past 20 years. Policies to provide maternal health care services free at the point of delivery are in place, but there are significant rural-urban disparities in coverage. The Reproductive Health Strategic Plan (2009-2013) covers human resource planning for maternal and newborn health, although the midwifery workforce is not specifically addressed. The country has 20 direct-entry midwifery programmes. Enrolment restrictions regarding age, height and marital status are likely to be reducing the pool of student candidates. The curriculum now includes ICM's essential competencies. Establishing solid accreditation and supervision systems, along with effective deployment and retention measures, will facilitate the work of the available midwifery workforce.
One of Asia's poorest countries, Myanmar faces significant humanitarian needs. More than 70 percent of its population lives in rural areas. Public funding for health and education is low. Nonetheless, an improvement in the health status of the population has been observed, and maternal mortality has been reduced by 43 percent in the past 20 years. Policies to provide maternal health care services free at the point of delivery are in place, but there are significant rural-urban disparities in coverage. The Reproductive Health Strategic Plan (2009-2013) covers human resource planning for maternal and newborn health, although the midwifery workforce is not specifically addressed. The country has 20 direct-entry midwifery programmes. Enrolment restrictions regarding age, height and marital status are likely to be reducing the pool of student candidates. The curriculum now includes ICM's essential competencies. Establishing solid accreditation and supervision systems, along with effective deployment and retention measures, will facilitate the work of the available midwifery workforce.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Nepal is currently in a process of post-conflict transition. Great disparities in access to health care can be found between different ethnic groups, among people of different education and income levels, and between geographic areas. The total fertility rate has declined and contraceptive use has increased significantly. The maternal mortality ratio has been reduced by 56 percent in the past 20 years. Health sector priorities focus on strengthening and expanding equitable access to and utilization of services, with a special focus on underserved populations. In 2006, a policy on skilled birth attendants endorsed the development of professional midwives. The policy led to the implementation of in-service training strategies for skilled birth attendants, and the expansion of birthing centres and emergency obstetric and newborn care facilities. Skilled attendants are still insufficient, in terms of numbers and of quality. Discussion is underway to start a direct-entry midwifery education programme, which would contribute to fast-tracking the development of a strong midwifery cadre.
Nepal is currently in a process of post-conflict transition. Great disparities in access to health care can be found between different ethnic groups, among people of different education and income levels, and between geographic areas. The total fertility rate has declined and contraceptive use has increased significantly. The maternal mortality ratio has been reduced by 56 percent in the past 20 years. Health sector priorities focus on strengthening and expanding equitable access to and utilization of services, with a special focus on underserved populations. In 2006, a policy on skilled birth attendants endorsed the development of professional midwives. The policy led to the implementation of in-service training strategies for skilled birth attendants, and the expansion of birthing centres and emergency obstetric and newborn care facilities. Skilled attendants are still insufficient, in terms of numbers and of quality. Discussion is underway to start a direct-entry midwifery education programme, which would contribute to fast-tracking the development of a strong midwifery cadre.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
In NiCaragua, poverty Is more severe In rural and peri-uroan areas. Income Inequality Is Increasing, particularly affecting women. The total fertility rate has declined, but great disparities can be found in contraceptive use betweer the poorest and the wealthiest quintiles of the population. The maternal mortality ratio has been reduced by nearly 50 percent since 1990. The National Health Policy does not specifically address maternal health staffing issues. A midwifery education programme is in place, and public and private institutions educate obstetric nurses. This cadre is recognized and accredited nationally, and an initiative is currently underway to broaden recognition to the Central American level. Regulation should be updated to allow the new cadre of obstetric nurses to perform to their full capacity especially in isolated facilities, where no other health professionals are available. A deployment strategy has been implemented to secure the posting of graduated obstetric nurses in areas with higher maternal mortality.
