Presenter: Caroline Homer, University of Technology, Sydney
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Background: Despite the focus on stillbirth that was well developed in the Lancet Stillbirth Series 2011, there has not been much specific action on how to achieve significant reductions. This presentation addresses the programmatic issues relevant to good maternal and newborn health care, and thus improved outcomes of pregnancy, including stillbirth reduction. The State of the World’s Midwifery 2014 report identifies a pathway to health for women and their families, from pre-pregnancy to the early months of childhood. The second article of the Lancet Series on Midwifery analyses the impact of making the full scope of midwifery care available to women with regard to reduction of maternal and newborn mortality and stillbirths. Drawing on the Pathway to Health from the 2014 State of the World’s Midwifery and the Lancet Series on Midwifery analysis, this presentation will describe the program methods and investments in midwifery that can lead to the “triple or quadruple” return on investment.
Method: The SOWMY Pathway was developed to help readers understand what fully integrated midwifery care along the lives of women and their families looks like. It identifies not only the action to be taken for the women on their pathway to health, but also the supporting pillars that enable that action, such as provision of care through collaborative practice by a team of health care professionals at several levels of the health system, starting as close to women as possible. The second article of the Lancet series on Midwifery identified the Essential Interventions in the LiST that are within the scope of midwifery practice including pre-pregnancy, antenatal, labour, birth, and post-partum care, and family planning and measured the impact of three scenarios for scaling up midwifery in LMICs on maternal and newborn deaths, and stillbirths by 2025.
Results: All scale-up scenarios resulted in reduction of mortality. Increase in coverage of the interventions delivered by midwifery over a 15-year period (2% per year on present baseline estimates), maternal and newborn mortality and stillbirths would be decreased by 27% with a modest (10%) coverage increase, by 50% with a substantial coverage increase (25%), and by 82% with universal coverage (95%).
Conclusion: Midwifery care is extremely effective and covers almost 90% of women’s needs, especially when provided within a functional health system with effective referral and transfer mechanisms to specialist care. The ten steps as identified in the Midwifery2030 Pathway to Health provide a framework for scaling-up midwifery, saving lives and improving health.