1.

1 The evidence of impact

This report sets out the evidence on the impact
of quality midwifery education on outcomes for
women, newborns, children and adolescents. It
highlights that the best midwifery education is
based on what women and newborns need, that
interprofessional learning and teamwork is
effective, and that the best outcomes come from
a model of midwife-led continuity of care.
Examples show that improvements in midwifery
education are making a difference in low-,
middle- and high-income countries, as well as in
humanitarian and fragile settings.
Midwifery education contributes to the
transformation and expansion of the health
workforce and increases the potential to
accelerate inclusive economic growth and
progress towards health equity (22). Educating
midwives empowers a predominantly female
profession with knowledge, skills and the
capacity for leadership.
Yet the evidence also indicates a startling lack
of investment in midwifery skills education and
training in low- and middle-income countries
(LMICs) (14) with few educating providers to
international standards, even where health
workers are being given the professional title
“midwife” . This is despite the outcomes that can
be improved and the cost savings that can be
made when midwives are educated to
international standards (6, 7).
The report notes that to improve quality
midwifery education we need to take action on
significant system-wide constraints, including
inconsistency in education and training
standards, poor quality of education and care,
as well as a water and sanitation crisis in
educational institutions and health facilities. To
make progress we must also acknowledge and
address the sociocultural, economic and
professional barriers encountered by midwives
globally (17).
Importantly, the report highlights that universal
provision of quality midwifery education and
care upholds the rights of women, newborns
and their families, no matter their circumstances.
“The human right to health is
meaningless without good
quality care because health
systems cannot improve health
without it.”
Kruk et al. Lancet Global Health
Commission (4).
1.2 Global consultations to guide
change
To help chart a way forward, a series of global
multi-stakeholder consultations were convened
and a consensus reached on three strategic
priorities for strengthening midwifery education
in all countries:
• Every woman and newborn to be cared for
by a midwife, educated and trained to
international standards and enabled to legally
practise the full scope of midwifery. The title
“midwife” should only be used for providers
who are educated to international standards.
• Midwifery leadership to be positioned in
high-level national policy, planning and
budgeting processes to improve decisionmaking
about investments for midwifery
education to help achieve UHC.
• Coordination and alignment between
midwifery stakeholders at global, regional
and country levels to align education and
training processes, knowledge, research,
evidence-based materials, indicators and
investment.
Combining global evidence and findings from
the consultations, a seven-step action plan to
strengthen quality midwifery education is
presented here giving guidance to governments
and implementing partners to help transform
midwifery education.

This recognizes the wide variation in standards

of education and care provision across many
countries. It acknowledges that whereas some
countries can move rapidly to a high-quality
cadre of midwives, other countries will need
more time and have more investment to make.
Investing in midwifery education cannot take
place in a vacuum. Strengthened regulation,
deployment and better working conditions and
remuneration will also be needed, along with
support for stronger midwifery associations.
1.3 Making it happen
The final section of the report builds on
commitments to the GSWCAH and sets out
how partnerships could implement the sevenstep
action plan for midwifery education.
Radical reform in midwifery education will
require a coordinated and comprehensive effort
from health, education, finance, labour and
foreign affairs sectors of government, together
with civil society, the public and private sectors,
trade unions and associations, institutions and
academia (22).
1.4 Who is this report for?
The audience includes all those determined to
improve the lives of women and newborns
everywhere. Midwifery is a complex intervention
involving women, newborns and their families,
taking place at home, as well as in primary,
secondary and tertiary facilities (23). The report is
therefore for people in government, and outside
government, involved in health services, health
financing, education, water and sanitation,
transport and communications, as well as for
those working on gender and rights-based
issues and advocacy.
Stakeholders include the current and future
midwifery workforce, leaders who work in or with
governments, nongovernmental organizations
(NGOs), civil society, UN agencies, professional
associations, academics and researchers. It is for
our partners in the private sector, foundations
and bilateral donors, the media and human
rights advocates. It is for people working in
conflict zones and other humanitarian disasters.
The report aims to inspire those passionate
about the education and empowerment of
midwives and other health workers to improve
the quality of care, and is for those who are
deeply engaged, every day, in educating
midwifery care providers.
Ultimately, this report is for the women and
newborns who need our help, and for the
midwives and others who provide their care.
1.5 Why now?
It is time to take heed of the evidence. It is time
we listened to the experts who contributed to
the global consultations, listened to the voices of
women and midwives, and aligned our efforts,
accelerated and accounted for our actions, and
strengthened quality midwifery education.
Last, but not least, women and midwives
themselves are demanding better quality
midwifery education.
“Midwives want better
education, including access to
higher education and
development, to be empowered
to take leadership, to know their
skills are valued by medical
doctors and to provide better
quality of care for women and
their newborns.”
Midwives Voices, Midwives Realities (24).