In NiCaragua, poverty Is more severe In rural and peri-uroan areas. Income Inequality Is Increasing, particularly affecting women. The total fertility rate has declined, but great disparities can be found in contraceptive use betweer the poorest and the wealthiest quintiles of the population. The maternal mortality ratio has been reduced by nearly 50 percent since 1990. The National Health Policy does not specifically address maternal health staffing issues. A midwifery education programme is in place, and public and private institutions educate obstetric nurses. This cadre is recognized and accredited nationally, and an initiative is currently underway to broaden recognition to the Central American level. Regulation should be updated to allow the new cadre of obstetric nurses to perform to their full capacity especially in isolated facilities, where no other health professionals are available. A deployment strategy has been implemented to secure the posting of graduated obstetric nurses in areas with higher maternal mortality.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
An estimated 66 percent of Niger’s young and mostly rural population lives in poverty, and a similar percentage of the adult population is illiterate. Drought cycles and desertification, along with armed conflict in the north, have hindered development efforts. Niger has the highest fertility rate in sub-Saharan Africa. Access to reproductive health services and information is limited and sociocultural norms pose additional barriers. Maternal mortality has progressively decreased in the past 20 years but remains very high. The Poverty Reduction Strategy seeks to increase contraceptiv use. Priority human resources for health strategies include: recruitment of competent midwives, training obstetrician- gynaecologists and village health workers, and retention of health workers. The National Health Development Plan prioritizes the expansion of emergency obstetric and newborn care and the eradication of traditional practices that adversely affect women’s health, among other measures. Quality improvement efforts to strengthen human resources for health management are currently in place.
An estimated 66 percent of Niger’s young and mostly rural population lives in poverty, and a similar percentage of the adult population is illiterate. Drought cycles and desertification, along with armed conflict in the north, have hindered development efforts. Niger has the highest fertility rate in sub-Saharan Africa. Access to reproductive health services and information is limited and sociocultural norms pose additional barriers. Maternal mortality has progressively decreased in the past 20 years but remains very high. The Poverty Reduction Strategy seeks to increase contraceptiv use. Priority human resources for health strategies include: recruitment of competent midwives, training obstetrician- gynaecologists and village health workers, and retention of health workers. The National Health Development Plan prioritizes the expansion of emergency obstetric and newborn care and the eradication of traditional practices that adversely affect women’s health, among other measures. Quality improvement efforts to strengthen human resources for health management are currently in place.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Nigeria faces challenges related to the high growth rate of its large population. The total and adolescent fertility rates are high and modern contraceptive use remains low. The weak health system, women’s low social status, and harmft traditional practices continue to present significant barriers to efforts to improve women’s health. The maternal mortality ratio has only decreased by 24 percent since 1990, and remains very high. A policy for free maternal care services is being implemented. Nigeria has a strong body of registered midwives, and relicensing is compulsory every three years. However, access to quality care in rural and remote areas is problematic, due to difficulties in retaining qualified health care providers. In 2009 the Ministry of Health launched the Midwives Service Scheme to address shortages of midwifery cadres at the primary health care level. In response to the shortage of faculty in education institutions, retired midwives are being recruited to fill gaps.
Nigeria faces challenges related to the high growth rate of its large population. The total and adolescent fertility rates are high and modern contraceptive use remains low. The weak health system, women’s low social status, and harmft traditional practices continue to present significant barriers to efforts to improve women’s health. The maternal mortality ratio has only decreased by 24 percent since 1990, and remains very high. A policy for free maternal care services is being implemented. Nigeria has a strong body of registered midwives, and relicensing is compulsory every three years. However, access to quality care in rural and remote areas is problematic, due to difficulties in retaining qualified health care providers. In 2009 the Ministry of Health launched the Midwives Service Scheme to address shortages of midwifery cadres at the primary health care level. In response to the shortage of faculty in education institutions, retired midwives are being recruited to fill gaps.
> MIDWIFERY WORKFORCE'
> MIDWIFERY WORKFORCE'
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
Pakistan's large and young population is rapidly increasing. Rural-to-urban migration is high. Progress has been made o gender equality; however, the literacy rate for women and participation of women in the workforce remain low. Use of contraceptives has risen in the past decade and the total fertility rate has slightly declined. Maternal mortality has beer ‘educed by 48 percent since 1990. A national maternal, newborn and child health programme was drafted in 2005 and aims to improve accessibility to quality services, with an emphasis on low-income groups and vulnerable members of society. There is a policy of free provision of health care, although women still incur out-of-pocket charges. A greater Focus on midwifery has resulted from the 2005 policy, facilitating the establishment of the Midwives Association of Pakistan. Training and supporting a new cadre of community midwives has started in selected districts and attention is oeing given to increase the midwifery faculty. Further activities are required to address gaps in the training curriculum and in the provision of midwifery care.
