Who will be there when women deliver?

Think about this: Africa has 24% of the global burden of disease, but just 3% of the health workforce. High-income countries, which have only one-third of the world’s population, make up about 75% of the health workforce. This imbalance must be addressed.

Skilled health workers are the foundation of a functioning health system. When a country has a shortage of healthcare providers, the entire population suffers and women are disproportionately impacted. In developing regions, the lack of trained doctors, nurses, and midwives to provide women with pregnancy and delivery care has devastating consequences: nearly 300,000 women die every year from pregnancy, millions suffer serious health problems, and three million newborns do not survive their first month of life.

It is clear that increasing the number of well-trained health workers is a critical step to improving the health and wellbeing of women and children. The question is: What is the most efficient and cost-effective way for developing countries to build bigger and better cadres of health workers? One way is to educate and recruit more women into the health workforce, especially as midwives, of which the world is in a dire need.

Midwives, when trained to international standards, can deliver 87% of the essential care needed by women. Investing in midwifery is also a best-buy in health. Investments in midwifery education and training can yield – as a 2013 World Bank study[1] from Bangladesh shows – a 16% return on investment in terms of lives saved and caesarean sections avoided. And then, of course, there is the fact that the health and well-being is inextricably linked to gender equity. If that’s not a winning investment, I don’t know what is.

In addition to educating and recruiting more health workers, developing countries, with support from donor countries, need to do more to keep those they have. In Uganda, despite a severe shortage of health workers, last year the Foreign Ministry advertised opportunities for over 200 medical professional to work abroad. At least 400 jumped at the opportunity, including 180 midwives. Who can blame them when even neighboring countries often offer them a better salary? But in a country where an estimated 16 women die each day due to complications related to childbirth, the loss of so many midwives would be devastating. In a landmark case, the Institute of Public Policy and Research, a Ugandan think-tank, is now seeking a court injunction to block what it calls a “state-facilitated medical brain drain” that violates the right to health care.

The right to health has been enshrined in international and regional human rights treaties, as well as national constitutions all over the world. Despite this, human resources for health have been one of the most neglected components in global and national development strategies. Now we have the opportunity to correct that wrong.

With the Millennium Development Goals concluding at the end of 2015, governments are in the midst of negotiating a new set of even more ambitious Sustainable Development Goals. Building a strong health work force, with a particular focus on skilled female health workers, including midwives, must be prioritized and moved up the agenda in development discussions. If it is not, women and newborns will continue to die from conditions that could have been easily prevented with proper care. Providing all women with the sexual and reproductive health care they need not only save lives and improves the health of women and children, it improves the wellbeing of families, builds stronger communities, and ultimately reduces poverty and creates more productive societies. When we invest in women’s health, everybody wins.


Katja Iversen
CEO, Women Deliver


[1] Evans T. Value for money assessment: Community-based midwifery diploma program. Washington DC:
The World Bank, 2013.