In a seminar in London 16-17 March arranged by #midwives4all a group of scientists, midwives, obstetricians, activists and social entrepreneurs discussed the importance of midwifery and midwives for the sexual and reproductive health and rights of women and girls.
The basis for the discussion was the evidence, as presented in the Lancet articles on Midwifery, Newborns and Stillbirths, that clearly demonstrates the potential benefits of all women having access to basic sexual and reproductive health services over the lifespan and the key role midwives can play in delivering those services.
So, if the evidence is there, why is it not happening everywhere, and what can we do to make it happen?
I think that maternal mortality and the lack of sexual and reproductive health and rights have to be seen as the consequence of the lethal combination of social injustice and structural gender discrimination.
The social injustice is obvious. Any mapping of maternal mortality shows that it is the poor women that suffer the most. The more well-off women even in low income settings have to a large extent access to services, the poor are left out.
The gender discrimination part is equally obvious. Just close your eyes and imagine a world where men got pregnant… See?
So, what can we do? We need to work in three areas to promote development and change.
First of all, money matters. Services for all cost more that low and middle income countries can afford. National governments have to do more but external financing is necessary for many years to come. We need a massive increase in financing for health services where both governments and donors have to step up to the plate.
Secondly, knowledge. The evidence is there but has to be spread. There are for example still two misunderstandings out there that have to be addressed, one saying that countries can do with less trained staff than midwives for care during pregnancy and childbirth, the other saying that trained midwives is not enough, it should be medical doctors, preferably obstetricians. The Lancet series is necessary reading.
Finally we need social mobilisation and advocacy. Gender equality will not come from top-down pressure, the main energy has to be bottom-up.
The Swedish government has declared that it will conduct a feminist foreign policy. A strong priority for Sexual and Reproductive Health and Rights in Sweden’s development cooperation is an expression of that policy.
Sida’s Lead Policy Expert on Health