Pakistan's large and young population is rapidly increasing. Rural-to-urban migration is high. Progress has been made o gender equality; however, the literacy rate for women and participation of women in the workforce remain low. Use of contraceptives has risen in the past decade and the total fertility rate has slightly declined. Maternal mortality has beer ‘educed by 48 percent since 1990. A national maternal, newborn and child health programme was drafted in 2005 and aims to improve accessibility to quality services, with an emphasis on low-income groups and vulnerable members of society. There is a policy of free provision of health care, although women still incur out-of-pocket charges. A greater Focus on midwifery has resulted from the 2005 policy, facilitating the establishment of the Midwives Association of Pakistan. Training and supporting a new cadre of community midwives has started in selected districts and attention is oeing given to increase the midwifery faculty. Further activities are required to address gaps in the training curriculum and in the provision of midwifery care.
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
Part of one of the largest Pacific islands, Papua New Guinea has a culturally diverse and fast growing population, which us predominantly young and rural. The total fertility rate remains high. With a reduction in maternal mortality of only 26 percent since 1990, Papua New Guinea's current ratio is among the highest in the Western Pacific. Skilled attendance at birth is low, mainly due to an acute shortage of midwives, poor accessibility, lack of adequate delivery facilities and low levels of trust in public services. The current National Health Plan 2011-2020 addresses the needs for health facilities at community level. Plans to fill the midwifery gap in the country are underway, by strengthening the midwifery education institutions. Currently there is no direct-entry programme for midwifery education, and the only available education is sequential (a one-year midwifery programme after three years of nursing education).
Part of one of the largest Pacific islands, Papua New Guinea has a culturally diverse and fast growing population, which us predominantly young and rural. The total fertility rate remains high. With a reduction in maternal mortality of only 26 percent since 1990, Papua New Guinea's current ratio is among the highest in the Western Pacific. Skilled attendance at birth is low, mainly due to an acute shortage of midwives, poor accessibility, lack of adequate delivery facilities and low levels of trust in public services. The current National Health Plan 2011-2020 addresses the needs for health facilities at community level. Plans to fill the midwifery gap in the country are underway, by strengthening the midwifery education institutions. Currently there is no direct-entry programme for midwifery education, and the only available education is sequential (a one-year midwifery programme after three years of nursing education).
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Rwanda has made clear progress in rebuilding its society in recent years. Modern contraceptive use has increased, but the total fertility rate remains high, and the population is growing fast. Measures are in place to curb the spread o HIV and to promote women’s empowerment. Maternal mortality has been significantly reduced, especially in the pas decade, but remains high. The national health development strategy prioritizes maternal and newborn health, and an insurance plan provides free maternal and newborn health services. Rwanda has begun developing a full midwifery cadre in addition to nurse-midwives, and regulations for the midwifery profession need to be developed. Pre-service education capacity will increase in response to the government's commitment to train five times more midwives, but the country is not yet producing an adequate number of competent midwives. Lack of specialized midwifery schools and faculty shortages are the main constraints.
Rwanda has made clear progress in rebuilding its society in recent years. Modern contraceptive use has increased, but the total fertility rate remains high, and the population is growing fast. Measures are in place to curb the spread o HIV and to promote women’s empowerment. Maternal mortality has been significantly reduced, especially in the pas decade, but remains high. The national health development strategy prioritizes maternal and newborn health, and an insurance plan provides free maternal and newborn health services. Rwanda has begun developing a full midwifery cadre in addition to nurse-midwives, and regulations for the midwifery profession need to be developed. Pre-service education capacity will increase in response to the government's commitment to train five times more midwives, but the country is not yet producing an adequate number of competent midwives. Lack of specialized midwifery schools and faculty shortages are the main constraints.
> MIDWIFERY WORKFORCE:
> MIDWIFERY WORKFORCE:
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Midwives (including nurse-midwives)*
Midwives (including nurse-midwives)*
>» SERVICES
>» SERVICES
A national maternal and newborn health plan exists that includes the midwifery workforce
A national maternal and newborn health plan exists that includes the midwifery workforce
> MIDWIFERY WORKFORCE!’
> MIDWIFERY WORKFORCE!’
