African Midwives: Key to Maternal and Newborn Survival and Continental Development

New York / Addis Ababa — Tonight, thousands of women across Africa are delivering babies. Their chances of survival depend on their location, the speed of accessing care, and the readiness of the health system to respond.

Although maternal mortality in Africa has fallen by 40 % since 2000, progress has slowed. The continent still accounts for over 70 % of global maternal deaths, and a woman with pregnancy complications here is roughly 130 times more likely to die than a woman in Europe or North America.

The majority of these deaths are preventable. Postpartum hemorrhage is the leading direct cause, while indirect factors such as HIV, malaria, and anemia also contribute significantly. All are linked by delays—seeking care, reaching a facility, and receiving timely treatment. Moreover, many deaths occur inside health facilities, indicating not only a lack of care but also deficiencies in facility preparedness, referral mechanisms, teamwork, and emergency response.

Across the continuum of maternal care, a well‑trained midwife can identify danger signs early, manage complications, coordinate referrals, and provide respectful, high‑quality care. Midwives currently deliver up to 90 % of essential sexual, reproductive, maternal, and newborn services, especially in the weakest health‑system communities. Yet they cannot act alone; their effectiveness relies on a strong health system with functional primary care, reliable referral and transport networks, consistent supplies of medicines and blood, and accessible emergency obstetric and neonatal services. Despite their vital role, midwives remain among Africa’s most neglected and underfunded health professionals.

According to recent WHO and UNFPA data, only four of 51 reporting African countries reach the WHO benchmark of 9.23 midwives per 10,000 population, while the remaining 47 fall short. Moreover, about 34 % of midwives who are trained are unemployed. The issue is not merely a shortage of graduates; it is the need to integrate existing educated midwives, deploy them where demand is highest, and retain them.

Eliminating preventable maternal mortality by 2030 presents one of Africa’s most demanding tests of leadership, equity, and health sovereignty.

The appointment of H.E. Dr. Samia Suluhu Hassan, President of Tanzania, as the African Union Champion for Maternal and Child Health has intensified political commitment to ending maternal deaths. In a recent op‑ed, President Hassan urged African leaders and partners to adopt a clear roadmap—the Three Zeros framework—namely: zero home deliveries lacking skilled care and emergency referrals; zero preventable maternal and newborn deaths through high‑quality, respectful, emergency‑ready services; and zero unvaccinated children by prioritizing zero‑dose children in primary health care and outreach. Midwife investment is essential to achieving these goals.

Investing in midwives delivers not only moral but also substantial economic returns. UNFPA estimates that each midwife investment can yield up to ten times its cost in social and economic benefits. In Sierra Leone, modeling indicates that universal midwife‑led care could save 2,278 maternal lives, 19,029 newborns, prevent 39,970 stillbirths, and avoid nearly 860,000 unintended pregnancies by 2035. Moreover, because most midwives are women, expanding this workforce creates thousands of stable, skilled, and dignified formal‑sector jobs—especially in rural and underserved areas—transforming unpaid caregiving into salaried employment and fostering women’s economic empowerment while bolstering Africa’s overall development.

Investing in midwives together with multi‑skilled community health workers strengthens the continuum of care, extending from households and communities to primary health facilities and referral hospitals. Community health workers can detect early pregnancy risks, promote antenatal visits, encourage skilled birth attendance, improve immunization coverage, and enable timely referrals, while midwives deliver the clinical expertise needed to prevent maternal and newborn deaths. This combined workforce underpins a people‑centered primary health care system that aligns with the African Union’s vision of health sovereignty.

Africa has already demonstrated political leadership in building a robust health workforce. In 2016, the continent pledged to train and deploy two million community health workers to address chronic staffing gaps—already half achieved. Under the guidance of H.E. Bola Ahmed Tinubu, President of Nigeria and AU Champion for Human Resources for Health and the Community Health Delivery Partnership, Africa is accelerating efforts to reach the two‑million multi‑skilled community health worker target by 2030.

Midwifery should receive comparable political ambition, accompanied by a clear continental target to close the midwifery gap.

Any midwifery target must be embedded within a broader health workforce agenda. Reducing maternal mortality requires a multidisciplinary team—including nurses, physicians, anesthetists, laboratory technicians, pharmacists, blood service personnel, and emergency transport staff. This integrated model empowers community health workers to deliver a comprehensive package of services—health promotion for mothers and children, disease prevention, immunization, early pregnancy risk identification, referrals, and connections to health facilities.

Similarly, as Africa rallied to expand community health workers, leaders should now rally around a target to educate, deploy, and retain the midwives essential for ending preventable maternal and newborn deaths and improving health outcomes across the continent.

The following evidence‑based priorities, championed by the Midwifery Accelerator initiative, provide a practical roadmap:

First, increase and institutionalize financing for the health workforce, including midwives, as a strategic investment in health security and sovereignty.

This entails accelerating the Lusaka Agenda and Accra Reset, prioritizing domestic funding for workforce compacts, and bolstering primary health care systems in high‑burden countries. Establishing dedicated workforce budget lines and enhancing financial management efficiency through digital tools will demand stronger public finance management capacity, cross‑ministerial coordination, and strategic alignment of partner contributions with national health workforce development plans.

Second, expand equitable access to skilled maternal and newborn care by strategically deploying midwives to underserved, high‑burden, and rural areas.

We must educate, deploy, and retain sufficient midwives to enhance the quality, continuity, and responsiveness of maternal and newborn care. This requires high‑quality midwifery education aligned with international and national standards, financing new positions and integrating unemployed midwives, and focusing training where demand is greatest. Retention is vital, as inadequate conditions—limited career progression, low pay, and migration—drive skilled midwives from many African nations. A resilient workforce depends on investment in decent work, professional recognition, and supportive, accountable workplaces.

Third, we must advocate for and empower midwives by building leadership, strengthening coalitions, and amplifying the voices of women and communities.

Midwives should play a central role in designing models of care, not just delivering them. Professional associations must be seated at policy and financing tables, the Chief Midwifery Officer Network should be formalized, and communities need a stronger say in holding health systems accountable.

Fourth, maternal survival must be treated as a whole‑of‑government responsibility.

Supported by political and financial commitments, this requires engagement beyond health ministries—spanning finance, education, gender, and planning portfolios—as well as local government and civil society partners.

Through the AU Champion Roadmap on Maternal and Child Health, the AU Commission works with member states, Africa CDC, UNFPA, and other partners to strengthen accountability, data systems, and peer learning. Accountability must drive this agenda: each maternal death should be counted, reviewed, and leveraged to strengthen health systems. Measured deaths become priorities, and priorities attract funding.

The AU Champion Roadmap calls for sustained, African‑led domestic financing for maternal, newborn, and child health. Investing in midwives is an investment in maternal and newborn survival, women’s economic empowerment, resilient primary health care, and Africa’s future prosperity. Preventing maternal deaths protects families, creates decent jobs, bolsters trust in public institutions, and safeguards the continent’s greatest asset—its people.

Africa has demonstrated that shared ambition can drive transformative change. This resolve must be matched with sustained commitment and resources to ensure that no woman or newborn’s life is cut short for preventable reasons. A strong, resilient midwifery workforce is within our collective reach, and we must harness it to secure Africa’s health sovereignty, sustainable development, and future prosperity.

Dr. Diene Keita, Executive Director of UNFPA, and Dr. Jean Kaseya, Director General of Africa CDC.

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