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
Years of internal conflict have decimated Sudan's infrastructure and the workforce of a once impressive health system The southern states are about to secede to become the independent Republic of South Sudan. This profile concerns the whole country except the South. The population is two thirds rural and widely dispersed with more than 60 percer living in poverty. Fifty percent of women living in rural areas have no access to emergency obstetric care. Maternal mortality is very high and has not decreased significantly since 1990. The main providers, village midwives, are inadequately trained, unpaid and poorly supported. Rural retention is an acute problem. Midwifery education suffers from lack of competent faculty and poorly resourced schools. In spite of many challenges, Sudan is making significant efforts to prioritize maternal and newborn health services in national policies. A national strategy for scaling-up midwifery has been developed, and a new regulatory framework for midwifery has been established.
Years of internal conflict have decimated Sudan's infrastructure and the workforce of a once impressive health system The southern states are about to secede to become the independent Republic of South Sudan. This profile concerns the whole country except the South. The population is two thirds rural and widely dispersed with more than 60 percer living in poverty. Fifty percent of women living in rural areas have no access to emergency obstetric care. Maternal mortality is very high and has not decreased significantly since 1990. The main providers, village midwives, are inadequately trained, unpaid and poorly supported. Rural retention is an acute problem. Midwifery education suffers from lack of competent faculty and poorly resourced schools. In spite of many challenges, Sudan is making significant efforts to prioritize maternal and newborn health services in national policies. A national strategy for scaling-up midwifery has been developed, and a new regulatory framework for midwifery has been established.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
A national maternal and newborn health plan exists that includes the midwifery workforce
A national maternal and newborn health plan exists that includes the midwifery workforce
Tajikistan was the poorest of the Central Asian republics when it became independent in 1991. A long civil war led to the deterioration of economic and social development, which affected health outcomes. An estimated 22 percent of the population live in poverty. The total fertility rate remains high and contraceptive use is low. Yet, maternal health is making progress, with the halving of the maternal mortality ratio between 1990 and 2008. Midwives are unevenly distributed between urban and rural areas, and between primary care units and hospitals, with notable attrition in the remote postings. Out-of-pocket payments are frequent. Midwifery is taught by medical staff rather than by experienced midwives, and the latter often work as obstetricians’ assistants, rather than as autonomous professionals. In 2010, the Ministry of Health reviewed cases of maternal death in order to gain further evidence of key challenges that need to be addressed.
Tajikistan was the poorest of the Central Asian republics when it became independent in 1991. A long civil war led to the deterioration of economic and social development, which affected health outcomes. An estimated 22 percent of the population live in poverty. The total fertility rate remains high and contraceptive use is low. Yet, maternal health is making progress, with the halving of the maternal mortality ratio between 1990 and 2008. Midwives are unevenly distributed between urban and rural areas, and between primary care units and hospitals, with notable attrition in the remote postings. Out-of-pocket payments are frequent. Midwifery is taught by medical staff rather than by experienced midwives, and the latter often work as obstetricians’ assistants, rather than as autonomous professionals. In 2010, the Ministry of Health reviewed cases of maternal death in order to gain further evidence of key challenges that need to be addressed.
> MIDWIFERY WORKFORCE:
> MIDWIFERY WORKFORCE:
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Half of the small but quickly growing population of Timor-Leste continues to live in poverty. Inequitable access to healt care is due to geographic and economic factors, and also to lack of health care providers. Health facilities and roads the were severely damaged during the civil war are being rebuilt. Contraceptive use is low and the fertility rate is one of the world’s highest. Maternal mortality has declined significantly since 1990, but remains high. The 2004-2015 Nationa Reproductive Health Strategy addresses education of skilled health personnel and access to emergency obstetric and newborn care. A three-year direct-entry midwifery programme is available. Midwifery is recognized as an autonomous profession, and midwives are authorized to practise all essential ICM competencies. The East Timor Midwifery Association is being established in 2011. Scaling up the provision of quality midwifery services requires improved access to facilities and continued political stability.
Half of the small but quickly growing population of Timor-Leste continues to live in poverty. Inequitable access to healt care is due to geographic and economic factors, and also to lack of health care providers. Health facilities and roads the were severely damaged during the civil war are being rebuilt. Contraceptive use is low and the fertility rate is one of the world’s highest. Maternal mortality has declined significantly since 1990, but remains high. The 2004-2015 Nationa Reproductive Health Strategy addresses education of skilled health personnel and access to emergency obstetric and newborn care. A three-year direct-entry midwifery programme is available. Midwifery is recognized as an autonomous profession, and midwives are authorized to practise all essential ICM competencies. The East Timor Midwifery Association is being established in 2011. Scaling up the provision of quality midwifery services requires improved access to facilities and continued political stability.
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
A national maternal and newborn health plan exists that includes the midwifery workforce
A national maternal and newborn health plan exists that includes the midwifery workforce
> POLICIES
> POLICIES
With only 13 percent of the population living in urban areas, Uganda is predominantly rural. The country has a high fertility rate, contraception use is low, and its population is one of the fastest growing in the world. The maternal mortality ratio has declined by 36 percent since 1990, but remains high. The Government has made maternal and child health a development priority, and has launched a road map for the reduction of maternal and newborn mortality Although there is a general shortage of midwifery tutors, more are being trained. The traditional three-year midwifery education programme is no longer offered in many public education institutions. A new course is being designed for a master’s of science in nursing and midwifery. Registered midwives are encouraged to participate in continuing education programmes to upgrade their skills. The Uganda Nurses and Midwives Council is actively promoting midwifery education.
With only 13 percent of the population living in urban areas, Uganda is predominantly rural. The country has a high fertility rate, contraception use is low, and its population is one of the fastest growing in the world. The maternal mortality ratio has declined by 36 percent since 1990, but remains high. The Government has made maternal and child health a development priority, and has launched a road map for the reduction of maternal and newborn mortality Although there is a general shortage of midwifery tutors, more are being trained. The traditional three-year midwifery education programme is no longer offered in many public education institutions. A new course is being designed for a master’s of science in nursing and midwifery. Registered midwives are encouraged to participate in continuing education programmes to upgrade their skills. The Uganda Nurses and Midwives Council is actively promoting midwifery education.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
> POLICIES
> POLICIES
Tanzania’s mostly rural and fast growing population registers a high fertility rate and low contraceptive use. Child
Tanzania’s mostly rural and fast growing population registers a high fertility rate and low contraceptive use. Child
> MIDWIFERY WORKFORCE'
> MIDWIFERY WORKFORCE'
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
>» SERVICES
>» SERVICES
> MIDWIFERY WORKFORCE’
> MIDWIFERY WORKFORCE’
A national maternal and newborn health plan exists that includes the midwifery workforce
A national maternal and newborn health plan exists that includes the midwifery workforce
Landlocked in southern Africa, Zambia has reached a degree of stability in the past decade, after years of unrest following independence. Although contraceptive use has risen significantly, the total fertility rate and the adolescent fertility rate are very high. HIV/AIDS prevalence is also very high, and 37 percent of maternal deaths are due to HIV. Maternal mortality has increased dramatically since the 1990s, and remains high. Improving maternal and newborn health has become a political priority. The 2010 national human resources for health plan expresses the Government commitment to increase the number of midwives and the quality of their education. A new direct-entry programme has been implemented. A new professional association is being developed. Career opportunities for the midwifery workforce in the fields of teaching and research are being developed. Midwives play a key role in HIV prevention anc care, including prevention of mother-to-child transmission.
Landlocked in southern Africa, Zambia has reached a degree of stability in the past decade, after years of unrest following independence. Although contraceptive use has risen significantly, the total fertility rate and the adolescent fertility rate are very high. HIV/AIDS prevalence is also very high, and 37 percent of maternal deaths are due to HIV. Maternal mortality has increased dramatically since the 1990s, and remains high. Improving maternal and newborn health has become a political priority. The 2010 national human resources for health plan expresses the Government commitment to increase the number of midwives and the quality of their education. A new direct-entry programme has been implemented. A new professional association is being developed. Career opportunities for the midwifery workforce in the fields of teaching and research are being developed. Midwives play a key role in HIV prevention anc care, including prevention of mother-to-child transmission.
>» MIDWIFERY WORKFORCE
>» MIDWIFERY WORKFORCE
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Explanatory notes: “Annex 2 provides a complete list of source data. All data sources are from 2008 unless otherwise stated. Where country respondents stated that data were not available, the term ‘Unavailable’ is used. In all other instances, ‘—' is used to denote a nil response or data that requires further verification. 1. 2008 estimates based on country data returns and the WHO Global Atlas of the Health Workforce. 2. Includes midwives, nurse-midwives and nurses with midwifery competencies. These figures do not necessarily reflect the number of practising midwives or the ICM definition of a midwife. 3. Auxiliary midwives and auxiliary nurse-midwives.
Zimbabwe's economy, basic services and health system started to deteriorate in the 1990s, and the humanitarian situation remains critical. The lack of safe drinking water and adequate sanitation has led to cholera outbreaks and fooc shortages. Heavily hit by the HIV epidemic, the population growth rate is slow due to short life expectancy at birth. Use of contraceptive methods has risen, and HIV prevalence is starting to decline. However, maternal mortality has doubled since 1990, and more than half of all maternal deaths are linked to HIV. Maternal and newborn health is an essential component in Zimbabwe's health policy. In a context of the scarcity of resources, addressing staff shortages and increasing retention are among the key priorities. Midwifery is considered a specialty of nursing rather than an autonomous profession. Understaffing in midwifery schools affects the quality of the support and supervision available to students. Midwifery associations are advocating improvements in the work environment.
Zimbabwe's economy, basic services and health system started to deteriorate in the 1990s, and the humanitarian situation remains critical. The lack of safe drinking water and adequate sanitation has led to cholera outbreaks and fooc shortages. Heavily hit by the HIV epidemic, the population growth rate is slow due to short life expectancy at birth. Use of contraceptive methods has risen, and HIV prevalence is starting to decline. However, maternal mortality has doubled since 1990, and more than half of all maternal deaths are linked to HIV. Maternal and newborn health is an essential component in Zimbabwe's health policy. In a context of the scarcity of resources, addressing staff shortages and increasing retention are among the key priorities. Midwifery is considered a specialty of nursing rather than an autonomous profession. Understaffing in midwifery schools affects the quality of the support and supervision available to students. Midwifery associations are advocating improvements in the work environment.
> MIDWIFERY WORKFORCE'
> MIDWIFERY WORKFORCE'
Number of facilities providing essential childbirth care — Unavailable
Number of facilities providing essential childbirth care — Unavailable
INTRODUCTION
INTRODUCTION
ABBREVIATIONS AND ACRONYMS
ABBREVIATIONS AND ACRONYMS
Missing midwives. Gap calculation
Missing midwives. Gap calculation
supplementation, management of hypertension, diabetes and malaria, during the antenatal period; antibiotics for premature rupture of membranes, labor and delivery management, as well as referral to a BEmONC or CEmONC facility (as a proxy for the skills of a midwife at delivery), active management of the third stage of labor, magnesium sulfate for eclampsia, neonatal resuscitation during childbirth; and breastfeeding promotion and preventive postnatal care after delivery. Coverage was increased linearly for all interventions by the amount needed to match the change in labor and delivery management that was needed to achieve the target midwifery coverage (10% for current coverage < 10%; 25% for current coverage <20%; 50% for current coverage < 40% and 75%/90% for current BEMONC >40%). Total fertility rate was forced to remain above 2.0 while coverage of all other interventions was capped at 99%.
supplementation, management of hypertension, diabetes and malaria, during the antenatal period; antibiotics for premature rupture of membranes, labor and delivery management, as well as referral to a BEmONC or CEmONC facility (as a proxy for the skills of a midwife at delivery), active management of the third stage of labor, magnesium sulfate for eclampsia, neonatal resuscitation during childbirth; and breastfeeding promotion and preventive postnatal care after delivery. Coverage was increased linearly for all interventions by the amount needed to match the change in labor and delivery management that was needed to achieve the target midwifery coverage (10% for current coverage < 10%; 25% for current coverage <20%; 50% for current coverage < 40% and 75%/90% for current BEMONC >40%). Total fertility rate was forced to remain above 2.0 while coverage of all other interventions was capped at 99%.
All photos by Vincent Fauveau (except tall African figure at far left from Elisa Gleize) and are available at: www.art-and-pregnancy.com. The designations employed and the presentation of material in the present document do not imply the expression of any opinion on the part of the United Nations Population Fund or the State of the World’s Midwifery partners concerning the legal or other status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.
All photos by Vincent Fauveau (except tall African figure at far left from Elisa Gleize) and are available at: www.art-and-pregnancy.com. The designations employed and the presentation of material in the present document do not imply the expression of any opinion on the part of the United Nations Population Fund or the State of the World’s Midwifery partners concerning the legal or other status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries.

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